COVID-19 can manifest with a diverse range of symptoms affecting various parts of the body. Gastrointestinal issues, including abdominal pain, are increasingly acknowledged as a presentation of the illness.
The Link Between COVID-19 and Abdominal Pain
Abdominal pain is a documented symptom of COVID-19, with its reported incidence varying across studies, ranging from approximately 0.3% to 25% of patients. In some cases, abdominal pain can be among the first or even the sole symptom experienced by an individual with COVID-19.
The character of this pain can differ significantly among individuals. It may present as a general discomfort, sharp localized pains, or cramping sensations reminiscent of a common stomach bug. The location of the pain can also vary, with reports of discomfort in the right upper quadrant, epigastric region, or a more diffuse or generalized abdominal ache.
Biological Causes of Abdominal Pain in COVID-19
The SARS-CoV-2 virus primarily gains entry into human cells by binding to angiotensin-converting enzyme 2 (ACE2) receptors. These receptors are not only abundant in the respiratory tract but are also highly expressed throughout the gastrointestinal tract, particularly in the epithelial cells of the small and large intestines, including the ileum, duodenum, and colon. This widespread presence allows the virus to directly infect the lining of the gut.
Direct viral infection of intestinal cells can lead to localized inflammation and cellular damage, contributing to abdominal pain. Evidence of viral RNA in stool samples further supports the gut as a site of viral activity. Beyond direct cellular invasion, the body’s systemic inflammatory response to the virus can also play a role in generating abdominal discomfort. This response involves inflammatory mediators that can lead to widespread inflammation throughout the body, potentially affecting gastrointestinal organs and contributing to generalized pain.
Associated Gastrointestinal Symptoms
Abdominal pain often appears alongside other gastrointestinal symptoms in individuals with COVID-19, providing a more complete picture of the digestive system’s involvement. Diarrhea is a frequently reported companion symptom, with its prevalence ranging widely, from about 2% to 50% of patients. This can vary in severity and duration.
Nausea and vomiting are also commonly observed, affecting approximately 1% to 27.5% and 1% to 15.4% of patients, respectively. Another prominent symptom is loss of appetite, or anorexia, reported in a significant portion of patients, ranging from about 26.8% to 50%. These symptoms collectively indicate the broad impact of the virus on the digestive system.
Management and When to Seek Medical Attention
For mild abdominal pain associated with COVID-19, at-home management focuses on supportive care to alleviate discomfort. Staying well-hydrated by drinking plenty of fluids is important, as is consuming bland foods that are easy on the stomach, such as those included in the BRAT diet (bananas, rice, applesauce, toast). Rest also plays a role in recovery, and over-the-counter pain relievers or antacids may help manage symptoms.
Seek medical attention if abdominal pain or associated symptoms worsen. Immediate evaluation is needed for:
- Severe or rapidly worsening abdominal pain.
- A high fever.
- Inability to keep fluids down, which can lead to dehydration. Signs of dehydration include dark urine, extreme weakness, a dry mouth and tongue, or dizziness.
Other concerning symptoms include:
- Bloody or black diarrhea.
- Yellowing of the skin or eyes.
- Chest pain.
- Difficulty breathing.
For children, seek medical attention for:
- Persistent fever for four or more days.
- Difficulty feeding.
- Any change in skin color.