Chronic Abdominal Pain
Abdominal pain that lasts over 3 months is considered chronic and the conditions that may cause the discomfort are put in a different category than acute abdominal pain. There are many causes of the chronic version of this symptom and sorting out what is behind it is never easy. Other symptoms such as changes in bowel, urinary, menstrual or neurological symptoms are often helpful in understanding where the pain is coming from.
If no other symptoms are present to suggest which physiological system the pain is coming from, there may be associations to suggest its source. If the pain is related to food intake or stress, the likely culprit is the digestive system. The connection to food is logical but what about stress?
There is such a close connection between the brain and the gut that they could be seen as one. The gut is sometimes called the second brain because of the similarity in its biochemistry and function. The brain is the center where large amounts of data collected by our sensory apparatus is processed, stored and available to contribute to thinking, planning and carrying out actions. The brain must be able to discriminate between lots of information in order to categorize it correctly, store and retrieve it appropriately. The complexity and coordination of actions that the brain commands in response to situations again requires the ability to sort out options and act appropriately as well. Lots of data to sort. The function of the brain depends on complex nerve signaling carried out by a family of chemicals called neurotransmitters.
The gut too is a center where vast amounts of information must be received, processed and appropriate actions carried out. Think of the contents of a meal as a huge amount of data that needs sorting. The gut’s data processing system must direct the appropriate breakdown of large food substances into discrete and absorbable “packets”, and they need to be distinguished from packets that are not ready or should not be absorbed, like toxins. No wonder the biochemistry of the gut depends on the same kind of smart neurotransmitter system. Many people are aware that there is more serotonin (a well known member of the family of neurotransmitters) made in the gut than in the brain.
So what about abdominal pain and stress as a link in understanding the pain? The body has two main ways of being – action and rest. They always exist together simultaneously but one predominates and the other one is quite recessed. In sleep our “action” state is in retreat. In an argument our “rest” state is all but evaporated. In the action state, our body is configured primarily for action: all resources go to heart, lungs, muscles, sensory apparatus and brain information processing and decision making. Little resources are given to digestion. In the rest state the heart, lungs, muscle, sensory gear and brain get a bit of a rest and resources go to digestion, immune function, tissue repair and detoxification.
This relationship between stress produced by “outside” conditions and gut function is pretty easy to grasp. But what about the relationship between a “happy gut” and the experience of feeling stressed? An unhappy gut flora can lead to deterioration in mood, attention and decreased resilience to stress. The health of the digestive system and of our entire bodies depends on a symbiotic relationship with the trillions of bacteria that live there. We have two articles here on our website that describe this relationship: one on bloating and another called dysbiosis. To find out more about the origins and cures for conditions related to disruption in this symbiotic relationship, see those articles. Much of what we describe on those pages applies to what is going on with chronic abdominal pain especially in the context of experiencing stress.
A happy flora depends on a variety of things aside from the absence of external mental or physical conflict. It depends on good food. Fruits and vegetables – our intestinal bugs like these things. Processed foods, antibiotics taken for infection or in the food itself, pesticides and other toxins disrupt our flora and can set up a sequence of breakdowns in our brain and gut that leads to chronic pain. Our flora depends to an amazing extent on regular physical activity. Less physical activity leads to poor flora leads to decreased stress resilience leads to depressed mood leads to increased anxiety leads to less restful sleep leads to more fatigue leads to less physical activity. You see where this is going.
The reduction of support devoted to the gut that occurs in conditions of chronic stress — the chronic ‘action’ state turned on — will not only disrupt the health of the microbial flora, it will also disrupt the gut’s ability to move gut-contents smoothly through the long tube that is the intestine. A condition of stagnation or poor motility or a condition of exaggerated motility may both result. This is why constipation and diarrhea are so often associated with chronic abdominal pain coming from the digestive system. Decreased intestinal motility is associated with an aching or pressure kind of abdominal pain often associated with distension. Increased intestinal motility is associated with a cramping kind of abdominal pain often associated with discomfort during the act of having a bowel movement.
So what does this relationship between the brain, exercise, toxins, stress, diet, sleep and abdominal pain have to do with getting relief?
Because of the complexity of these relationships, it is not surprising that most people with chronic abdominal pain have difficulty in both understanding and successfully treating the condition. More conventional physician practices rarely take the time to try and understand which of these factors may be playing a role. The Plum Spring Clinic uses functional medicine testing that can help identify whether stress hormones, dysbiosis, sleep and dietary factors are playing a role in an individual’s specific case. Only after having a good idea what is going on can a holistic repair program be designed that incorporates the understanding of these factors and strategies to repair them. The Plum Spring Clinic team has many years experience working with individuals doing this work. We would like to help you. Call the clinic or fill out a contact form and arrange to have a welcome call with either our Health Coach Kathleen Williams or our Clinic Director – Nate Kelly, RD. They would be happy to discuss how this approach would work for you and to answer any questions you have about how we can help you solve your chronic abdominal pain.