Pain in abdominal muscles

Pain in the abdominal muscles is often called the general term - abdominal pain syndrome, which in turn can be a leading symptom complex, directing a diagnostic and therapeutic strategy. However, contrary to the generally accepted opinion, abdominal pains do not always refer to gastroenterological problems, they can be provoked both by various organic, functional, and inorganic, dynamic factors.

If you divide the pain symptoms by the mechanism of occurrence, you will find that only a few species have direct relation to myalgia (muscle pain): 

• Visceral abdominal pain - pathological stretching of the walls of hollow internal organs and vascular disorders. To the muscle tissue is related only pain in the smooth muscles of the organs.
• Somatic abdominal pain - combined pathology of internal organs and directly peritoneum, hypertension of abdominal muscles.
• Reflected abdominal pain - anatomical infringement, organ damage, irradiation of pain, partly in the abdominal muscles.
• Psychogenic abdominal pain is a pain symptom that does not have an organic or vascular cause, often manifested as a 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], [3]

Causes of pain in abdominal muscles

Determine why and where the stomach aches sometimes is very difficult, respectively, the causes of pain in the abdominal muscles are not easy to differentiate from abdominal pain of a different nature. Typically, the factors that provoke pain in the abdomen are divided into three broad categories, including various nosological groups: 

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

Also, the causes of the pain symptom may be psychogenic factors (depressive state) and are familiar to all situations - physical overstrain, athletic loads on muscles and injuries.

Since the pain in the muscle tissue most often develops because of spastic tension, hypertonia, it is advisable to treat the symptom as a protective mechanism, in clinical practice it is called - the protective tension of the muscles of the abdominal wall. 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 trauma. The degree of stress intensity depends on the rate of development of the inflammatory process and on the state, such as the nervous system. The most common obvious protective hypertonicity, pain in the abdominal muscles occurs in the clinical picture of an acute abdomen, provoked by such diseases: 

• Acute appendicitis.
• Perforation of an ulcer of the duodenum or stomach.
• Acute intestinal obstruction.
• Acute vascular conditions - violation of arterial or venous blood flow, ischemia, intestinal infarction.
• Acute inflammation of the gallbladder, pancreas.
• Rupture of the tube with ectopic pregnancy.
• Aneurysm of the aorta of the abdominal cavity.
• Acute inflammatory processes in the pelvic organs in women (tumor, cyst).

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

• Infringement of hernia abdominalis - hernia of the abdomen or prolapse of internal organs through the perforation of the peritoneum (artificial, traumatic or natural).
• Stretching of the muscles of the abdominal cavity. Most often, the pain is caused by microtraumas of the internal structure of the muscle tissue. Causes - physical overstrain, stress, sports training, moving loads, weights, less often - pregnancy.
• Injuries to the abdominal area can be blunt or penetrating. Penetrating trauma leads to intra-abdominal bleeding and even to peritonitis, a blunt trauma often results in intra-abdominal hematoma and pain in the abdominal muscles.
• Rupture of ligaments, abdominal muscles. Violation of the integrity of the muscle tissue can be complete, partial. Spontaneous, partial muscle rupture is provoked by intense physical exertion on atrophied, atonic abdominal muscles.

In addition, abdominalgia (pain in the muscles of the abdominal zone) can be provoked by vertebrogenic causes: 

• Osteochondrosis of the lumbosacral zone.
• Spondylosis.
• Tuberculosis of the osseous system.
• Injury of the spine.

Quite often, myalgias that touch the abdomen are caused by myofascial pain syndrome (MFBS). With MFBS, direct and oblique muscles ache, the cause of pain is vertebrogenic pathology or physical overstrain, a characteristic sign is the presence of diagnostic trigger points of pain.

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

[4], [5], [6], [7]

Symptoms of pain in the abdominal muscles

Symptoms of pain in the abdominal muscles can be systematized according to these types:

Pathogenetic systematization: 

• Colic, spasm of smooth muscles of abdominal organs in combination with protective tension and pain in the muscles of the abdomen. Spasms appear spontaneously, have a paroxysmal character, can decrease with taking antispasmodics, applying warming procedures. Spasms can irradiate in the lower back, in the back, in the leg. The pain is accompanied by visceral reflexes (arrhythmia, vomiting, headache), provokes the forced position of the body.
• Reflected abdominal pain is aching, drawing character, often diffuse and poorly localized.
• The pain caused by the violation of blood circulation in the abdominal cavity has a paroxysmal character, increases to a very strong one.
• Peritoneal abdominal pain develops spontaneously, but can occur and gradually, as a rule, clearly localized, the pain zones are well palpated. The pain increases with movement, with coughing and sneezing, accompanied by a typical protective hypertension of the abdominal muscles and a protective body posture.

Classification of symptoms by speed and nature of sensations: 

• Acute pain - develop spontaneously, quickly, rarely last more than an hour.
• Chronic pain is often associated with muscle stretching, develops gradually, lasts a long time until the complete restoration of the structure of the muscle fibers.

Classification of symptoms with the flow: 

• Surgical acute pain (clinic of an acute abdomen), often accompanied by a protective muscle tension.
• Acute abdominal pain, non-surgical.
• Chronic organic abdominal pain.
• Chronic functional abdominal pain.

The classification by pathogenesis includes a long list, from which only the motor form (hyperkinetic, hypokinetic, atonic symptom), as well as traumatic and neurological species, pertain to muscle pains.

You should know the alarming symptoms of pain in the abdominal muscles, which can point to the clinic of acute, urgent conditions:

The speed of the development of pain, the nature of the symptom	Possible reasons
The pain develops rapidly, grows and has a sharp, painful character, accompanied by a protective tension of the abdominal muscles	Perforation of stomach ulcers, intestines Rupture of aneurysms Rarely - myocardial infarction Biliary colic
The pain arises spontaneously, is intense, lasts a long time, until 12-24 hours. Often the pain is cramping, spastic	Pancreatitis Intestinal obstruction Occlusion of the mesenteric circulatory system
Pain in the abdomen, including in the muscles, increases gradually, lasts for days	Cholecystitis Diverticulitis
Pain in the abdomen is combined with tachycardia, cyanosis of the skin, pressure loss, increased body temperature, vomiting, strong tension of the abdominal muscles	Appendicitis Cyst rupture Ectopic pregnancy

Typical muscle pains in the abdomen caused by physical overstrain and stretching of ligaments, muscle fibers, appear as pulling, aching sensations, amplifying in movement. As a rule, such symptoms of pain in the muscles of the abdominal region pass within 2-3 days, calm down at rest and are not a sign of serious pathology.

Pain of abdominal muscles in pregnancy

The pain symptom in the abdominal area of a pregnant woman can be caused

"Obstetric" conditions, as well as physiological, natural causes associated with an increase in the uterus and stretching of the abdominal muscles.

The pains of the abdominal muscles during pregnancy are an occasion for anxiety, as for the future mother herself and for the treating gynecologist. First of all, with the appearance of the first painful sensations, the possible pathological causes are excluded:

• The threat of termination of pregnancy, miscarriage, including "septic", which manifests itself in the clinical picture of an acute abdomen.
• Ectopic pregnancy.
• Fibromioma.
• Rupture of the uterus.
• Preeclampsia.
• Detachment of the placenta.
• Acute pyelonephritis.
• Rarely, rupture of an aneurysm (artery).
• Rarely - spontaneous hematoma of the abdominal muscles.

Fortunately, pain in the abdominal muscles during pregnancy in 75% of cases is associated with an explicable, physiological cause. Gradually increasing uterus causes a natural stretching of the abdominal muscles, which previously performed the "corset" function, and in the process of bearing the fetus perform the task of maintaining the uterus. The most direct muscles are those that run down from the ribs to the pubic region. Those women who took care of the elasticity of the muscle tissue in advance, that is, were engaged in training, stretching will pass almost imperceptibly. If the muscles are "lazy", atrophic, or, on the contrary, are too strained, the pain symptom can appear as pulling, aching sensations, increasing as the fetus develops, until the umbilical hernia or hernia of the white abdominal line appears.

Diagnosis of pain in abdominal muscles

Abdominal myalgia presents a rather difficult task in the sense of accurate and timely diagnosis due to its nonspecificity and close connection of the peritoneal muscle tissue with the smooth muscles of the internal organs located in the abdomen.

Particular attention is paid to the diagnosis of children, pregnant women and elderly people, as well as those who have a history of such diseases:

• Diseases of the kidneys and liver.
• Diabetes.
• Endocrine pathologies.
• Disease of the pelvic organs.
• Insufficiency of blood circulation, vascular disorders.
• Injuries of the spine.

Diagnosis of pain in the abdominal muscles can include such steps:

• Elimination of physical overstrain - training, movement of weights and so on.
• Exclusion of traumatic damage to the abdominal muscles (bumps, bruises, falls, accidents).
• All female subjects are subject to a biochemical test to determine a possible pregnancy.
• Urinalysis to exclude or confirm pathologies of the genitourinary system.
• The blood test (leukocyte level) is mandatory, but not specific, the absence of leukocytosis does not exclude the possibility of inflammation or infectious pathology.
• Biochemical blood test, functional hepatic tests to confirm or exclude diseases of the gallbladder, liver.
• Ultrasound of the abdominal cavity.
• Roentgen of the spine.
• Electrocardiogram for the prevention of heart attack, myocardial ischemia.
• EGF to confirm or exclude diseases of the digestive tract.

The main and primary method, which involves the diagnosis of pain in the abdominal muscles, is an objective visual examination:

• Inspection of the patient.
• Determination of the posture, position of the body.
• Palpation (tense, flaky or soft abdomen).
• Determination of the pulse rate.
• Percussion to determine the possible perforation of hollow organs.
• Determination of palpation of trigger muscle zones with suspected myofascial syndrome.

The most dangerous symptoms, which dictate urgent medical measures and the diagnosis in the shortest possible time, are the following signs:

• Pain in the muscles of the abdominal region and dizziness.
• Reduction of blood pressure, a drop in the pulse, tachycardia.
• Febrile state.
• Bleeding (visible - in urine, in feces).
• Vomiting.
• Ascites or atypical abdominal enlargement.
• Absence of peristaltic noise.
• Positive symptom of Schetkina-Blumberg.
• Protective tension of abdominal muscles.

[8], [9], [10]

Treatment of pain in abdominal muscles

Treatment of myalgia of the abdominal zone depends on the revealed etiological cause. If the pain symptom is provoked by physical overexertion, the pain appeared after training, the treatment of pain in the abdominal muscles is not difficult. The first thing that needs to be done is to give peace to the muscle tissue and reduce the strain on the abdomen. It is possible to use an immobilizing dressing, bandage, gentle massage, rubbing relaxing external means, but warming is unacceptable. As a rule, after 2-3 days the pain subsides without any complications.

Treatment of a painful sign for suspected more serious conditions, the disease is primarily aimed at stopping pain.

General principles of therapy of abdominal pain:

• Normalization of structural disorders of the abdominal cavity.
• Normalization of the function of the body that provokes pain.
• Normalization of the function of the nervous system, which is directly related to the sensation of pain.

The tasks of therapy for acute and chronic pain differ from each other. With the acute nature of the symptom, the immediate action is a quick diagnosis and anesthesia, in chronic pain the provoking factor is already established, but not eliminated. Therefore, the treatment of pain in the abdominal muscles should be aimed at eliminating a chronic, sluggish disease, that is, etiotropic therapy is needed.

Since myalgia in the abdominal zone is most often a spasm, most often prescription drugs are antispasmodics. Modern antispasmodics are represented by a wide range of drugs that affect the entire process of contracting the smooth muscles of the internal organs, as well as the contraction of the striated muscle tissue. By the mechanism of arresting the spasm, antispasmodics can be divided into 2 groups:

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

The choice of antispasmodics depends on the type of pain symptom, its location, intensity and concomitant symptoms.

Summarizing, it can be noted that therapeutic actions in the treatment of abdominal pain can be grouped in such directions:

1. Pain relief.
2. Treatment of the main 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 revealed symptomatology. Often, the cause of surgery is untimely access to a doctor and self-treatment, so patients should know what is unacceptable with abdominal pain, in the abdominal muscles:

• If the pain is tolerable, you can not take painkillers, so as not to "lubricate" the clinical picture of the disease.
• You can not warm up the stomach, put a heating pad, warming compresses to avoid peritonitis, internal bleeding, you can apply cold.
• You can not take laxatives, put enemas.
• It is advisable to refrain from food, drink abundantly.
• When muscle pain should stop sports training, to exclude physical activity.

Prevention of pain in the abdominal muscles

Preventive measures against abdominal pain have not yet been developed, this is explained by multiple causes that provoke abdominal pain. In addition, it is impossible to prevent the syndrome because of its nonspecificity, but there is

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

• It is reasonable to relate your physical abilities to the task at the training.
• It is essential to warm up the muscles of the whole body, including the abdominal muscles.
• To choose the program of trainings taking into account individual features, probably, in view of available chronic diseases.
• It is necessary to take breaks between intensive loads.
• When moving weights, distribute the weight of the load evenly, maintain a straight posture.
• Regularly train the muscular corset, including the muscles of the back and abdomen.
• With the first pain symptoms, take a break, give rest to overloaded muscles.

In addition, the prevention of abdominal pain may consist of standard outpatient examinations, which every adult person should be burned annually. Comprehensive examination at least once a year according to statistics reduces the risk of pain in the abdomen, in his muscles by 55-60%.

Pain in the abdominal muscles is not a pathological symptom, as it concerns a fairly quickly restored muscular structure, but any abdominal discomfort can be a sign of a serious illness. As they say, there are thousands of ailments, but one's health, so it's better to protect it and keep it in advance.