What is Recurrent Abdominal Pain (RAP) and How Can It Be Treated

Recurrent abdominal pain is a common condition necessitating a medical consultation, especially amongst children and women, where multiple causes and/or symptoms may be present.

Oftentimes these symptoms have more to do with lifestyle choices such as diet, gut health and psychological well-being but may also be an early symptom of more severe conditions.

Common causes of recurrent abdominal pain:

• Indigestion
• Constipation
• Stomach ulcers
• Urinary tract infections
• Period pains
• Cancer
• Liver and/or gallbladder problems
• Some sort of parasitic/pathogenic infection
• Irritable bowel syndrome
• Inflammatory bowel disease
• An abdominal muscle injury

Recurrent abdominal pain (RAP) has been used to describe functional abdominal pain within those suffering from it with many patients, the majority being women and children, having no real identifiable organic causes.

This may lead to the development of chronic abdominal pain (CAP) as a lack of diagnosis and treatment may exacerbate the emerging condition.

 

  

How is Recurrent Abdominal Pain Classified?

The guidelines mostly used to describe and possibly diagnose recurrent abdominal pain in the past related to the use of Apley’s Criteria, which was developed in 1975.

 Although mostly having to do with the incidents of RAP in children, similar behaviours and symptoms may be present in adults.

 Due to a majority of the occurrences of these issues arising from possible childhood trauma, in adults the origin may be more difficult to narrow down.

 The criteria for recurrent abdominal pain is that there should have been 3 or more episodes of abdominal pain over 3 months at the least, and be severe enough to such an extent as to interfere with daily functioning like school or work commitments, social engagements as well as personal/self care and development.

 Abdominal pain is still one of the more common reasons for hospitalization around the world and, if any, the organic causes of abdominal pain should be rigorously tested and excluded.

 Unfortunately, recurrent abdominal pain may manifest as functional gastrointestinal disorders leading to cases of chronic abdominal pain (CAP) unless a diagnosis is made and intervention takes place.

Another classification system was developed in 1999 by the Pediatric Gastroenterology Multinational Rome Working Division where more specific diagnostic categories than recurrent abdominal pain were developed and allowed for a more specific symptom-based criteria for diagnosis.

 These criteria are described as indigestion, irritable bowel syndrome, functional abdominal pain, abdominal migraines , and aerophagia.

It is through the development of these criteria that it became apparent that much of the recurrent abdominal pain and chronic abdominal pain present, especially within children, is a result of psychological distress.

 

Common methods that may help in the treatment of recurring abdominal pain:

 Drinking of more water

• Healthy eating routines
• Higher fiber diets
• Exercise
• Taking a warm bath or using a hot water bottle
• Tailored diets that cut out specific food groups
• Psychological therapy

  

Recurrent Abdominal Pain and Mental Well-Being

A massive study was conducted by a group of researchers using The Raine Study, a randomised controlled trial designed to test the effects of ultrasound over the course, and after the fact, of pregnancy.

 Almost 3000 women and their children were followed from birth until the age of 17, where physical and detailed, self-administered questionnaire-based assessments regarding health and lifestyle were used to determine the effect of abdominal pain.

 It was found that during these studies, abdominal pain was common in children and adolescents, particularly females.

The study revealed that one third of seventeen year-olds experience some form of abdominal pain, and that those adolescents with frequent abdominal pain were more than twice as likely to have a history of depression.

 Within the same vein, children with recurrent abdominal pain had a higher chance of frequent abdominal pain, depression or anxiety during their teenage years compared to those without recurrent abdominal pain growing up.

 The study highlighted that an increase in incidences of bullying within school correlated with the increase of recurrent abdominal pain.

Considering the large emotional and psychological effects that bullying has on childhood aspects of mental health such as anxiety and depression, it becomes clearer to see that the correlation between psychological distress and recurrent abdominal pain is also there.

  

The Effects of Psychological Stress on RAP

Whether bullying serves as a trigger for the psychological distress or aids in driving that destructive psychological state, the victims of these experiences have been shown to exhibit symptoms that are physically not there.

 These may include adverse health conditions and disorders such as recurrent abdominal pain. These conditions and disorders may then develop into chronic health issues in the future requiring further, sometimes more drastic, medical intervention as an adult.

 The correlation between children with frequent abdominal pain and the psychological condition of their parents was investigated by the Medical Research Council.

Children that had recurrent/persistent abdominal pain were found again to be almost twice as likely to suffer from some form of mental distress.

 Once these psychological disorders were accounted for and controlled, the physical symptoms associated with RAP decreased by half.

 

Possible Treatment Methods for Stress-Related RAP

In an article published in 2006, researchers attempted to form a standardized assessment for recurrent abdominal pain.

Several mental as well as physical evaluations were investigated such as examining the effects of cognitive-behavioural therapies, fiber treatments and behavioural conditioning procedures.

 Of all these methods, cognitive-behavioural approaches appeared as a probably effective treatment for undiagnosed recurrent abdominal pain.

 Fiber interventions were found to aid in recurrent abdominal pains associated with constipation while behavioural conditioning procedures were found to not meet the required criteria for effective treatment options.

  

A Possible Treatment for Recurrent Abdominal Pain

The group undergoing these cognitive-behavioural interventions showed no evidence for any negative effects of treatment.

 A large majority of the children (87,5%), when studied in a school setting, were shown to be pain-free after three months of follow-up interventions compared to those at the start (37,5%).

 A second study comparing the effects of both cognitive-behavioural family intervention and standard paediatric care saw that both treatment procedures were effective at reducing the levels of pain intensity as well as the behaviour related to pain management.  

The parents involved reported higher levels of satisfaction in children receiving the cognitive-behavioural family intervention treatment than those receiving standard care.

Those receiving the cognitive-behavioural treatments had a higher chance of the complete elimination of pain as well as a lower chance of relapsing after 6 and 12 months.

RAP is Complicated so Pay Attention to the Signs

Based on a modern understanding of recurrent abdominal pain, it is clear to see that the possible causes are vast.

Linked with the incidence of poor mental health, this only serves to complicate diagnosis and treatment. 

Research points towards a plethora of social and psychological roots in the occurrence of recurrent abdominal pain and that an optimized assessment of all potential psychological and physiological contributors be accounted for when recurrent abdominal pain is described. 

There are some signs that do not point towards recurring abdominal pain as the cause of some discomfort. These extreme indications need to be addressed as soon as possible. 

Signs that you should see a medical professional:

• Continual/uncontrollable vomiting or diarrhoea
• Chronic constipation
• Fever caused from abdominal pains
• Pain when urinating
• Blood in the stool or in vomit
• A history of anaemia
• An inability to pass gas
• Difficulty in swallowing
• Dizziness/light-headedness
• When a lump is present in the abdominal area
• Unintentional weight loss

  

Conclusion: Consult with Medical Professionals

Irritable bowel syndrome is another cause of recurrent abdominal pains and its treatment options vary in comparison to the interventions required for other causes of recurrent abdominal pain such as indigestion, constipation, stomach ulcers and other potential chronic abdominal problems. 

Because of this wide scope of potential causes and symptoms, and all of these conditions requiring their own treatment options, the importance of consulting with a doctor and potentially a gastroenterologist professional is a crucial first step towards finding the root cause and the subsequent treatment for recurrent abdominal pain.