Pain of the Abdominal Wall (Shingles). As in the chest, shingles pain may suddenly appear in the abdominal wall. The typical burning pain is often thought to be appendicitis or other internal disease. The appearance of the rash along the painfully involved nerve route makes identity of the pain obvious.

Lower Abdominal Pain. Abdominal pain below the umbilicus, in later life, will generally be due to the colon, appendix, ovary, uterus, bladder and hernia. Pain and discomfort due to

Lower abdomen

Fig. 99. The lower abdomen is below the umbilicus down to the groin. Difficulties here include hernia, appendicitis, colon disease and troubles with the urinary tract.

the menstrual cycle, of course, are no longer present after the change of life.

Pain of the Colon and Intestinal Tract. Pain from the large and small intestine is identified by the cramp, a pain felt every few minutes-the typical pain of intestinal origin. Often called gas pains, it ranges from slight discomfort to severe anguish, with a measure of relief in between cramps. These pains are felt below the umbilicus and above the groin and will be readily identified as pain of the intestine when the characteristic cramping is remembered.

Appendicitis produces discomfort more than real pain when it begins. It is felt about the umbilicus and is nearly always accompanied by nausea and vomiting. After a short time (8-12 hours), the pain moves into the right side, fairly low in the abdomen and eventually, a soreness of the right lower abdomen predominates. If the abdomen is pushed inward, even lightly, considerable pain will be felt directly over the inflamed appendix. In younger years, appendicitis is not so difficult to identify, but in later years, when it is not so common, the pain of appendicitis is harder to identify.

Pain of the Female Organs. Pain in diseases of the main portion of the uterus is felt in the lower abdomen, down the inner surface of the legs and, at times, in the lower back. It is quite variable. The ovary, at fifty years of age, may be the site of severe pain but variability of the pain (in the female only), is very great and can be interpreted only by the physician.

Urinary Bladder Pain. Bladder pain is felt when the bladder is over-stretched with urine. This pain begins as a distressful fulness and proceeds to extreme pain when the bladder cannot be emptied. Tapping over the bladder region (low in the abdomen) is very painful, and welcome relief is obtained when the bladder finally is emptied. Another bladder pain is experienced when the inside wall is irritated and inflamed (cystitis). As the bladder in this condition empties itself, the irritated walls touch each other to cause a brief knife-like pain.

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