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Forum Name: Gastroenterology Topics

Question: Sneezing causes sharp upper right abdominal pain


 scotthorn22 - Fri Jun 11, 2010 8:22 pm

I ate a fairly large meal today, and within 30 minutes, I sneezed. Right away I felt a sharp, shooting pain in my upper right abdominal area that lasted for 20-30 seconds. I stood up and bent over to try to ease the pain. In the past, these pains have lasted for around 10 seconds (have had them for at least 2 years). On all prior occasions, I have just remained still and waited for the pain to subside.

I probably sneeze about twice a day, and these pains happen maybe once every 3-4 weeks, so they are infrequent. Today's was the worst of them all, and it almost feels like a muscle cramp. I sneezed a few hours later today (somewhat focusing on that area) and had no pain.

I have Googled these symptoms, and I am beginning to think that the painful sneezes occur after eating large meals. In other words: large meal + big sneeze soon after = sharp abdominal pain.

I don't have medical coverage right now, so going to a doctor or hospital is not an option unless my life is in danger. Any thoughts as to what could be causing these infrequent, sharp, upper right, abdominal pains that feel like muscle cramps, last 10-30 seconds and are triggered by sneezing?

Thank you!
 Dr.M.Aroon kamath - Fri Jul 09, 2010 1:23 am

User avatar Hi,
I note from your profile that you had undergone spinal fusion surgery (T6-T12) in 2003- details of the events leading to the surgery and details of the surgical procedure(approach,type of fixation etc) are unfortunately missing.

This past history certainly would lead one to first consider your symptoms as sequelae of this prior surgery and the trauma that lead to it.

The trauma to your spine (T6-T12) was in the vicinity of the lower thoracic spinal nerves (which in turn give rise to the lower intercostal nerves).

The 7th intercostal nerve terminates at the level of the xyphoid process of the sternum. The 10th intercostal nerve terminates at the level of the umbilicus. The twelfth (subcostal) thoracic is distributed to the abdominal wall below the umbilicus and groin.

Thus, your trauma and the surgery that followed had the potential for adversely affecting the lower intercostal nerves.

As your symptoms started about 2 years back (ie, 5 years following the trauma),is likely that another factor(of a more recent onset) has precipitated these episodes of pain.

Following any spinal trauma/spinal surgery, "stabilization" of the area occurs- ie, healing of the soft tissues(ligaments,muscles etc) apart from bony union.This seems to have gone on satisfactorily in your case, as you were almost asymptomatic for nearly 5 years post-surgery.

Some of the aggravating factors could be,
- on-going age related spondylitic changes causing spurs.
- a minor trauma which had been overlooked,
- muscle strain, partial muscle tear and
- postural.

There is another entity unconnected to the past trauma which is capable of producing similar pains is,
- Chronic abdominal wall pain: frequently unrecognized or confused with visceral pain. Often leads to extensive, expensive and futile search for a visceral cause. It is believed to be an "entrapment neuropathy" involving the lower(T 7-T 12) intercostal nerves. After coursing in between the abdominal wall muscles, these make an acute turn (90º)and pass through the posterior sheath of the rectus abdominis muscle through a fibrous opening and then via its anterior sheath.It has been postulated that the nerve compression occurs during its course through the rectus sheath.the nerve may also get entrapped in scar tissue( a neighbouring scar of previous surgery).

Pain is always very localized (patients tend to point out the site of pain with a finger tip). Acts such as coughing , stretching, standing, and lifting, tend to worsen the pain. Other things such as bloating, overeating, nausea, and menstruation can aggravate the pain worse by causing vascular congestion leading to further nerve compression.

Diagnostic clinical test is the Carnett’s test: demonstrated by palpating the tender spot in the prone relaxed patient and looking for continuing or often increased tenderness as the patient is asked to tense the abdominal wall by elevating the head and shoulders or raising their legs (positive test). If the pain is visceral, the pain is relieved (negative test), as the muscle guarding protects the viscera.
You need to see your orthopedic surgeon for a full assessment.
Good luck!

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