Majority of people must have experienced above belly button pain at least once in their lives. This may also be categorized as upper abdomen pain and is localized in the area below the xiphoid process of sternum or chest bone and above the umbilicus or belly button.
Since, upper abdomen is home to many visceral organs especially gastrointestinal organs, pain experienced in this area involve a diversity of causes ranging from gastritis, peptic ulcers, pancreatitis and food poisoning to appendicitis, hernia and diverticulitis.
In women, pelvic inflammatory diseases (PID), ectopic pregnancy and physiological pain associated with changes in the body due to pregnancy can also cause above belly button pain. The usual causes of upper abdominal pain are mild and self limiting; only few may need medical intervention.
It is also worth mentioning that sometimes this kind of pain may not be due to the organs in the region but may indicate a problem in some other organ (radiating pain from other organ) such as in some cases of heart attack, people may feel discomfort just below the xiphoid process and may misinterpret this sensation as simple heart burn. This can lead to serious consequences.
In this article, we’ll be focusing on some common causes of above belly button pain, their treatment and what can we do to either prevent the occurrence of diseases that are involved or prevent the severe consequences and complications of these diseases.
what you will read next :
Divisions of upper abdomen
As we said before, abdomen houses many visceral organs and for easy understanding and categorization of causes of pain in abdomen, the abdominal area is divided into different sections that includes right upper quadrant (RUQ), epigastric region, left upper quadrant (LUQ), right flank, umbilical, left flank, right lower quadrant (RLQ), hypogastric region and left lower quadrant (LLQ). This division helps in suspecting the possible cause of pain based on the organ located in that particular zone. For example, pain in epigastric region may indicate a possible problem in stomach or esophagus such as gastro esophageal reflux disease (GERD), peptic ulcer and gastritis.
Similarly, pain in right upper quadrant may direct our suspicion towards a problem in either gallbladder such as gallstones or liver such as acute hepatitis, liver abscess or duodenal ulcer, pancreatitis etc.
Since our article is about pain in region above the umbilicus, our focus will be primarily on right upper quadrant, epigastric region, left upper quadrant and umbilical region only.
What causes pain in the area above belly button?
Since, this area mostly contains organs of gastrointestinal tract, major cause of pain is related to discomfort in the organs of GI tract only.
Some other causes may include kidney stones; pain associated to musculoskeletal system or even psychosomatic disorder due to anxiety and depression.
Causes of upper belly button pain based on pain location
Around the umbilicus or belly button: Periumblical
- Appendicitis
Pain around the belly button can be an initial sign and symptom of an inflamed appendix. Appendix is a vestigial finger like organ attached to the lower right corner of ascending colon. How its inflammation begins is unknown but studies suggest that it is multifactorial and could have familial cause or due to obstruction of lumen of appendix or certain foods may trigger it.
The diagnosis of appendicitis is mostly clinical that is your doctor decides whether you have appendicitis or not on the basis of clinical signs and symptoms that you present with. In this case, patients complain of colicky pain around their belly button which intensifies with next 24 hours and eventually shifts to the right lower of abdomen.
Appendicitis is an emergency and needs quick appendectomy as a delay in surgery may be associated with perforation of appendix followed by generalized peritonitis in which the patient may present with abdominal tenderness and severe vomiting.
Other symptoms along with pain around umbilicus that can help in diagnosing appendicitis are loss of appetite, nausea, vomiting, fever, diarrhea or constipation and progressive abdominal pain.
- Gastroenteritis or stomach flu
It is the irritation and inflammation of intestines for which parasites, bacteria, viruses and toxins are to be blamed for.
If you are suffering from gastroenteritis, you will experience pain and cramps in your abdomen, watery diarrhea, nausea, vomiting, fever, head and body ache.
Persistent vomiting and diarrhea may lead to signs of dehydration and you may feel dizzy and exhausted.
Gastroenteritis caused by viruses is contagious and the transmission occurs if a healthy person comes in contact with vomit or stool of the diseased person.
Gastroenteritis is usually self limited and your immune system protects you without any need for medical intervention. However, make sure to visit the doctor if you have very high fever, bloody diarrhea or dysentery, extreme pain and severe symptoms of dehydration such as generalized weakness, inability to stand properly due to feeling of dizziness, sunken eyes, extreme thirst, dried mouth and other mucous membranes etc.
- Diseases of intestine
- Small or large bowel obstruction:
also manifests as pain around the belly button with other symptoms such as abdominal distention, inability to pass stool or even gas, if severe, increased bowel sounds and vomiting.
Causes of obstruction vary from a strangulated hernia, twisted intestine or volvulus to intussusceptions or telescoping of a part of intestine into adjacent intestine.
Treatment begins with stabilizing the patient’s general condition by infusing IV fluids, placing nasogastric tube to relieve abdominal distension by removing the air entrapped in GI tract etc. Actual treatment will be done in accordance to the cause of obstruction, such as for intussusceptions barium or air enema is used. Volvulus and strangulated hernia may need surgical intervention.
- Irritable bowel syndrome or IBS
Pain related to IBS may involve area around the belly button and zones below it as IBS is mainly the disease of large intestines. It is a chronic condition with no known etiology or cause. Symptoms include abdominal pain, changed bowel movements with episodes of constipation and diarrhea, bloating and changed frequency of bowel movements. Although the actual cause of IBS remains unknown till this time, studies suggest that stress can trigger it. For mild to moderate cases, change in diet and lifestyle is suggested to prevent the symptoms. If symptoms are severe, medical intervention can be considered in which case treatment of symptoms will be done.
- Inflammatory bowel disease, IBD
This is also a common cause of abdominal pain and involves two variants: Ulcerative colitis and Crohn’s disease. It is defined as a chronic inflammation of GI tract, where in ulcerative colitis mainly large intestine and rectum is involved while as crohn’s disease can affect any region of GI tract from mouth till anus. What causes IBD is not known however a faulty and overactive immune system is thought be behind this disease, where genetics may be playing an important role.
Symptoms of IBD include diarrhea, abdominal pain, blood tinged stools or bleeding rectum, loss of weight and weakness. These symptoms are very similar to IBS and one can easily confuse the two, however, IBS is not associated with inflammation and tissue damage as seen in IBD.
IBD treatment includes use of steroids to lower the immune response of body to reduce the damage caused by it.
Pain in the epigastric area
Epigastrium is the area just below the xiphoid process of sternum. It mainly consists of stomach, distil part of esophagus, pancreas and part of liver and small intestine.
- Gastro esophageal reflux disease, GERD
GERD is a common cause of epigastric pain. It is a condition in which stomach acid refluxes or is pushed in a retrograde fashion into the esophagus, causing discomfort due to the irritation of esophageal lining by the acid. The symptoms of GERD include chronic heartburn, nausea, sour taste in mouth and even bad breath. These symptoms worsen after a meal and when lying down.
It occurs due to improper functioning of lower esophageal sphincter (LES) whose primary function is to prevent backflow of gastric contents into the esophagus. Factors that play role in this malfunctioning of LES include obesity, pregnancy, smoking, hiatal hernia, connective tissue disease such as scleroderma, severe vomiting that can damage LES etc.
Treatment for GERD involves making changes in diet and lifestyle. And if this does not help antacids, proton pump inhibitors and H2 blockers are used to relieve the symptoms.
GERD is a potent risk factor for Barrett’s esophagus which itself sets the ground for esophageal cancer. Hence, it should not be taken lightly and you should ask professional help if you think you have signs of GERD.
- Stomach related conditions
Stomach is the main organ located in epigastric region. Diseases associated with stomach that can cause pain in epigastrium are:
Gastric ulcers: Helicobacter pylori and excess use of NSAIDS such as Ibuprofen are common causes of gastric ulcer. It manifests as burning pain in the epigastrium which is relieved after a meal.
Gastritis: Same H.pylori, that causes gastric ulcers, can cause inflammation of the inner membrane that lines the stomach. Spicy foods, too much alcohol intake, smoking and chronic use of NSAIDS can also cause gastritis. Symptoms can either mimic ulcers or may not be present at all.
Gastroparesis: In this condition there is delayed emptying of food from the stomach. It occurs due damaged nerves around the antrum of stomach especially in people with chronic diabetes. Other causes may involve a viral infection or injured vagus nerve during a surgery etc. Symptoms are same as gastric ulcers and GERD, due to which it can be misdiagnosed.
- Acute Pancreatitis
It is the sudden inflammation of pancreas due its own digestive enzymes and the most common cause of this condition are gallstones and alcohol use.
Gallstones can migrate from gallbladder and obstruct common bile duct. Generally this blockade does not last long and thus does not cause any serious damage. However, if it persists, pancreatic enzymes accumulate and start digesting pancreatic tissue, which triggers its inflammation.
Mechanism involved in alcohol associated pancreatitis is not known but around 30 percent of acute pancreatitis occurs due to alcohol use.
Symptoms are intense stabbing pain that radiates to the back, worsens with eating or lying down and is progressive.
Treatment involves fluid infusion and pain relief. Endoscopic or surgical removal of obstruction may also be considered in severe cases.
Persistent acute pancreatitis can give rise to more prolonged condition such as chronic pancreatitis. Symptoms include abdominal pain, weight loss and fatty and smelly stool or steatorrhea. Complications of chronic pancreatitis are diabetes and pancreatic cancer.
Pain in the right and left upper quadrants of abdomen
Right upper quadrant
It consists of mainly liver, gallbladder, duodenum, part of pancreas and some portion of right kidney.
Gallbladder
- Cholilithiasis or gallstones and biliary colic
Gallstones are cholesterol stones made in the gallbladder. These do not cause any symptom as such unless they obstruct any duct such as bile duct, common bile duct, or pancreatic duct. This obstruction causes a colicky pain in the upper abdomen, which is sudden and rapidly intensifying. Pain may also radiate to back, between the scapulas or to the right shoulder.
Obesity, high cholesterol diet, age above 40 and being a female are some of the important risk factors of gallstones. Symptomatic gallstones may need surgical removal of gallbladder (cholecystectomy).
- Acute cholecystitis: In this disease the gallbladder is inflamed after the gallstones obstruct and block the main opening of gallbladder, cystic duct. As a result of this obstruction pressure within the gallbladder increases, triggering secretion of inflammatory enzymes and thus causing cholecystitis. Symptoms include right upper quadrant pain that radiates to back, nausea, vomiting and fever. Treatment includes controlling inflammation, infusing fluid and pain management. Surgery may be needed it obstruction is severe.
- Acute cholangitis: When bile stones obstruct common bile duct, stasis of bile and other biliary contents create a favorable condition for bacterial growth, leading to infection known as acute cholangitis. Fever, jaundice and right upper quadrant pain together comprise the Charcot’s triad that is suggestive of acute cholangitis. Treatments include broad spectrum antibiotic use.
Some other causes of right upper quadrant pain includes acute hepatitis where swollen, inflamed and thus enlarged liver, stretches the Glison capsule around it, causing pain; liver abscess that are cavities filled with pus, caused due to infection after a trauma or illness.
Right kidney stone can also present with pain in right upper quadrant (however, it is more specifically located in the flank area.)
Left upper quadrant
Major organ in this area is the spleen. It also contains parts of colon, pancreas and left kidney.
Spleenomegaly and spleenic infarction are some important diagnosis if someone has pain in this area.
Also, pancreatitis, gastric ulcer, gastritis and even a kidney stone may present with pain in this area.
After a long list of causes mentioned here, I hope I was able to point some of the important causes of upper belly pain. It is important that we remain vigilant when our body is trying to communicate with us using the “pain language”. Pain is very important so far our well being is concerned as it indicates that something is not right and that our body needs care and treatment.
Pain in the upper regions of belly button can be due to a diverse number of causes, most of which are mild and show spontaneous recovery while some may need medical intervention. Thus, a general information of all of prominent causes can help you understand what your body is trying to tell you and thus act accordingly.
Also, unhealthy diet and unhealthy lifestyle that includes lack of exercise, smoking and too much weight are risk factors of almost all major diseases. It is very important that we change our lifestyle in order to prevent these diseases and live a happy and healthy life!