Abdominal Cramping

Abdominal cramping is one of the most common gastrointestinal complaints in primary care, yet it is a symptom rather than a disease. The history does the diagnostic work: colicky periumbilical pain relieved by defecation suggests IBS; cramping with bloating after dairy suggests lactose intolerance; cyclical lower abdominal pain suggests dysmenorrhea; cramping with distension and obstipation raises the red flag of obstruction. The Rome IV criteria define IBS as recurrent abdominal pain at least one day per week over three months, associated with defecation or a change in stool frequency or form.\n\nEvidence-based management depends on subtype. Antispasmodics such as hyoscine and peppermint oil (enteric-coated, 0.2–0.4 mL) have consistent RCT support for IBS-type cramping, with peppermint oil meta-analyses showing roughly 40% relative improvement over placebo. Soluble fiber (psyllium) helps; insoluble bran can worsen cramping. A low-FODMAP diet produces meaningful symptom relief in about 50–70% of IBS patients in short-term trials, though long-term restriction carries microbiome and nutrition costs.\n\nAlarm features — unintentional weight loss, rectal bleeding, nocturnal pain, anemia, fever, new symptoms after age 50 — mandate investigation rather than empiric treatment. For functional cramping without alarm features, a stepwise approach of dietary adjustment, antispasmodics, and gut-directed psychological therapies covers the evidence base; supplements play a supporting, not central, role.

• •Cramping or colicky abdominal pain
• •Bloating and distension
• •Pain relieved or worsened by defecation
• •Altered stool frequency or form
• •Post-meal urgency
• •Cyclical pain with menses (gynecologic cramping)

• •Irritable bowel syndrome (visceral hypersensitivity)
• •Gas and fermentation of FODMAP carbohydrates
• •Constipation
• •Lactose or fructose intolerance
• •Dysmenorrhea or endometriosis
• •Gastroenteritis
• •Obstruction, IBD, or celiac disease (less common, higher stakes)