Abdominal Pain and Sickle Cell Disease

The most common symptom of sickle cell disease (SCD) is acute pain. Pain can affect any part of the body, but the abdomen is one of the most commonly affected areas. The abdomen includes organs located between the chest and groin.

Abdominal pain usually happens when sickle cells block blood flow and prevent oxygen delivery to the abdomen. The exact cause is often unknown, because many organ complications can cause pain in people with SCD.¹

Prevention of abdominal pain may involve treatments, transfusions, and hydration. Treatment depends on the exact cause, but usually includes drugs to help with pain.

What is abdominal pain?

Abdominal pain is pain that you feel anywhere between your chest and groin. It can feel like sharp cramps or aches. Inflammation or diseases that affect the organs in the abdomen cause abdominal pain. Major organs in the abdomen include:¹

• Appendix
• Gallbladder
• Intestines (small and large)
• Kidneys
• Liver
• Pancreas
• Spleen
• Stomach

There are a few types of abdominal pain, depending on the location of the pain and how often it occurs. Generalized pain is felt in more than half of the abdomen, and is usually caused by a virus or indigestion. Localized pain is felt in only 1 area of the abdomen, and is more likely to be a sign of a problem in an organ. Colicky pain starts and ends suddenly, and is often severe.¹

Abdominal pain is caused by many conditions. Common causes include:¹

• Acid reflux (heartburn/indigestion)
• Constipation or diarrhea
• Food poisoning
• Menstrual pain
• Stomach flu
• Stress
• Vomiting

Diseases that affect the digestive system can also cause abdominal pain. Some diseases that commonly cause abdominal pain include:¹

• Appendicitis
• Cancer of the stomach, colon, or other organs
• Crohn’s disease
• Irritable bowel syndrome
• Kidney stones
• Lactose intolerance
• Sickle cell disease

Why does sickle cell disease cause abdominal pain?

Acute pain crises are the most common cause of abdominal pain for people with SCD. They happen when sickled red blood cells block blood flow and prevent oxygen delivery to different parts of the body. Pain can happen anywhere in the body and in more than one spot at a time.²

The abdomen is a common area where people with SCD experience pain crises. The abdomen can be the only area affected, or it may cause generalized pain in other parts of the body.³

Abdominal pain is hard to manage because it can also be caused by other acute complications of SCD. In fact, a specific cause is rarely identified. Complications of SCD that may also cause abdominal pain include:^4,5

• Acute pancreatitis
• Gallstones
• Ischemic colitis
• Liver disease
• Splenic sequestration

Diagnosing the exact cause of abdominal pain may be helpful for treatment. Computed tomography (CT) and ultrasound exams may help evaluate abdominal organ function.⁴

How is abdominal pain prevented and treated?

Abdominal pain may be reduced by preventing acute pain crises. Some ways to prevent pain crises include:^2,4,6

• Avoiding extreme temperatures and high altitudes
• Chronic blood transfusions to reduce pain episodes and stroke
• Drinking plenty of water
• Treatment with the drug crizanlizumab-tmca
• Treatment with the drug hydroxyurea
• Vaccinations and antibiotics to prevent infections in children

Abdominal pain is first treated with hydration, pain medications, and other supportive measures. When symptoms worsen and doctors can diagnose specific organ failure, they may consider surgery.⁴

Blood transfusions may also help treat acute organ damage. Transfusing normal red blood cells in people with SCD reduces the percentage of sickle cells. This improves the ability of blood to carry oxygen around the body.⁴