Duration Health — Field Guide: Abdominal

Abdominal pain

Nausea, vomiting and diarrhea

Introduction

Abdominal pain, nausea and vomiting, and diarrhea are common complaints of travelers and adventurers and frequently occur together. Most of the time, these symptoms are due to benign causes like gas, acid reflux, viral illness, or food poisoning. Sometimes, you can get a bacterial infection of the gut that can be more severe or prolonged and may require antibiotic treatment.

Seek immediate medical care for persistent, unrelenting or severe abdominal pain lasting more than a few hours. Seek immediate medical care for vomiting that does not improve with medication or results in the inability to drink any fluids/maintain hydration. Seek immediate medical care for high fever and/or bloody diarrhea or diarrhea with mucus.

Upper abdominal pain, especially with symptoms such as shortness of breath or sweating, could be signs of a heart problem. Seek medical attention immediately. See the Chest Pain section for more detail.

Treatment

Abdominal Pain

If you have mild upper abdominal pain, heart burn or sour stomach, consider taking famotidine (generic for Pepcid®).

Nausea/Vomiting

For nausea and vomiting due to motion or sea sickness, consider taking meclizine (generic for Dramamine® Non-Drowsy) or dimenhyDRINATE (generic for Dramamine®). Scopolamine is a patch that is worn behind the ear to decrease the symptoms of motion sickness. Apply one patch to the hairless area behind one ear at least 4 hours before anti-nausea and anti-dizziness effect is required, for use up to 3 days. If you have nausea or vomiting due to another cause or the medications listed above do not work for sea/motion sickness, consider taking ondansetron. If you are vomiting and become dehydrated, use oral rehydration solution, which may hydrate the body better than water alone. Even if you are vomiting, the body will likely absorb some of the solution, helping to improve hydration.

Abdominal pain with nausea and vomiting without diarrhea is concerning and may indicate a more serious cause of your symptoms.

Diarrhea

If you have ongoing diarrhea, you may consider using oral rehydration solution to help maintain your hydration. If you have persistent diarrhea and abdominal cramping, loperamide (generic for Imodium®) or bismuth subsalicylate (generic for Pepto-Bismol®) can provide some relief of these symptoms. If you are traveling internationally and diarrhea is persistent, associated with fever, or associated with blood or mucus in the stool, you may have an infection for which antibiotics may be indicated. Consider taking azithromycin or a fluoroquinolone antibiotic, such as ciprofloxacin or levofloxacin. It is usually acceptable to take loperamide (generic for Imodium®) along with an antibiotic for control of symptoms, except in the case of fever and severe bloody diarrhea, in which case antibiotics should be taken alone. Diarrhea within the USA does not typically require antibiotic treatment.

When To Worry

Seek immediate medical care if you have any of the following:

  • worsening abdominal pain
  • pain in right lower abdomen
  • fever
  • severe nausea/vomiting
  • inability to drink fluids
  • decreased urination
  • severely decreased or absent bowel movements
  • blood in stool
  • lightheadedness, dizziness, fainting
  • abdominal pain when you are pregnant or there is a chance you could be pregnant

Quick Guide

If you have

  • abdominal pain or burning
  • sour stomach
  • increased belching

You may have

acid reflux

Consider using

bismuth subsalicylate (generic for Pepto-Bismol®) 2 tablets by mouth every 30-60 minutes as needed, do not exceed 16 tablets in 24 hours

OR

famotidine (generic for Pepcid®) 20 mg twice a day as needed

If you have

  • mildly decreased bowel movements

You may have

constipation

Consider using

docusate (generic for Colace®) 100 mg to 300 mg by mouth each day

OR

senna (generic for Senokot®) 1-2 tablets by mouth each day

If you have

  • motion sickness with nausea or vomiting

You may have

motion sickness

Consider using

meclizine (generic for Dramamine® Non-Drowsy) 25 mg or 50 mg, every 24 hours

OR

scopolamine 1 mg patch behind ear 12 hours before anticipated exposure to motion, then every 3 days as needed

OR

dimenhyDRINATE (generic for Dramamine®) 50 mg every 4-6 hours

If you have

  • nausea
  • vomiting
  • mild upper abdominal pain/cramping

You may have

gastroenteritis

Consider using

ondansetron (generic for Zofran®) 4 mg every 8 hours as needed

OR

Pediatrics

For children age 17 and under

ondansetron can be used at adult doses over age 4; consult a physician for children under 4.

See also: Pediatrics

If you have

  • NO fever
  • watery diarrhea without blood/mucus
  • abdominal cramping with or without vomiting

You may have

gastroenteritis

Consider using

for mild to moderate symptoms: loperamide (generic for Imodium®) 4 mg every 6 hours as needed (do not take for more than 2 days)

OR

bismuth subsalicylate (generic for Pepto-Bismol®) 2-4 caplets every hour as needed. Do not exceed 8 caplets in 24 hours. Use until diarrhea stops but not more than 2 days.

for moderate symptoms: azithromycin 500 mg daily for 3 days

and seek emergency medical care

OR

Pediatrics

For children age 17 and under

loperamide may be dosed according to bottle directions for children, but must be avoided if fever, abdominal pain, bloody, or mucousy stools are present

bismuth subsalicylate (Pepto-Bismol®) is not for use in children.

See also: Pediatrics

If you have

  • fever >100.4 degrees
  • diarrhea with streaks of blood or mucus
  • abdominal cramping with or without vomiting

You may have

infectious diarrhea

Consider using

for mild to moderate symptoms: azithromycin 500 mg daily for 3 days

OR

for severe symptoms: ciprofloxacin 500 mg twice a day for 5 days PLUS metroNIDAZOLE 500 mg three times a day for 5 days

and seek emergency medical care

OR

Pediatrics

For children age 17 and under

azithromycin for traveler’s diarrhea 10 mg/kg daily for 3 days; maximum 500 mg per day

metroNIDAZOLE may be used only at the direction of a physician

ciprofloxacin is not for use in children

See also: Pediatrics

If you have any one of

  • worsening abdominal pain
  • pain in right lower abdomen
  • inability to drink fluids
  • decreased urination
  • decreased or absent bowel movements
  • blood in stool
  • lightheadedness, dizziness, fainting
  • confusion or change in mental status
  • are pregnant or concerned you might be pregnant

You may have

appendicitis or bowel obstruction or dehydration or sepsis or other emergency

You should

seek emergency medical care

Reference

ciprofloxacin

Ciprofloxacin (generic for Cipro) is a fluoroquinolone antibiotic. It can be used to treat infections in the abdomen. Consider ciprofloxacin for diarrhea with blood or mucous. Ciprofloxacin can be taken with ondansetron, if nausea and/or vomiting accompany abdominal pain or diarrhea. Do not take ciprofloxacin with dairy products such as milk or yogurt, or with calcium-fortified juice. Ciprofloxacin is also used to treat other infections, for example, skin infections, sinus infections, urinary tract infections, and infections with some bioterrorism agents including anthrax.

Prescription only

InfectionMedication

Oral rehydration solution (Pedialyte®)

Oral rehydration solution is a mixture of water, sugar, and salt that hydrates faster than water alone. Oral rehydration solutions are used in the developing world to treat severe dehydration, and have been shown in some cases to be just as effective as intravenous fluids in restoring hydration.

GeneralDisposable

ondansetron

Ondansetron (generic for Zofran) is an anti-nausea medication, and prevents nausea and vomiting. It's in a class of medications called 5-HT3 antagonists that work by tricking the nausea centers in the brain. Ondansetron can be used to treat the symptoms of nausea and vomiting from non-serious causes, such as food poisoning, as well as more serious causes.

Prescription only

GeneralMedication

metroNIDAZOLE

Metronidazole (generic for Flagyl) is an antiprotozoal and antibiotic, which means it fights bacteria as well as other organisms that cause disease. Metronidazole can be used to treat infections in the abdomen.

Prescription only

InfectionMedication

azithromycin

Azithromycin is an antibiotic. Azithromycin can be used to treat respiratory infections like pneumonia, abdominal infections, ear infections, throat infections, and other infections. It is often used in place of penicillin drugs in people with a penicillin allergy. It has a longer duration of action than other antibiotics, so it is usually given for a shorter course of therapy.

Prescription only

InfectionMedication

azithromycin pediatric

Azithromycin is an antibiotic. Azithromycin can be used to treat respiratory infections like pneumonia, abdominal infections, ear infections, throat infections, and other infections. It is often used in place of penicillin drugs in people with a penicillin allergy. It has a longer duration of action than other antibiotics, so it is usually given for a shorter course of therapy.

Prescription only

InfectionMedication

azithromycin suspension

Azithromycin is an antibiotic. Azithromycin can be used to treat respiratory infections like pneumonia, abdominal infections, ear infections, throat infections, and other infections. It is often used in place of penicillin drugs in people with a penicillin allergy. It has a longer duration of action than other antibiotics, so it is usually given for a shorter course of therapy.

Prescription only

InfectionMedication

famotidine

Famotidine (generic for Pepcid) is used to treat gastritis (pain or burning in the stomach area) and sometimes used with other medications to treat allergic reactions.

GeneralMedication

meclizine

Meclizine (generic for Dramamine Non-Drowsy) is used to treat dizziness (vertigo).

TravelMedication

scopolamine

Scopolamine is a patch that is worn behind the ear to decrease the symptoms of motion sickness. Apply one patch to the hairless area behind one ear at least 4 hours before anti-nausea and anti-dizziness effect is required, for use up to 3 days. If therapy for more than 3 days is required, remove the first patch and apply a new patch behind the other ear.

Prescription only

TravelMedication

docusate

Docusate (generic for Colace) is a stool softener used to treat constipation. It generally results in a bowel movement in 12 to 72 hours.

GeneralMedication

senna

Senna (generic for Senokot) is a laxative used to treat constipation. It generally results in a bowel movement in 6-12 hours.

GeneralMedication

bismuth subsalicylate

Bismuth subsalicylate (generic for Pepto-Bismol) is used to treat upset stomach and diarrhea.

GeneralMedication

loperamide

Loperamide (generic for Imodium) is an anti-diarrheal medication. It treats diarrhea by slowing movement through the gut. Loperamide can be used for the treatment of acute diarrhea, particularly from an infection.

GeneralMedication

dimenhyDRINATE

Dimenhydrinate (generic for Dramamine, generic for Driminate) is used to treat and prevent motion sickness.

TravelMedication

loperamide blisterpack

Loperamide (generic for Imodium) is an anti-diarrheal medication. It treats diarrhea by slowing movement through the gut. Loperamide can be used for the treatment of acute diarrhea, particularly from an infection.

GeneralMedication

dimenhyDRINATE blisterpack

Dimenhydrinate (generic for Dramamine, generic for Driminate) is used to treat and prevent motion sickness.

TravelMedication

ondansetron pediatric

Ondansetron (generic for Zofran) is an anti-nausea medication, and prevents nausea and vomiting. It's in a class of medications called 5-HT3 antagonists that work by tricking the nausea centers in the brain. Ondansetron can be used to treat the symptoms of nausea and vomiting from non-serious causes, such as food poisoning, as well as more serious causes.

Prescription only

GeneralMedication

loperamide pack

Loperamide (generic for Imodium) is an anti-diarrheal medication. It treats diarrhea by slowing movement through the gut. Loperamide can be used for the treatment of acute diarrhea, particularly from an infection.

GeneralMedication

rifaximin

Rifaximin is an antibiotic used to treat E. coli associated traveler's diarrhea.

Prescription only

TravelMedication

tinidazole

Tinidazole is an antiparasitic used to treat infections caused by amoebas, giardia and trichomonas.

Prescription only

TravelMedication

albendazole

Albendazole is an antiparasitic used to treat infections caused by tapeworms, hookworms, pinworms and longworms. It works by killing the worms present in the gastrointestinal tract.

Prescription only

TravelMedication

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