It is a common problem for both children and adults but waking up with stomach pains can affect a person’s life especially when it repeatedly disturbs sleep. We use the term ‘stomach pain’ loosely to describe abdominal pain, but the stomach is a specific organ whereas the abdomen is a portion of the torso. Abdominal pain is a common symptom that most of us experience every now and then. However, when it is severe or recurrent then it needs to be investigated.
Stomach vs Abdomen Pain
The stomach is located in the left upper quadrant of the abdomen. It is tucked under the bottom part of the left ribcage and part of it extends across the upper middle portion of the abdomen. Change in position and distension of the stomach with food and drink can alter this location to a slight extent. However, there is a number of other organs in this abdominal quadrant including the left kidney, spleen, pancreas, portion of the liver and the intestines. Therefore it is difficult to isolate pain in the left upper quadrant as originating solely from the stomach.
Abdominal pain can be localized or diffuse, meaning that it occurs in one specific region or is experienced somewhat to the same level throughout the abdomen. It is often difficult to isolate the exact region of the pain when it is diffuse and this can sometimes complicate the diagnosis if no other symptoms are present. Often the cause of abdominal pain cannot be identified but it is usually not a cause for concern if it it is temporary and does not tend to recur.
Why does stomach pain occur at night?
There are a number of reasons why stomach pain or abdominal pain may occur at night or worsen at night. In some instances it may be related to the time of the day but other factors like position, lifestyle and dietary factors can also contribute to nighttime stomach pain. Irrespective of the location or time of day, pain is a symptom and occurs as a result of some underlying cause. It is this cause that needs to be identified and that exacerbation or onset of pain at night can be a helpful indicator of a possible cause.
Most of the causes of nighttime abdominal pain are usually related to the digestive system. The abdominal cavity is filled primarily with the organs of the digestive system but furthermore the digestive organs are more likely to undergo changes with position and time of day that will make pain more likely to arise. Understanding the interplay of these various factors is therefore important to firstly diagnosing the possible cause and secondly to taking measures that can reduce nighttime pain and prevent sleep disruption.
Increased stomach acid
The stomach acid increase around the early parts of the morning and it is therefore not uncommon that conditions which may be caused by or aggravated by more stomach acid will therefore cause more intense symptoms at night.
Lying flat when sleeping can allow movement of organs and secretions that were otherwise pulled downwards by gravity while standing, sitting or moving around. Conditions worsened by upward movement will therefore present more prominently while lying flat.
Slow bowel motility
The movement through the bowels slow down at night due to the reduced nerve stimulation of the tiny muscles in the bowel gut. It is further slowed by the lack of movement. Conditions that are eased with greater bowel motility will therefore aggravate during sleep.
Causes of Nighttime Stomach Pain
Nighttime stomach pain should be correlated with other symptoms to help identify the cause. Most of the time it is due to upper digestive conditions so accompanying symptoms may include nausea, vomiting, regurgitation, heartburn, excessive belching and changes in appetite. The three most likely causes of abdominal pain worse at night includes gastritis, peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD) also known commonly as acid reflux.
- Gastritis is a common stomach disorder where the stomach walls become inflamed. It is often due to H.pylori infection and the excessive use of NSAIDs. There is a typical gnawing stomach pain along with other symptoms often described as indigestion. The symptoms may worsen with eating and hunger.
- Peptic ulcer disease is another common stomach and intestinal condition. Open sores (ulcers) form in the wall of the stomach and also the first part of the small intestine known as the duodenum. It may arise as a complication of severe or long standing gastritis and therefore be due to the same causes. The symptoms are also very similar.
- Gastroesophageal reflux disease (GERD) is an esophageal condition where the esophagus becomes inflamed due to the backward flow of stomach acid from the stomach into the esophagus. It is mainly due to a weakened lower esophageal sphincter (LES). The typical symptom is heartburn, nausea and regurgitation.
Other conditions where nighttime stomach pain may also occur includes:
- Hiatal hernia where a portion of the stomach slips through the esophageal opening in the diaphragm into the thoracic (chest) cavity. This protrusion is only partial. Lying flat can aggravate it as the effect of gravity is negated.
- Abdominal migraines is a condition mainly seen in children. Abdominal pains occur for no known reasons and it tends to worsen at night. There is a link with a family history of migraine headaches.
- Cyclic vomiting syndrome is another condition that occurs predominantly in children. There are episodes of vomiting for no clearly identifiable reason and abdominal migraines may also be present.
There are a host of other conditions that also need to be considered when attempting to diagnose nighttime stomach pain. These conditions include:
- Inflammatory bowel disease
- Irritable bowel syndrome
Many of these conditions aggravate with the consumption of spicy foods, alcohol, caffeinated beverages and other foods. If these foods or beverages are consumed late at night, either for dinner or as a pre-bedtime snack then it is more likely to lead to nighttime abdominal pain and affect sleep patterns. Strenuous physical activity involving the abdominal muscles can also cause pain that may be more prominent when at rest like during sleep time.