Learn more about what might be causing the cramps, how you can treat them, and when you should contact your doctor.

Causes of Stomach Pain in People Who Have EPI

Stomach pain may sometimes stem from the cause of your EPI rather than the condition itself, says Joshua S. Forman, MD, a gastroenterologist at the University of Maryland St. Joseph Medical Center in Towson. For example, chronic pancreatitis, certain other pancreatic conditions, and surgery involving the pancreas, stomach, or intestines can all cause abdominal pain. But stomach pain can also be caused by EPI itself. “The inability to break down the nutrients in the food you consume can result in the development of bloating and gas,” Dr. Forman says, “which can cause abdominal discomfort and pain.” It can be difficult to determine whether your pain is a symptom of EPI or related to its cause, says Dhiraj Yadav, MD, a gastroenterologist at the University of Pittsburgh Medical Center. If you consistently experience abdominal pain after eating — with or without bloating, cramping, diarrhea, or oily stools — he says, “You should definitely be talking to your doctor about what could be the cause.”

Adjusting Your EPI Treatment

A possible reason for your stomach pain and discomfort is that you aren’t taking your enzymes properly or your dose isn’t high enough. “People with EPI aren’t always properly educated on how to take pancreatic enzymes correctly,” Forman says. Don’t hesitate to ask your doctor for specific instructions, including whether you should take PERT before, during, and/or after a meal and how much of each dose you should take at which time. Even if you do this, you may still experience abdominal discomfort if your enzyme dose isn’t high enough. “A lot of people with EPI tend to be underdosed,” he says, which could lead to digestive pain and discomfort,” says Forman. According to Dr. Yadav, “This is the most common reason that people with EPI continue to have symptoms.” If you’re being treated for EPI but are still experiencing diarrhea or fatty stools in addition to cramping or stomach pain, talk with your doctor, who may decide to raise your dose of enzymes, notes Yadav. If your enzymes are increased and your abdominal pain subsides along with your other symptoms, he says, “This would be indirect evidence that the lower dosage was the cause of your symptoms.” But if your stomach pain continues after your enzyme dose is increased and other symptoms go away, Yadav says, your doctor should evaluate your condition to determine whether there’s another underlying issue that could be causing your cramps, such as inflammation in your pancreas or bacterial overgrowth in your gut.

While it’s important to determine the causes of your stomach pain, you also need to know what to do for the discomfort. To minimize and find relief from your symptoms, try these tips. Rethink your meal size and timing. “It’s important to eat smaller and more frequent meals,” Forman advises. This can ease the burden on your digestive system and allow your gastrointestinal system to digest more nutrients. Limit certain dietary fats. Since fat can be the most difficult nutrient to digest, it makes sense for people with EPI to avoid especially fatty, greasy foods. If you’re taking adequate doses of enzymes, though, Yadav says, you shouldn’t need to dramatically cut back on fat. Keep in mind that healthy fats help your body absorb fat-soluble vitamins (vitamins A, D, E, and K) that tend to be lacking in people with EPI. Drink plenty of fluids. “Good hydration is important for people with EPI,” Forman says, because it helps aid digestion and nutrient absorption. Try to drink most of your liquids in between meals — about 20 to 30 minutes after you eat — to increase the absorption of nutrients. Watch your fiber intake. “Eating too much fiber can increase bloating and gas,” Forman says, especially from legumes (such as beans, peas, and lentils) and cruciferous vegetables (such as Brussels sprouts, broccoli, and cabbage) as well as fruits (such as peaches, pears, and apples). Yadav adds that unless you suspect that fiber is causing your stomach problems, your fiber intake probably doesn’t need to be restricted. Eat easy-to-digest foods. Until your symptoms subside, stick to EPI-friendly foods, such as white rice and pasta, lean proteins (such as broiled white fish), and low-fiber fruits (such as fruit cocktail). Exercise. Staying active can help ease digestive problems. Aim for at least 30 minutes a day of moderate activity, such as walking or biking. Try natural, soothing remedies. Forman notes that natural remedies for stomach pain, such as a heating pad, and relaxation techniques, such as practicing deep breathing, massage, and gentle posing or stretching, may be helpful. Bonus: These practices have little to no risk of side effects. Forman adds that some people with EPI find that peppermint or chamomile tea also helps ease digestive discomfort. Ask your doctor about over-the-counter medications. A gas-relieving medication may be helpful for some people with stomach pain from EPI, Forman says. He adds that while over-the-counter pain relievers such as ibuprofen, naproxen, and acetaminophen are generally safe when used occasionally, it’s important not to take them regularly without your doctor’s approval. Overuse of some of these drugs can aggravate your digestive symptoms and potentially lead to stomach bleeding. Additional reporting by Colleen de Bellefonds