Colicky Abdominal Pain

30.06.2023 Chukwudi Eze 0 Comments

Stomach aches are common. Often, they are not a cause for concern. However, there are many different causes of abdominal pain, and some could be a sign of a serious illness. Because of this, it is important to not ignore persisting abdominal pain, even if the pain is not constant or daily.

There are many different organs in the abdomen, including the stomach, small intestine, colon, liver, gallbladder, spleen, and pancreas.
Any one of these organs can cause pain.
If you are feeling pain in the abdomen—be it upper, lower, mild, sharp or cramp-like, it can be challenging to figure out the cause by yourself.

Gastroenterologists are specialists who can help determine the exact cause of your abdominal pain. There are four main types of abdominal pain: generalized, localized, cramp-like and colicky. Generalized pain appears most often with a stomach virus, indigestion or gas.

The pain can be felt in over half of the abdomen.
If the pain becomes severe, it could indicate a blockage of the intestines.
Localized abdominal pain means that it is limited to one area of the abdomen.
Most often, localized pain is caused by problems in a particular organ, such as an ulcer of the stomach or diverticulitis of the colon,

Crampy pain could be associated with a few different things, such as diarrhea, constipation, bloating or gas. This is common if someone suffers from celiac disease, pancreas problems (exocrine pancreatic insufficiency or EPI) or irritable bowel syndrome (IBS),

IBS is an intestinal disorder that affects both the large and small intestine.
In women, cramping can be associated with menstruation, ovulation, miscarriage or other complications with reproductive organs.
Crampy pain usually comes and goes and can subside on its own without treatment.
Colicky pain is usually a symptom of more serious conditions like gallstones or kidney stones,

Colicky pain occurs suddenly and without warning, and is usually quite severe. Acid reflux, or GERD, is also a condition which can affect the abdomen. It can cause heartburn, indigestion or pain when swallowing. Some people with GERD will have upper stomach pain and not classic heartburn (so-called dyspepsia pattern GERD).

If you are experiencing weight loss, fevers or rectal bleeding in addition to abdominal pain, you could be suffering from Crohn’s disease, which is a chronic inflammatory condition of the gastrointestinal tract, or even from colon cancer,
We call these types of symptoms “alarm features.” Other alarm symptoms are a loss of appetite, feeling full before a meal is complete (early satiety), vomiting and trouble swallowing.

These symptoms should never be ignored as they often indicate a more serious cause of pain. It is very important not to ignore or minimize your symptoms and remember to discuss any persisting abdominal complaints with your primary care physician. The board-certified physicians at Greater Boston Gastroenterology can diagnose and treat your abdominal pain.

Contents

- 0.0.1 What is a colicky pain in the abdomen?
0.1 What does colicky pain feel like?

1 Why is it called colicky?
2 What is the difference between colicky pain and constant pain?
3 Is colic different than gas?
4 When does colic pain start?
- - 4.0.1 Is colic pain due to gas?
  - 4.0.2 What type of stomach pain is serious?
5 Is colicky pain bad?
6 Why is colic worse at night?
- - 6.0.1 What is the difference between colicky pain and constant pain?
7 Is colic pain due to gas?

What is a colicky pain in the abdomen?

Abdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly. Almost everyone has pain in the abdomen at some point. Most of the time, it is not serious. How bad your pain is does not always reflect the seriousness of the condition causing the pain. For example, you might have very bad abdominal pain if you have gas or stomach cramps due to viral gastroenteritis, However, fatal conditions, such as colon cancer or early appendicitis, may only cause mild pain or no pain. Other ways to describe pain in your abdomen include:

Generalized pain – This means that you feel it in more than half of your belly. This type of pain is more typical for a stomach virus, indigestion, or gas. If the pain becomes more severe, it may be caused by a blockage of the intestines.Localized pain – This is pain found in only one area of your belly. It is more likely to be a sign of a problem in an organ, such as the appendix, gallbladder, or stomach.Cramp-like pain – This type of pain is not serious most of the time. It is likely to be due to gas and bloating, and is often followed by diarrhea. More worrisome signs include pain that occurs more often, lasts more than 24 hours, or occurs with a fever.Colicky pain – This type of pain comes in waves. It very often starts and ends suddenly, and is often severe. Kidney stones and gallstones are common causes of this type of belly pain.

You can try the following home care steps to ease mild abdominal pain:

Sip water or other clear fluids. You may have sports drinks in small amounts. People with diabetes must check their blood sugar often and adjust their medicines as needed.Avoid solid food for the first few hours.If you have been vomiting, wait 6 hours, and then eat small amounts of mild foods such as rice, applesauce, or crackers. Avoid dairy products.If the pain is high up in your abdomen and occurs after meals, antacids may help, especially if you feel heartburn or indigestion. Avoid citrus, high-fat foods, fried or greasy foods, tomato products, caffeine, alcohol, and carbonated beverages.DO NOT take any medicine without talking to your provider.

These additional steps may help prevent some types of abdominal pain:

Drink plenty of water each day.Eat small meals more frequently.Exercise regularly.Limit foods that produce gas.Make sure that your meals are well-balanced and high in fiber. Eat plenty of fruits and vegetables.

Get medical help right away or call your local emergency number (such as 911) if you:

Are currently being treated for cancerAre unable to pass stool, especially if you are also vomitingAre vomiting blood or have blood in your stool (especially if bright red, maroon or dark, tarry black)Have chest, neck, or shoulder painHave sudden, sharp abdominal painHave pain in, or between, your shoulder blades with nauseaHave tenderness in your belly, or your belly is rigid and hard to the touchAre pregnant or could be pregnantHad a recent injury to your abdomenHave difficulty breathing

Contact your provider if you have:

Abdominal discomfort that lasts 1 week or longerAbdominal pain that does not improve in 24 to 48 hours, or becomes more severe and frequent and occurs with nausea and vomitingBloating that persists for more than 2 daysBurning sensation when you urinate or frequent urinationDiarrhea for more than 5 daysFever, over 100°F (37.7°C) for adults or 100.4°F (38°C) for children, with painProlonged poor appetiteProlonged vaginal bleedingUnexplained weight loss

Your provider will perform a physical exam and ask about your symptoms and medical history. Your specific symptoms, the location of pain and when it occurs will help your provider detect the cause. LOCATION OF YOUR PAIN

Where do you feel the pain?Is it all over or in one spot?Does the pain move into your back, groin, or down your legs?

TYPE AND INTENSITY OF YOUR PAIN

Is the pain severe, sharp, or cramping?Do you have it all the time, or does it come and go?Does the pain wake you up at night?

HISTORY OF YOUR PAIN

Have you had similar pain in the past? How long has each episode lasted?When does the pain occur? For example, after meals or during menstruation?What makes the pain worse? For example, eating, stress, or lying down?What makes the pain better? For example, drinking milk, having a bowel movement, or taking an antacid?What medicines are you taking?

OTHER MEDICAL HISTORY

Have you had a recent injury?Are you pregnant?What other symptoms do you have?

Tests that may be done include:

Barium enema Blood, urine, and stool tests CT scan Colonoscopy or sigmoidoscopy (tube through the rectum into the colon) ECG (electrocardiogram) or heart tracing Ultrasound of the abdomen Upper endoscopy (tube through the mouth into the esophagus, stomach and upper small intestine) Upper GI (gastrointestinal) and small bowel series X-rays of the abdomen

Stomach pain; Pain – abdomen; Belly ache; Abdominal cramps; Bellyache; Stomachache McQuaid KR. Approach to the patient with gastrointestinal disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine,26th ed. Philadelphia, PA: Elsevier; 2020:chap 123.

Landmann A, Bonds M, Postier R.
Acute abdomen.
In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds.
Sabiston Textbook of Surgery,21st ed.
St Louis, MO: Elsevier; 2022:chap 46. Smith KA.
Abdominal pain.
In: Walls RM, Hockberger RS, Gausche-Hill M, eds.
Rosen’s Emergency Medicine: Concepts and Clinical Practice,9th ed.

Philadelphia, PA: Elsevier; 2018:chap 24. Weber F. Gastrointestinal and hepatic manifestations of systemic diseases. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease,11th ed. Philadelphia, PA: Elsevier; 2021:chap 37.

What does colicky pain feel like?

A colic pain in adults may feel like a dull ache, a cramp or a sharp pain and occurs usually after a large meal or around bedtime.

Why is it called colicky?

History – The word “colic” is derived from the ancient Greek word for intestine (sharing the same root as the word “colon”). It has been an age-old practice to drug crying infants. During the second century AD, the Greek physician Galen prescribed opium to calm fussy babies, and during the Middle Ages in Europe, mothers and wet nurses smeared their nipples with opium lotions before each feeding.

What is the difference between colicky pain and constant pain?

Lower Abdominal Pain | Doctor Also see the separate articles on,, and, For abdominal pain by regions see the separate articles on,,,, and, Abdominal pain is a common presenting problem in primary care or A&E. Symptoms may be acute (an ‘acute abdomen’), subacute or chronic.

How ill is the patient?
- For acute abdominal pain :
  - Always check – and document – vital signs, particularly pulse rate, temperature and blood pressure.
  - Subtle changes in vital signs may indicate serious illness – eg, unexplained tachycardia may be the main/only clue to a serious abdominal/pelvic condition.
  - If the patient is shocked, arrange immediate hospital assessment and management.
  - Give analgesia if needed: intravenous (IV) opiates may be given if needed, and do not affect clinical assessment; titrate small doses and monitor blood pressure.
  - Aim to identify urgent problems (see under ‘Urgent or easily missed causes of acute abdominal pain’, above).
  Always consider ectopic pregnancy in any woman of childbearing age.
- For subacute or chronic abdominal pain – look for ‘red flags’ and other alerting features such as:
  - Age >60 years.
  - Relevant family history – ovarian or bowel cancer, familial polyposis coli.
  - History suggesting gastrointestinal (GI) bleed.
  - Unexplained weight loss (or poor growth in children).
  - Repeated consultations for the same problem; change in pattern of consultation (‘beware the patient with thin notes’).
  - Anaemia.
  - Masses or organomegaly.
History and examination ± initial investigations (see ‘History’ and ‘Examination’ sections, below).
Decide initial management :
- Have a low threshold for admission/referral of young children, the elderly, the immunocompromised and those with learning difficulties – these groups are more likely to present late or without classical symptoms and signs and may deteriorate quickly.
- Symptoms and signs may evolve over time – reassessment is an important tool.
- If the patient is discharged, ensure they know when to seek further help.

Location, nature and severity of pain:
- Colicky (waves of pain): suggests obstructed viscus – eg, intestinal obstruction, renal colic, biliary colic.
- Tearing pain: suggests aortic dissection or rupture.
- Constant sharp pain, worse on movement or coughing: suggests peritonitis.
- Constant dull ache: suggests inflammation – eg, appendicitis, diverticulitis.
- The pattern of pain may change over time – eg, early appendicitis, mesenteric ischaemia or bowel strangulation may begin as colicky pain and then become constant as the condition progresses; pain may localise as the parietal peritoneum becomes involved.
Any radiation or referred pain?
- Aortic aneurysm, renal and pancreatic pain: may radiate to the back.
- Renal colic: may radiate to the groin.
- Diaphragmatic irritation: may cause shoulder tip pain.
- Gallbladder pain: may radiate to the scapula.
Onset of pain:
Very sudden onset suggests rupture or torsion of an organ (eg, ruptured aneurysm, ectopic pregnancy, torsion of testis or ovary).
Other symptoms:
- Systemic symptoms: fever, night sweats, weight loss.
- Vomiting: may be due to severe pain (eg, testicular torsion), gastroenteritis or obstruction.
- Bleeding: upper GI (haematemesis or melaena) or lower GI (rectal bleed).
- Constipation or diarrhoea.
- Vaginal bleeding or discharge: consider gynaecological/obstetric causes.
Past medical history:
- Note any similar episodes.
- Note previous illness or surgery.
- Note Medication/allergies/last meal.

See the separate article.

A urine pregnancy test should be offered to women of childbearing age who have abdominal pain (to help rule out ectopic pregnancy). If ectopic pregnancy is suspected, the woman should be referred for urgent hospital assessment, even if the urine test is negative.
± microscopy and culture.
Depending on the clinical scenario, consider:
- Blood tests:
  - FBC (for occult bleeding).
  - Erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP) – for inflammatory bowel disease.
  - Coeliac antibodies (anti-endomysial antibody or tissue transglutaminase test).
  - U&E, glucose, LFT, amylase, calcium.
- Ultrasound of the abdomen and pelvis.

Urine pregnancy test.
Urinalysis ± microscopy and culture.
Depending on the clinical scenario, consider:
- ECG.
- Blood tests:
  - FBC.
  - Group/crossmatch blood.
  - ESR/CRP
  - U&E, glucose, amylase, calcium.
- Erect CXR (looking for air under the diaphragm).
- Plain abdominal X-ray (or erect and supine abdominal X-rays if an obstruction is suspected) – may show up obstruction, volvulus, ischaemia, severe constipation.
- Ultrasound or CT scans.

Further investigations will depend on initial assessment findings and initial investigation results, but may include:

Upper or lower GI endoscopy.
Ultrasound or CT scans targeted at suspected pathology.
Diagnostic laparoscopy.
Laparotomy.



Diffuse pain or variable locations : Surgical/gynaecological – peritonitis, aortic aneurysm or dissection, intestinal obstruction, adhesions,, ovarian hyperstimulation syndrome Medical -, diabetic ketoacidosis, sickle cell crisis, hypercalcaemia,,,,,,,, hereditary angio-oedema. Infections -,,,, yersinial enterocolitis. Toxins – opiate withdrawal, methanol poisoning, heavy metal poisoning, black widow spider bite, scorpion sting. Abdominal wall -, muscle strain or injury,, spinal pain. Others – lactose intolerance, specific food allergy, abdominal migraine, somatisation,,, fictitious pain.
Right subcostal :	Epigastric : Cardiac – myocardial infarction,, pericarditis. Pre-eclampsia. Aortic aneurysm or dissection. Mesenteric ischaemia or infarction. Gastric – oesophagitis, gastritis, peptic ulcer, or, Pancreas -, pancreatic cyst or,	Left subcostal : Cardiac (see ‘Epigastric’ region). Lung – pneumonia, pleurisy, pulmonary embolus. Spleen – rupture, abscess, acute, Gastric (see ‘Epigastric’ region).
Right flank and loin : Aortic aneurysm or dissection. Renal -,, tumours. Retrocaecal appendicitis. Ovarian pathology. Other problems – gallstones (rarely), retroperitoneal haemorrhage, mesenteric ischaemia.	Central abdomen : Appendicitis. Mesenteric adenitis. Small bowel – mesenteric ischaemia or infarction, small bowel obstruction, Crohn’s disease. Pancreas (see ‘Epigastric’ region). Lymph nodes – lymphoma or metastases.	Left flank and loin : Aortic aneurysm or dissection. Renal – stones, pyelonephritis, tumours. Diverticulitis. Ovarian pathology. Other problems – pancreatitis (rarely), retroperitoneal haemorrhage, mesenteric ischaemia.
Right iliac fossa : Appendicitis. Mesenteric adenitis. Meckel’s diverticulitis. Ectopic pregnancy and other gynaecological causes (see ‘Left iliac fossa’). Testicular torsion. Urinary tract – infection or stones. Colon (see ‘Left iliac fossa’). Hernia – inguinal or femoral. Caecal tumours.	Lower abdomen : Urinary tract – distended bladder, infection. Colon (see ‘Left iliac fossa’). Gynaecological (see ‘Left iliac fossa’). Obstetric -, labour, placental abruption.	Left iliac fossa : Gynaecological – ectopic pregnancy,, ovarian torsion, or tumour, ovulation pain,, Testicular torsion. Urinary tract – infection or stone. Colon – diverticulitis or diverticular disease, inflammatory bowel disease, large bowel obstruction or tumour, irritable bowel syndrome, constipation. Hernia – inguinal or femoral. Appendicitis in a patient with situs inversus (rare).

Diffuse pain or variable locations :

Surgical/gynaecological – peritonitis, aortic aneurysm or dissection, intestinal obstruction, adhesions,, ovarian hyperstimulation syndrome
Medical -, diabetic ketoacidosis, sickle cell crisis, hypercalcaemia,,,,,,,, hereditary angio-oedema.
Infections -,,,, yersinial enterocolitis.
Toxins – opiate withdrawal, methanol poisoning, heavy metal poisoning, black widow spider bite, scorpion sting.
Abdominal wall -, muscle strain or injury,, spinal pain.
Others – lactose intolerance, specific food allergy, abdominal migraine, somatisation,,, fictitious pain.

Right subcostal :

Epigastric :

Cardiac – myocardial infarction,, pericarditis.
Pre-eclampsia.
Aortic aneurysm or dissection.
Mesenteric ischaemia or infarction.
Gastric – oesophagitis, gastritis, peptic ulcer, or,
Pancreas -, pancreatic cyst or,

Left subcostal :

Cardiac (see ‘Epigastric’ region).
Lung – pneumonia, pleurisy, pulmonary embolus.
Spleen – rupture, abscess, acute,
Gastric (see ‘Epigastric’ region).

Right flank and loin :

Aortic aneurysm or dissection.
Renal -,, tumours.
Retrocaecal appendicitis.
Ovarian pathology.
Other problems – gallstones (rarely), retroperitoneal haemorrhage, mesenteric ischaemia.

Central abdomen :

Appendicitis.
Mesenteric adenitis.
Small bowel – mesenteric ischaemia or infarction, small bowel obstruction, Crohn’s disease.
Pancreas (see ‘Epigastric’ region).
Lymph nodes – lymphoma or metastases.

Left flank and loin :

Aortic aneurysm or dissection.
Renal – stones, pyelonephritis, tumours.
Diverticulitis.
Ovarian pathology.
Other problems – pancreatitis (rarely), retroperitoneal haemorrhage, mesenteric ischaemia.

Right iliac fossa :

Appendicitis.
Mesenteric adenitis.
Meckel’s diverticulitis.
Ectopic pregnancy and other gynaecological causes (see ‘Left iliac fossa’).
Testicular torsion.
Urinary tract – infection or stones.
Colon (see ‘Left iliac fossa’).
Hernia – inguinal or femoral.
Caecal tumours.

Lower abdomen :

Urinary tract – distended bladder, infection.
Colon (see ‘Left iliac fossa’).
Gynaecological (see ‘Left iliac fossa’).
Obstetric -, labour, placental abruption.

Left iliac fossa :

Gynaecological – ectopic pregnancy,, ovarian torsion, or tumour, ovulation pain,,
Testicular torsion.
Urinary tract – infection or stone.
Colon – diverticulitis or diverticular disease, inflammatory bowel disease, large bowel obstruction or tumour, irritable bowel syndrome, constipation.
Hernia – inguinal or femoral.
Appendicitis in a patient with situs inversus (rare).

Is colic different than gas?

What Are The Symptoms of Gas? – Just as crying is a fact of baby life, so, too, is baby gas. But when your infant has painful gas, especially if it’s frequent, it can cause your baby to cry or become fussy—until it’s passed; unlike colic, which causes crying and fussiness that lasts for hours across days and weeks.

Gas can have distinctive symptoms, too, such as a swollen-looking belly. Likewise, your baby may lift their legs and/or arch their back. It may also cause your baby to cry while passing gas or soon after. Then, of course, there’s the obvious audible toots or burps. Infant gas, fortunately, isn’t a medical condition, but it can sometimes cause your little one pain or discomfort.

However, there are things you can do to help relieve your infant’s gas —even simple tactics such as massage can help. Another way to help your gassy baby feel better is to use Infants’ Mylicon Gas Relief drops in either our dye-free or original formula.

When does colic pain start?

If your baby cries for longer than 3 hours a day, your baby might have colic. Colic is not caused by another medical problem. Many babies go through a fussy period. Some cry more than others. If you have a baby with colic, you are not alone. One in five babies cry enough that people call them colicky.

Colic usually starts when babies are about 3 weeks old.
It gets worse when they are between 4 and 6 weeks old.
Most of the time, colicky babies get better after they are 6 weeks old, and are completely fine by the time they are 12 weeks old.
Colic normally begins at about the same time every day.
Babies with colic are usually fussier in the evenings.

Colic symptoms often begin suddenly. Your baby’s hands may be in a fist. The legs may curl up and the belly may seem swollen. Crying may last for minutes to hours. Crying often calms down when your baby is tired or when gas or stool is passed. Even though colicky babies look like they have belly pain, they eat well and gain weight normally.

Pain from gasHungerOverfeedingBaby cannot tolerate certain foods or certain proteins in breast milk or formulaSensitivity to certain stimuliEmotions such as fear, frustration, or even excitement

People around the baby may also seem worried, anxious, or depressed. Often the exact cause of colic is unknown. Your baby’s health care provider can often diagnose colic by asking you about the baby’s medical history, symptoms, and how long the crying lasts.

Stimulants, such as caffeine and chocolate.Dairy products and nuts. Your baby may have allergies to these foods.

Some breastfeeding moms avoid eating broccoli, cabbage, beans, and other gas-producing foods. But research has not shown that these foods can have a negative effect on your baby. Other possible triggers include:

Medicines passed through breast milk. If you are breastfeeding, talk to your own doctor about the medicines you take.Baby formula. Some babies are sensitive to proteins in formula. Talk to your baby’s doctor about switching formulas to see if that helps.Overfeeding or feeding the baby too quickly. Bottle feeding your baby should take about 20 minutes. If your baby is eating faster, use a nipple with a smaller hole.

Talk to a lactation consultant to learn more about the possible causes related to breastfeeding. What comforts one baby may not calm another. And what calms your baby during one episode may not work for the next. But try different techniques and revisit what seems to help, even if it only helps a little. If you breastfeed:

Allow your baby to finish nursing on the first breast before offering the second. The milk at the end of emptying each breast, called the hind milk, is far richer and sometimes more soothing.If your baby still seems uncomfortable or is eating too much, offer only one breast as often as you want, over a 2 to 3 hour period. This will give your baby more hind milk.

Sometimes it can be really hard to stop your baby from crying. Here are techniques you may want to try:

Swaddle your baby. Wrap your baby snugly in a blanket.Hold your baby. Holding your baby more may help them be less fussy in the evening. This will not spoil your baby. Try an infant carrier that you wear on your body to hold your baby close.Gently rock your baby. Rocking calms your baby and can help your baby pass gas. When babies cry, they swallow air. They get more gas and more stomach pain, which causes them to cry more. Babies get in a cycle that is hard to break. Try an infant swing if your baby is at least 3 weeks old and can hold their head up.Sing to your baby.Hold your baby in an upright position. This helps your baby pass gas and reduces heartburn.Try placing a warm towel or warm water bottle on the baby’s stomach.Lay babies on their stomach when they are awake and give them back rubs. Do not let babies sleep on their stomachs. Babies who sleep on their stomachs have a higher risk of sudden infant death syndrome ( SIDS ).Give your baby a pacifier to suck on.Put your baby in a stroller and go for a walk.Put your baby in a car seat and go for a drive. If this works, look for a device that makes a car motion and sound.Put your baby in a crib and turn on something with white noise. You can use a white noise machine, a fan, vacuum cleaner, washing machine, or dishwasher.Simethicone drops are sold without a prescription and may help reduce gas. This medicine is not absorbed by the body and is safe for infants. A doctor may prescribe stronger medicines if your baby has severe colic that may be secondary to reflux.

Your baby will most likely outgrow colic by 3 to 4 months of age. There are usually no complications from colic. Parents can get really stressed when a baby cries a lot. Know when you have reached your limit and ask family members or friends to help. If you feel like you may shake or hurt your baby, get help right away. Call the provider if your baby is:

Crying a lot and you are unable to calm your baby3 months old and still has colic

You need to make sure that your baby does not have any serious medical problems. Call your baby’s provider right away if:

Your baby’s behavior or crying pattern changes suddenlyYour baby has a fever, forceful vomiting, diarrhea, bloody stools, or other stomach problems

Get help right away for yourself if you feel overwhelmed or have thoughts of harming your baby. Infantile colic – self-care; Fussy baby – colic – self-care Maheshwari A, Gupta SK. Colic and gastrointestinal gas. In: Wylie R, Hyams JS, Kay M, eds. Pediatric Gastrointestinal and Liver Diseases,6th ed.

Philadelphia, PA: Elsevier; 2021:chap 10.
Onigbanjo MT, Feigelman S.
The first year.
In: Kliegman RM, St.
Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds.
Nelson Textbook of Pediatrics,21st ed.
Philadelphia, PA: Elsevier; 2020:chap 22.
Updated by: Neil K.
Aneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA.

Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Is colic pain due to gas?

Colic and Gas Colic is usually defined as crying that lasts more than 3 hours per day for more than 3 days out of the week in an otherwise healthy infant under 3 months of age. It can be very stressful and frustrating to parents. Colic usually begins suddenly, with loud and mostly continuous crying.

Temperament and adjusting to the world. Newborns must also make adjustments to the world they are living in. Not all babies have the same temperament. Some adjust to lights, loud noises, and all the other stimulation around them with no trouble, while others are not able to adapt as easily. Just like adults, some babies are easy-going, and some are impatient. Crying may be one way for a baby to vent feelings as he or she is getting adjusted to the world. An inability to self-soothe. Some babies seem overly sensitive to stimulation and are unable to calm themselves. As a baby matures, he or she is better able to regulate his or her immature nervous system. As this happens, colic disappears. Gas. Gas may contribute to colic. Gas is produced by bacteria in the intestines and can also be swallowed into the intestines (aerophagia). Symptoms of gas include fussiness, enlarged abdomen, and passage of excessive gas through burping or flatulence. Milk allergy. Milk allergies may cause abdominal pain, but usually also cause diarrhea. A baby who can’t tolerate cow’s milk and responds to a change in formula may have a milk allergy. However, there is no evidence that changing to a non-milk formula has any effect on colic.

A child who is otherwise well, who cries or is fussy several hours a day, especially from 6 p.m. to midnight, with no apparent reason, may have colic. Also, babies with colic may burp frequently or pass a significant amount of gas, but this is thought to be due to swallowing air while crying, and is not a cause of colic.

The face may be flushed.
The abdomen may be tense with legs drawn toward it.
The hands may be clenched.
The symptoms of colic may look like other conditions or medical problems.
Always consult your child’s healthcare provider for a diagnosis.
All families are at risk of having a baby with colic.
All babies are at equal risk of developing colic, no matter their sex, race, or socioeconomic class.

Colic may become a concern due to the following reasons:

Frustrating and stressful to parents Parents and infant lose sleep Infant may be overfed in an attempt to stop the crying

Babies with colic usually grow and gain weight appropriately, despite being fussy or irritable, being gassy, and losing sleep. A healthcare provider will examine your baby and obtain a medical history. Questions might be asked about how long and how often your child cries, if you have noticed anything that seems to trigger the crying, and what comfort measures are effective, if any.

Not sucking or drinking a bottle well Drinking less milk than usual Gastrointestinal (GI) issues like vomiting or diarrhea Becoming more irritable when held or touched Strange sounding cry Change in breathing rate or effort Being more sleepy or sluggish than usual

Call your child’s healthcare provider if you note any of these symptoms, or if your baby is crying excessively. Your child’s healthcare provider will examine your child to make sure other problems are not present that might be causing colic-like symptoms.

Learning how to interpret your baby’s cry can be helpful in dealing with colic.
It does take some time for parents and babies to become accustomed to each other.
Remember, babies will cry for a certain length of time every day under normal circumstances.
What works for one baby may not work for another.

Other suggestions include the following:

Make sure your baby is not hungry, but do not force feed if he or she is not interested in the bottle or breast. Change your baby’s position. Sit him or her up if lying down. Let your baby face forward if you are carrying or holding him/her facing your chest. Babies like to see different views of the world. Give your baby interesting things to look at: different shapes, colors, textures, and sizes. Talk to your baby. Sing softly to your baby. Rock your baby. Walk your baby. Swaddle your baby in a blanket. Place your baby in an infant swing on a slow setting. Let your baby lay on his or her belly on your lap, and softly rub his or her back. Go for a ride in the car. The motion of the car often soothes babies. Try using something in your child’s room that makes a repetitive sound, such as a fan, a wind-up alarm clock, or heartbeat CD. The sound of a vacuum or washing machine may also soothe a fussy baby. Hold and cuddle your baby. Babies cannot be spoiled by too much attention. However, they can have problems later in life if they are ignored and their needs are not met as infants. Try using a pacifier. Let an adult family member or friend (or a responsible babysitter) care for your baby from time to time so that you can take a break. Taking care of yourself and lowering your stress level may help your baby as well.

The symptoms of colic usually resolve by the time a baby is about 4 months of age but may last until the age of 6 months. Consult your child’s healthcare provider for more information. : Colic and Gas

What type of stomach pain is serious?

Stomach pain; Pain – abdomen; Belly ache; Abdominal cramps; Bellyache; Stomachache Abdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly. You know that awful feeling: you’re nauseous; your stomach feels like it’s tied in a knot, and you don’t even want to move. What does your pain mean? Well, let’s talk today about abdominal pain. So, what causes abdominal pain? Almost everyone has pain in their belly at one time or another.

Most of the time, a serious medical problem is not the cause, and how bad your pain is doesn’t always reflect the seriousness of the problem causing your pain. You may feel very bad pain if you are having gas or stomach cramps due to viral gastroenteritis, better known as a stomach virus. And some life-threatening conditions, such as colon cancer or a very early case of appendicitis, may cause only mild pain, or no pain at all.

The important thing to know about abdominal pain is when you need immediate medical care. Less serious causes of abdominal pain include constipation, irritable bowel syndrome, food allergies, lactose intolerance, food poisoning, and a stomach virus. Other, more serious, causes include appendicitis, an abdominal aortic aneurysm, a bowel blockage, cancer, and gastroesophageal reflux.

Sometimes, you may have abdominal pain from a problem that isn’t in your belly, like a heart attack, menstrual cramps, or pneumonia. So, what do you do about abdominal pain? Well, if you have mild abdominal pain, here are some helpful tips; Try sipping water or other clear fluids. Avoid solid food for the first few hours.

If you’ve been vomiting, wait 6 hours and then eat small amounts of mild foods like rice, applesauce, or crackers. If your pain is high in your abdomen and occurs after meals, antacids may help, especially if you are feeling heartburn or indigestion. You should seek medical attention if you have abdominal pain and are being treated for cancer, you can’t pass any stool, you’re vomiting blood, or you have chest, neck, or shoulder pain. There are three body views (front, back, and side) that can help you to identify a specific body area. The labels show areas of the body which are identified either by anatomical or by common names. For example, the back of the knee is called the “popliteal fossa,” while the “flank” is an area on the side of the body. The process of digesting food is accomplished by many organs in the body. Food is pushed by the esophagus into the stomach. The stomach mixes the food and begins the breakdown of proteins. The stomach propels the food then into the small intestine. The small intestine further digests food and begins the absorption of nutrients. Since the abdominal area contains many different organs it is divided in smaller areas. One division method, uses one median sagittal plane and one transverse plane that passes through the umbilicus at right angles. This method divides the abdomen into four quadrants. Medical personnel can easily refer to these quadrants when describing pain or injury regarding a victim. The appendix is a small finger-shaped tube that branches off the first part of the large intestine. The appendix can become inflamed or infected causing pain in the lower right part of the abdomen. Blood from the aorta reaches the kidneys so it can be filtered and cleaned. Among other functions, the kidneys remove toxins, metabolic waste, and excess ions from the blood which leaves the body in the form of urine. You know that awful feeling: you’re nauseous; your stomach feels like it’s tied in a knot, and you don’t even want to move.

What does your pain mean? Well, let’s talk today about abdominal pain.
So, what causes abdominal pain? Almost everyone has pain in their belly at one time or another.
Most of the time, a serious medical problem is not the cause, and how bad your pain is doesn’t always reflect the seriousness of the problem causing your pain.

You may feel very bad pain if you are having gas or stomach cramps due to viral gastroenteritis, better known as a stomach virus. And some life-threatening conditions, such as colon cancer or a very early case of appendicitis, may cause only mild pain, or no pain at all.

The important thing to know about abdominal pain is when you need immediate medical care.
Less serious causes of abdominal pain include constipation, irritable bowel syndrome, food allergies, lactose intolerance, food poisoning, and a stomach virus.
Other, more serious, causes include appendicitis, an abdominal aortic aneurysm, a bowel blockage, cancer, and gastroesophageal reflux.

Avoid solid food for the first few hours. If you’ve been vomiting, wait 6 hours and then eat small amounts of mild foods like rice, applesauce, or crackers. If your pain is high in your abdomen and occurs after meals, antacids may help, especially if you are feeling heartburn or indigestion. You should seek medical attention if you have abdominal pain and are being treated for cancer, you can’t pass any stool, you’re vomiting blood, or you have chest, neck, or shoulder pain.

Call your doctor if you have abdominal pain that lasts 1 week or longer, if your pain doesn’t improve in 24 to 48 hours, if bloating lasts more than 2 days, or if you have diarrhea for more than 5 days.

Is colicky pain bad?

Should your baby see a doctor? – Persistent crying could be colic, which isn’t considered harmful to the baby. But long periods of crying may also signal some kind of physical distress. Have your baby’s pediatrician perform a thorough exam to help rule out any physical reasons why your baby is crying so excessively.

Walk, rock, or take your baby for a car ride. Many babies find motion relaxing. Specially designed baby swings or vibrating chairs may also help. Just remember to use the seatbelts and read the safety instructions.Use a pacifier or help your baby find their fist to suck on.Rub your baby’s tummy or give your baby an infant massage.Place your baby on their belly across your legs and pat their back.Run a white noise machine. The hum from a vacuum or a clothes dryer may also help. Swaddle your baby.If you’re breastfeeding, consider changes to your diet. Milk products, caffeine, and foods like onions and cabbage in your diet can disagree with your baby’s sensitive stomach. What’s more, research published in the journal American Family Physician found that breastfeeding moms who cut out cow’s milk, nuts, eggs, soy, and other common allergens saw their babies with colic cry 137 less minutes per day versus the 51-minute reduction seen in controls.If you are bottle-feeding with formula, try changing to a hydrolyzed formula.Give your baby five drops of the probiotic Lactobacillus reuteri daily if you breastfeed. In one study, adding this probiotic was seen to reduce crying in breastfed babies with colic by 61 minutes, although it increased crying in bottle-fed babies.

In adults, colicky pain is usually a sharp, localized gastrointestinal or urinary pain that can arise abruptly, and tends to come and go in spasmlike waves. This can happen repeatedly over weeks, months, or years. It often occurs in hollow organs of the abdomen (such as the small and large intestines, rectum, and gallbladder ) and in the urinary tract (such as in the kidneys or ureter ).

Why is colic worse at night?

Chemical imbalance – Yet another theory is that colic stems from an imbalance of the brain chemicals melatonin and serotonin. Colicky babies might have more serotonin, which makes the intestinal muscles contract, says Marc Weissbluth, M.D., professor of clinical pediatrics at Northwestern University School of Medicine and author of Your Fussy Baby,

One reason colicky babies can fuss more at night, he explains, is that serotonin levels peak in the evening. This imbalance, the theory goes, naturally resolves when babies start making melatonin, which relaxes intestinal muscles. Babies get ample melatonin from their parents in utero, but levels drop after birth until the baby starts producing it on their own at 3 to 4 months—interestingly, around the same time that colic typically disappears.

“This hypothesis should reassure mothers that they didn’t cause colic,” Dr. Weissbluth says. “It takes away the guilt that you’re doing something wrong and aren’t able to soothe your baby.”