From the Guidelines
Steroids can cause abdominal cramping as a side effect, particularly during withdrawal, as evidenced by corticosteroid withdrawal syndrome which can present with abdominal pain among other symptoms. This condition is under-recognized, occurring in about half of patients tested immediately after withdrawal of medium- or high-dose prednisolone used for long periods 1. The syndrome can mimic the underlying disease and includes symptoms such as weakness, fatigue, loss of appetite, weight loss, nausea and vomiting, diarrhea, and abdominal pain.
When considering the management of patients on steroids, it's crucial to assess for osteoporosis risk factors and consider preventive measures such as calcium and vitamin D supplementation, as well as bisphosphonate therapy in high-risk patients 1. However, the primary concern regarding abdominal cramping is the potential for corticosteroid withdrawal syndrome and gastrointestinal irritation, especially when steroids are taken without food.
To minimize discomfort from abdominal cramping, patients are advised to take steroids with meals and maintain adequate hydration. In cases where potassium levels are low, potassium supplements might be recommended by a healthcare provider. The risk of abdominal cramping increases with higher doses and longer treatment durations of steroids. If severe or persistent abdominal pain occurs, it is essential to contact a healthcare provider, as this could indicate more serious complications requiring medical attention.
Key considerations for managing abdominal cramping in patients on steroids include:
- Taking steroids with food to reduce gastrointestinal irritation
- Maintaining adequate hydration
- Following prescribed dosing schedules
- Monitoring for and managing potassium depletion
- Being aware of the signs of corticosteroid withdrawal syndrome and seeking medical attention if symptoms persist or worsen.
From the Research
Abdominal Cramping and Steroids
- Abdominal cramping can be a symptom associated with steroid use, as evidenced by studies on the effects of steroids on the gastrointestinal system 2, 3, 4.
- High-dose steroid therapy can decrease the clinical expression of peritonitis, leading to delayed recognition and treatment of gastrointestinal perforation, which can cause abdominal cramping 2.
- In patients with Crohn's disease, high-dose steroids can be effective in reducing abdominal masses, but may also increase the risk of postoperative complications, including infectious complications 3, 4.
- Anabolic steroid use has been linked to various gastrointestinal side effects, including abdominal cramping, as well as more severe complications such as hepatotoxicity and renal failure 5, 6.
- A case study of a bodybuilder using steroids reported muscle cramps as a symptom of rhabdomyolysis, a serious condition that can cause abdominal cramping 6.
Key Findings
- Steroid use can increase the risk of postoperative complications, including abdominal cramping, in patients with inflammatory bowel disease 4.
- High-dose steroid therapy can mask symptoms of gastrointestinal perforation, leading to delayed treatment and increased mortality 2.
- Anabolic steroid use can cause a range of gastrointestinal side effects, including abdominal cramping, and more severe complications such as hepatotoxicity and renal failure 5, 6.