ABDOMINAL PAIN

Abdominal pain is any discomfort or pain felt in the region between the chest and the pelvis. It is one of the most common reasons people seek medical attention in Singapore — and one of the most complex to diagnose, because so many different organs and structures share this space.

The abdomen houses the stomach, small intestine, large intestine, liver, gallbladder, pancreas, spleen, kidneys, bladder, and — in women — the uterus and ovaries. Pain can arise from any of these organs, from the muscles and nerves of the abdominal wall itself, or even be referred from another part of the body entirely.

Abdominal pain can come from many different sources — organs, muscles, nerves, or even the gut-brain connection. Understanding the source is the first step toward lasting relief.

• Indigestion and bloating
• Constipation or diarrhoea
• Food intolerances or allergies
• Food poisoning
• Irritable bowel syndrome (IBS)
• Inflammatory bowel disease (Crohn’s disease, ulcerative colitis)

• Menstrual cramps and dysmenorrhoea
• Ovulation pain (mittelschmerz)
• Endometriosis
• Pelvic inflammatory disease (PID)
• Pelvic pain

Chronic or recurrent abdominal pain is one of the more challenging conditions to diagnose, because the cause is often not visible on standard scans. At Singapore Paincare, our team uses a systematic, multi-dimensional approach — guided by the Painostic® methodology — to assess not just what is visible on imaging, but how pain patterns, nerve sensitivity, and functional factors are contributing to your symptoms.

Abdominal pain rarely presents in isolation. Accompanying symptoms can be important clues:

• Pain that is sharp, dull, burning, cramping, or aching
• Pain that is constant or comes in waves
• Nausea, vomiting, or loss of appetite
• Bloating, gas, or changes in bowel habits
• Fever or chills (may indicate infection)
• Pain that radiates to the back, shoulder, or groin
• Unexplained weight loss
• Blood in urine or stools

Your specialist will:

1. Take a detailed pain history — location, character, timing, triggers, and history of investigations
2. Perform a focused physical examination of the abdomen
3. Review previous investigations (blood tests, ultrasound, CT, colonoscopy, endoscopy)
4. Order additional tests if needed — this may include targeted nerve blocks, which can serve both a diagnostic and therapeutic role
5. Formulate a differential diagnosis that considers the abdominal wall, internal organs, and referred pain sources

Our pain specialists work alongside gastroenterologists and other specialists to ensure that complex cases receive the appropriate expert input.

The right treatment depends on the underlying cause. At Singapore Paincare, we focus on non-surgical, minimally invasive approaches wherever clinically appropriate — aiming to break the pain cycle, address the root cause, and reduce your reliance on long-term medication.

Medications may be used to manage the pain cycle alongside procedural treatment:

• NSAIDs — to reduce inflammation; note that certain NSAIDs can irritate the stomach lining and may not be suitable for GI-related pain
• Nerve stabilisers (gabapentin, pregabalin) — reduce nerve hypersensitivity contributing to chronic abdominal pain
• Antidepressants at low dose (amitriptyline) — modulate pain perception and support gut-brain regulation; helpful in functional pain and IBS
• Antacids and acid-suppression therapy — for GERD, peptic ulcer, and gastritis-related pain

Core muscle rehabilitation and physiotherapy may be recommended, especially for abdominal wall pain, post-surgical pain, or where muscle function has been disrupted by chronic pain.

A precisely formulated combination of local anaesthetic, anti-inflammatory, and muscle relaxant delivered to the specific pain source — including nerve blocks for visceral pain pathways. Particularly effective for acute pain episodes and abdominal wall pain.

Surgery is not the first choice for most causes of abdominal pain — but for certain structural conditions, it may be the most appropriate option.

Depending on the diagnosis, surgery may be a viable treatment for abdominal pain. It is important to understand that surgery always carries associated risks, potential complications, and recovery downtime, which means it may not be suitable for every patient. Before deciding whether to proceed with surgery, a thorough evaluation of both non-surgical and surgical options should be conducted with your specialist.

Laparoscopic (keyhole) surgery is a minimally invasive surgical technique that uses small incisions and a camera to operate inside the abdomen. It may be performed to treat conditions including:

• Pancreatitis — to remove damaged pancreatic tissue or gallstones blocking the pancreatic duct
• Gallstones (cholecystectomy) — removal of the gallbladder when gallstones are causing recurring pain
• Hernia — to repair the weakened abdominal wall allowing tissue to protrude
• Pelvic inflammatory disease (PID) — to drain abscesses or remove affected tissue when the condition does not respond to antibiotics

Not all causes of abdominal pain can be prevented, but you can reduce your risk of recurrence by:

• Maintaining a balanced diet rich in fibre; staying well hydrated
• Identifying and avoiding food triggers (e.g., for IBS or food intolerances)
• Managing stress — the gut-brain connection means that anxiety and chronic stress can worsen functional abdominal pain
• Exercising regularly to support bowel motility and core muscle function
• Avoiding smoking and excessive alcohol consumption
• Following up with your specialist if pain recurs after treatment

If your abdominal pain is linked to one of these conditions, our specialists have specific expertise in each: