Abdominal muscle pain

Pain in the abdominal muscles is often referred to by the general term - abdominal pain syndrome, which in turn can be the leading symptom complex guiding the diagnostic and therapeutic strategy. However, contrary to popular belief, abdominal pain is not always related to gastroenterological problems, it can be provoked by various organic, functional, and inorganic, dynamic factors.

If we divide pain symptoms by the mechanism of occurrence, it turns out that only some types are directly related to myalgia (muscle pain):

• Visceral abdominal pain is a pathological stretching of the walls of hollow internal organs and vascular disorders. Only pain in the smooth muscles of organs is related to muscle tissue.
• Somatic abdominal pain is a combined pathology of the internal organs and the peritoneum itself, hypertonicity of the abdominal muscles.
• Reflected abdominal pain is an anatomical infringement, organ damage, irradiation of pain, partially into the abdominal muscles.
• Psychogenic abdominal pain is a pain symptom that does not have an organic or vascular cause, often manifesting as myalgia.

Pain in the abdominal muscles associated with traumatic damage to muscle fibers. This symptom is an independent sign of dysfunction of the abdominal muscular system.

[ 1 ], [ 2 ]

Causes of abdominal muscle pain

It is sometimes very difficult to determine why and where the stomach hurts, and accordingly, the causes of pain in the abdominal muscles are not easy to differentiate from abdominal pain of a different nature. As a rule, factors that provoke painful sensations in the abdominal area are divided into three broad categories, including various nosological groups:

1. Diseases of the hollow organs located in the abdominal area, including the clinical condition "acute abdomen".
2. Reflected, radiating, extraparietal pain (outside the peritoneum) caused by diseases of the spine, heart, endocrine system, lungs, as well as intoxication.
3. Systemic pathologies.

Also, the causes of pain symptoms can be psychogenic factors (depressive state) and situations familiar to everyone - physical overexertion, sports loads on muscles and injuries.

Since muscle pain most often develops due to spastic tension, hypertonus, it is advisable to consider the symptom as a protective mechanism, in clinical practice it is called protective tension of the abdominal wall muscles. Such a reflex tonic response of the muscles of the anterior zone of the peritoneum always corresponds to the place of innervation of inflammation or injury. The degree of intensity of tension depends on the rate of development of the inflammatory process and on the condition, type of nervous system. Most often, obvious protective hypertonus, pain in the abdominal muscles occurs with the clinical picture of acute abdomen, provoked by such diseases:

• Acute appendicitis.
• Perforation of a duodenal or gastric ulcer.
• Acute intestinal obstruction.
• Acute vascular conditions – disruption of arterial or venous blood flow, ischemia, intestinal infarction.
• Acute inflammation of the gallbladder and pancreas.
• Rupture of the tube during ectopic pregnancy.
• Abdominal aortic aneurysm.
• Acute inflammatory processes in the pelvic organs in women (tumor, cyst).

If an acute condition is ruled out, the most likely causes of abdominal muscle pain may be:

• Incarceration of hernia abdominalis – abdominal hernia or prolapse of internal organs through openings in the peritoneal wall (artificial, traumatic or natural).
• Stretching of the abdominal muscles. Most often, pain is provoked by microtraumas of the internal structure of muscle tissue. Causes are physical overexertion, load, sports training, moving loads, weights, less often - pregnancy.
• Trauma to the abdominal area can be blunt or penetrating. Penetrating trauma leads to intra-abdominal bleeding and even peritonitis, blunt trauma often ends with intra-abdominal hematoma and pain in the abdominal muscles.
• Rupture of ligaments, abdominal muscles. Violation of the integrity of muscle tissue can be complete or partial. Spontaneous, partial muscle rupture is provoked by intense physical exertion on atrophied, atonic abdominal muscles.

In addition, abdominalgia (pain in the abdominal muscles) can be caused by vertebrogenic reasons:

• Osteochondrosis of the lumbosacral region.
• Spondylosis.
• Tuberculosis of the skeletal system.
• Spinal cord injury.

Quite often, myalgias affecting the abdomen are caused by myofascial pain syndrome (MPS). With MPS, the rectus and oblique muscles hurt, the cause of the pain is vertebrogenic pathology or physical overexertion, a characteristic sign is the presence of diagnostically significant trigger pain points.

It should be noted that according to statistics, defense musculaire - protective hypertonicity and pain in the abdominal muscles most often occurs with inflammation of the appendix, gall bladder and pancreas. Also, pain and muscle tension are expressed with perforation of an ulcer of a hollow organ, to a lesser extent - with inflammatory processes and hemorrhage into the peritoneum.

[ 3 ], [ 4 ], [ 5 ]

Symptoms of abdominal muscle pain

Symptoms of abdominal muscle pain can be classified into the following types:

Pathogenetic systematization:

• Colic, spasms of smooth muscles of abdominal organs in combination with protective tension and pain in the abdominal muscles. Spasms occur spontaneously, have a paroxysmal character, can be reduced by taking antispasmodics, using warming procedures. Spasms can radiate to the lower back, to the back, to the leg. The pain is accompanied by visceral reflexes (arrhythmia, vomiting, headache), provokes a forced body position.
• Reflected abdominal pain is aching, pulling in nature, often diffuse and poorly localized.
• The pain caused by circulatory problems in the abdominal cavity is paroxysmal and increases to a very strong level.
• Peritoneal abdominal pain develops spontaneously, but can also occur gradually, as a rule, it is clearly localized, the painful zones are easily palpated. The pain increases with movement, coughing, sneezing, and is accompanied by typical protective hypertonicity of the abdominal muscles and a protective body posture.

Classification of symptoms by speed and nature of sensations:

• Acute pain – develops spontaneously, quickly, and rarely lasts more than an hour.
• Chronic pain is often associated with muscle strain, develops gradually, and lasts a long time until the structure of muscle fibers is completely restored.

Classification of symptoms by course:

• Surgical acute pain (clinical acute abdomen), often accompanied by protective muscle tension.
• Acute abdominal pain, nonsurgical.
• Chronic organic abdominal pain.
• Chronic functional abdominal pain.

The classification by pathogenesis includes a long list, of which only the motor type (hyperkinetic, hypokinetic, atonic symptom), as well as traumatic and neurological types, are classified as muscle pain.

You should be aware of the alarming symptoms of abdominal muscle pain, which may indicate the clinical picture of acute, urgent conditions:

Rate of pain development, nature of symptom	Possible reasons
The pain develops quickly, increases and is acute, excruciating, accompanied by protective tension of the abdominal muscles.	Perforation of gastric ulcer, intestinal ulcer Rupture of aneurysm Rarely – myocardial infarction Biliary colic
The pain occurs spontaneously, is intense, lasts a long time, up to 12-24 hours. Often the pain is cramping, spasmodic	Pancreatitis Intestinal obstruction Occlusion of the mesenteric circulatory system
Abdominal pain, including muscle pain, increases gradually and lasts for days	Cholecystitis Diverticulitis
Abdominal pain is combined with tachycardia, cyanosis of the skin, a drop in blood pressure, elevated body temperature, vomiting, and severe tension in the abdominal muscles.	Appendicitis Ruptured cyst Ectopic pregnancy

Typical abdominal muscle pain caused by physical overexertion and stretching of ligaments, muscle fibers, manifests itself as pulling, aching sensations that intensify with movement. As a rule, such symptoms of abdominal muscle pain pass within 2-3 days, subside at rest and are not a sign of serious pathology.

Abdominal muscle pain during pregnancy

Pain in the abdominal area of a pregnant woman can be caused by

"obstetric" conditions, as well as physiological, natural causes associated with the enlargement of the uterus and stretching of the abdominal muscles.

Abdominal muscle pain during pregnancy is a cause for concern for both the expectant mother and the attending gynecologist. First of all, when the first painful sensations appear, possible pathological causes are excluded:

• Threat of termination of pregnancy, miscarriage, including "septic" miscarriage, which is manifested by the clinical picture of acute abdomen.
• Ectopic pregnancy.
• Fibromyoma.
• Uterine rupture.
• Preeclampsia.
• Placental abruption.
• Acute pyelonephritis.
• Rarely – rupture of an aneurysm (artery).
• Rarely - spontaneous hematoma of the abdominal muscle.

Fortunately, abdominal muscle pain during pregnancy in 75% of cases is associated with an explainable, physiological cause. The gradually increasing uterus causes natural stretching of the abdominal muscles, which previously performed a "corset" function, and during the process of bearing a fetus perform the task of supporting the uterus. The most susceptible to pain are the rectus muscles, running down from the ribs to the pubic area. In those women who took care of the elasticity of muscle tissue in advance, that is, did training, the stretching will pass almost unnoticed. If the muscles are "lazy", atrophic, or, on the contrary, too tense, the pain symptom can manifest itself in the form of pulling, aching sensations, increasing as the fetus develops, up to the appearance of an umbilical hernia or a hernia of the white line of the abdomen.

Diagnosis of abdominal muscle pain

Abdominal myalgia is a rather difficult task in terms of accurate and timely diagnosis due to its non-specificity and the close connection of the muscle tissue of the peritoneum with the smooth muscles of the internal organs located in the abdomen.

Particular attention when making a diagnosis is given to children, pregnant women and the elderly, as well as those with a history of the following diseases:

• Kidney and liver diseases.
• Diabetes mellitus.
• Endocrine pathologies.
• Diseases of the pelvic organs.
• Circulatory failure, vascular disorders.
• Spinal injuries.

Diagnosis of abdominal muscle pain may include the following steps:

• Avoiding physical overexertion – training, lifting heavy objects, etc.
• Exclusion of traumatic damage to the abdominal muscles (blows, bruises, falls, accidents).
• All females are subject to biochemical testing to determine possible pregnancy.
• Urine analysis to exclude or confirm pathologies of the genitourinary system.
• A blood test (leukocyte level) is mandatory, but is not specific; the absence of leukocytosis does not exclude the possibility of inflammation or infectious pathology.
• Biochemical blood test, functional liver tests to confirm or exclude diseases of the gallbladder and liver.
• Ultrasound of the abdominal cavity.
• X-ray of the spine.
• Electrocardiogram to exclude infarction, myocardial ischemia.
• FGDS to confirm or exclude diseases of the digestive tract.

The main and primary method that involves diagnosing abdominal muscle pain is an objective visual examination:

• Examination of the patient.
• Determination of posture, body position.
• Palpation (tense, board-like or soft abdomen).
• Determining the pulse rate.
• Percussion to determine possible perforation of hollow organs.
• Determination by palpation of trigger muscle zones in case of suspected myofascial syndrome.

The most dangerous symptoms that dictate urgent medical interventions and diagnosis as soon as possible are the following signs:

• Pain in the abdominal muscles and dizziness.
• Decreased blood pressure, decreased pulse rate, tachycardia.
• Feverish condition.
• Bleeding (visible - in urine, in feces).
• Vomit.
• Ascites or atypical abdominal enlargement.
• Absence of peristaltic noises.
• Positive Shchetkin-Blumberg symptom.
• Protective tension of the abdominal muscles.

[ 6 ], [ 7 ], [ 8 ]

Treatment for abdominal muscle pain

Treatment of abdominal myalgia depends on the identified etiologic cause. If the pain symptom is provoked by physical overexertion, the pain appeared after training, treatment of pain in the abdominal muscles is not difficult. The first thing to do is to give rest to the muscle tissue and reduce the load on the abdomen. It is possible to use an immobilizing bandage, a bandage, gentle massage, rubbing in relaxing external agents, but warming is unacceptable. As a rule, after 2-3 days the pain subsides without any complications.

Treatment of pain symptoms when more serious conditions or diseases are suspected is primarily aimed at relieving pain.

General principles of abdominal pain therapy:

• Normalization of structural disorders of abdominal organs.
• Normalization of the function of the organ that causes pain.
• Normalization of the function of the nervous system, which is directly related to the sensation of pain.

The objectives of acute and chronic pain therapy differ from each other. In the case of an acute symptom, the primary action is a quick diagnosis and pain relief, while in the case of chronic pain, the provoking factor has already been identified but not eliminated. Therefore, the treatment of abdominal muscle pain should be aimed at eliminating the chronic, sluggish disease, i.e., etiotropic therapy is necessary.

Since myalgia in the abdominal area is most often a spasm, antispasmodic drugs are most often prescribed. Modern antispasmodic drugs are represented by a wide range of drugs that affect the entire process of contraction of smooth muscles of internal organs, as well as the contraction of striated muscle tissue. According to the mechanism of spasm relief, antispasmodics can be divided into 2 groups:

1. Myotropic agents affecting smooth muscle tissue
2. Neurotropic agents that affect the transmission of pain nerve impulses

The choice of antispasmodic drugs depends on the type of pain symptom, its location, intensity and accompanying symptoms.

To summarize, it can be noted that therapeutic actions in the treatment of abdominal pain can be grouped into the following areas:

1. Pain relief.
2. Treatment of the underlying provoking factor.
3. Neutralization of motor dysfunction in the digestive tract.
4. Decreased visceral sensitivity.

Acute, urgent conditions require urgent measures, often surgical intervention within the limits of the identified symptoms. Often the reason for surgical intervention is untimely visit to the doctor and self-medication, so patients should know what is unacceptable for pain in the abdomen, in the abdominal muscles:

• If the pain is bearable, you should not take painkillers so as not to “obscure” the clinical picture of the disease.
• You cannot warm up the stomach, use a heating pad, warming compresses to avoid peritonitis, internal bleeding, you can use cold.
• You cannot take laxatives or use enemas.
• It is advisable to refrain from eating and drinking a lot.
• If you experience muscle pain, you should stop sports training and avoid physical activity.

Prevention of abdominal muscle pain

Preventive measures against abdominal pain have not yet been developed, this is explained by the multiple causes that provoke abdominal pain. In addition, it is impossible to prevent the syndrome due to its non-specificity, but there are

Prevention of abdominal muscle pain, concerning the so-called "training" pain. If we talk about myalgia of the abdominal area as a specific independent symptom, that is, about damage to muscle tissue, then most often it is associated with overload, overexertion, movement of weights and improper weight distribution. Therefore, preventive measures should be as follows:

• It is reasonable to correlate your physical capabilities with the task at hand during training.
• Be sure to warm up the muscles of the entire body, including the abdominal muscles.
• Select a training program taking into account individual characteristics, possibly taking into account existing chronic diseases.
• Be sure to take breaks between intense workouts.
• When moving heavy objects, distribute the weight of the load evenly and maintain a straight posture.
• Regularly train your core muscles, including your back and abdominal muscles.
• At the first symptoms of pain, take a break and give rest to the overworked muscles.

In addition, prevention of abdominal pain syndrome can consist of standard medical examinations, which every adult should undergo annually. According to statistics, a comprehensive examination at least once a year reduces the risk of abdominal pain, in its muscles, by 55-60%.

Pain in the abdominal muscles is not a pathological symptom, as it concerns a fairly quickly restored muscle structure, but any abdominal discomfort can be a sign of a serious disease. As they say, there are thousands of ailments, but health is one, so it is better to take care of it and preserve it in advance.