Abdominal Pain

You may think of the abdomen as the stomach and the rest of the digestive system—liver, gallbladder, pancreas, intestines—but there are many other organs, including the appendix, bladder, kidneys, numerous blood vessels, and parts of the reproductive system. So abdominal pain may accompany many other types of symptoms, depending on the underlying cause and the organ(s) involved.

Abdominal pain may accompany other symptoms affecting the digestive tract including:

• Belching

• Change in bowel habits

• Diarrhea

• Flatulence

• Gas

• Indigestion

• Nausea

• Poor appetite

• Vomiting

Abdominal pain may accompany symptoms related to other body systems including:

• Chest pain or pressure

• Easy bleeding or bruising

• Fatigue

• Fever and chills

• Flu-like symptoms

• Missed menstrual periods

• Pale skin

• Rapid heart rate

• Rapid breathing or shortness of breath

• Rash

• Tenderness in the belly with touch

• Urinary problems

In some cases, abdominal pain may accompany symptoms that might indicate a serious or life-threatening condition that should be immediately evaluated in an emergency setting. Symptoms that may indicate a serious or life-threatening condition include:

• Bloody or black stools

• Difficulty breathing

• Dizziness

• Fainting or change in level of consciousness or lethargy

• High fever (higher than 101 degrees Fahrenheit)

• Pulsating mass in abdomen

• Rapid pulse or rapid breathing

• Severe abdominal pain

• Vomiting blood or black material (resembling coffee grounds)

• Weakness

• Yellow skin and eyes (jaundice)

Common causes of abdominal pain often involve the digestive system. Relatively harmless gastrointestinal conditions include indigestion, gas and constipation. Stress and anxiety can also cause general abdominal pain. Sometimes children say they have a stomachache because they are trying to avoid a stressful or frightening situation, such as, trying to miss school to avoid issues with peers or friends.

However, it is always important to consider and rule out the possibility of physical causes, as abdominal pain can be from infection, malignancy, inflammation, trauma, obstruction, and other abnormal processes.

Life-threatening conditions, such as trauma, abdominal aortic aneurysm, and a bleeding peptic ulcer can cause abdominal pain and should be immediately evaluated in an emergency setting. Conditions involving other body systems, such as the endocrine, nervous, reproductive, and urinary systems, can also cause abdominal pain.

Abdominal pain may arise from problems in the digestive tract including:

• Appendicitis: You may experience early signs of appendicitis in the center of the abdomen, but the telltale sign is lower right abdominal pain and fever. Appendicitis is often a medical emergency because an inflamed and infected appendix can rupture and spread the infection.

• Bowel blockage or obstruction: Marked by stomach pain, spasms and swelling, constipation, vomiting, bloating and nausea, a bowel obstruction can lead to intestinal tearing and infection if not treated promptly.

• Celiac disease: You may experience abdominal bloating and pain, diarrhea, weight loss, and fatigue. There is no cure for celiac disease—a chronic, immune-mediated condition that causes your body to overreact to gluten and damages the lining of the small intestine—but eliminating gluten from your diet is a must.

• Colitis: An infection or inflammation of any part of your colon. Colitis is less severe than ulcerative colitis (UC)—a form of inflammatory bowel syndrome—because UC is a chronic, lifelong condition. Antibiotics can clear bacterial colitis, and viral colitis will typically clear on its own.

• Colorectal cancer: An uncommon, but possible cause of abdominal pain. Symptoms may also include fatigue, blood in stool, a change in bowel habits, bloating, and gas.

• Constipation: A very common condition in which you may not have a bowel movement as frequently as is normal for you, or it may be difficult to pass stool. For mild constipation, home treatments include drinking prune juice, a lot of water, and a taking stool softener.

• Diverticulitis: Typically felt in the lower left side, diverticulitis abdominal pain can be severe and associated with fever, chills, nausea, and possibly bloody stool. See a doctor for signs of diverticulitis, as complications include abscess and perforation.

• Food intolerances or allergies: Food allergies are an immune response, which can cause a range of symptoms throughout the body; food intolerance symptoms, in contrast, are typically localized and limited to the digestive tract. Allergy tests and elimination diets can help narrow down the cause of abdominal pain and other symptoms, such as asthma.

• Food poisoning: Telltale signs and symptoms of food poisoning include abdominal pain or cramps (which can be severe), diarrhea, and vomiting; fever, weakness, and skin symptoms are possible. Most cases are mild and do not require medical treatment other than preventing dehydration. Antibiotics are needed for severe bacterial food poisoning, such as E. coli.

• Gallstones: Upper-right abdominal pain is a classic sign of gallstones, especially after eating a meal. Medication may dissolve small gallstones, but gallbladder removal is the most common treatment.

• Gas: Your stomach and intestines produce gas (flatus) as they break down food. Some people and some types of foods produce more gas than others. Symptoms of gas include pain, fullness (bloating), abdominal noise, burping, and passing gas (flatulence). Gas is normal, but if it is bothersome, you can try over-the-counter antacids or Beano, which helps break down the sugars causing gas. An elimination diet can help you identify problem foods.

• Gastritis and viral gastroenteritis (stomach flu): With gastritis, inflammation of the stomach lining can cause central and lower abdominal pain along with nausea and vomiting. Gastritis may resolve on its own depending on the underlying cause. Stomach flu usually lasts 24 to 48 hours, but non-infectious gastritis can take longer to resolve. There is no specific stomach flu treatment. Drink watered-down sports drinks (no caffeine), broth, or an oral rehydration solution to prevent dehydration. Avoid eating for a day to help settle your stomach.

• Indigestion: Symptoms include abdominal pain and a burning sensation, heartburn, fullness, and belching. You may feel indigestion symptoms in the upper abdomen more than lower. Indigestion home remedies overlap with those for gas, including antacids and dietary changes. Acid reducers may be necessary for frequent or chronic indigestion and heartburn, as well as GERD (gastroesophageal reflux disease).

• Inflammatory bowel disease (Crohn’s disease, ulcerative colitis): IBD is a chronic condition characterized by abdominal cramping, nausea, loss of appetite, diarrhea, and weight loss. Symptoms may come and go. Prescription medicines can calm symptoms and reduce flare-ups.

• Irritable bowel syndrome: Symptoms of IBS include abdominal pain, bloating and cramping, along with constipation or diarrhea. IBS is a common condition that can be managed with medications and some diet modifications.

• Liver disease (hepatitis, cirrhosis, liver failure): At first, symptoms may be mistaken for indigestion or stomach flu, but liver disease symptoms will linger and you may also experience jaundice, loss of appetite, and fatigue. Some liver conditions resolve on their own; for others, treatment depends on the cause.

• Pancreatitis: Typically felt as severe, cramp-like pain in the upper and center part of abdomen that may radiate to the back on the left or right side. Fever, nausea and jaundice are also possible. Pancreatitis treatment typically involves intravenous antibiotics and other procedures to prevent complications.

• Peptic ulcer: Occurring in the stomach or duodenum (beginning of small intestine), peptic ulcers can cause severe abdominal pain. You may also experience a burning sensation, nausea, and loss of appetite. Antibiotics and acid reducers or acid blockers are effective treatments for most peptic ulcers, to allow the tissue to heal.

Abdominal pain can also be caused by problems in body systems other than the digestive tract including:

• Abdominal trauma: Damage of the organs or blood vessels within the abdomen can result in internal bleeding, even if there is no sign of trauma from the outside. Always seek professional medical care after an accident or injury from blunt force or an explosion to rule out internal damage.

• Abdominal tumor or mass: Ranging from a simple cyst to cancer, an abdominal mass causing pain and other symptoms requires prompt medical attention to diagnose and treat the problem.

• Endometriosis: A condition in which the uterine lining grows abnormally outside the uterus. Symptoms include lower back and abdominal pain during and after your period, cramps, fatigue, and heavy bleeding. Medication can help relieve endometriosis symptoms; surgery is necessary in some cases.

• Hernia: A painful lump is one sign of an abdominal hernia. A hernia causing problems in the lower abdomen is usually an inguinal hernia. A painful hernia may involve surgical repair.

• Kidney disease: Symptoms vary widely depending on the cause; kidney stone pain is usually severe and felt in the side of the abdomen and moves into the lower abdomen and groin. Treatment also depends on the cause.

• Medication side effect: Examples include anti-cancer drugs, antibiotics, and sodium phosphate.

• Ovarian cyst: Although they don’t often cause symptoms, ovarian cysts symptoms include lower abdominal pain, nausea and vomiting, pain with bowel movements, and possible changes in menstruation. See a gynecologist for signs of ovarian cysts.

• Prostatitis: Men with prostatitis may experience pain with bowel movements, testicular pain, and urinary retention in addition to abdominal pain. Prostatitis pain can be severe; see a healthcare professional for prostatitis symptoms. Prescription antibiotics can treat bacterial prostatitis.

• Sexually transmitted diseases: Pain from STDs typically involves the lower abdomen, or pelvic region, and may occur with intercourse. Along with pelvic pain, symptoms range from skin symptoms to painful urination to vaginal or penile discharge. Contact a healthcare professional if you suspect an STD.

• Shingles: This viral infection begins in nerves affecting one side of the body, and the abdominal area is a classic starting point. Before the shingles rash erupts, you may experience a painful tingling sensation in a band along the side of your abdomen.

• Spleen (enlarged spleen): An enlarged spleen may cause left upper abdominal pain and possibly left shoulder pain, as well as fatigue, lack of energy, easy bleeding, and feeling full after eating a small amount. Seek prompt medical care for these symptoms.

• Toxic exposures: Toxic chemicals, poisonous plants, and poisonous insect bites can cause abdominal pain and many other symptoms involving the skin, lungs, brain and nerves. Contact poison control (1-800-222-1222) in case of toxic exposures, regardless of symptoms.

• Urinary tract infection: In addition to pain in the lower belly, you’ll likely experience pain or burning with urination, smelly urine, and frequent urge to urinate (but you may not be able to). Contact your doctor for a diagnosis and antibiotics if you think you could have a bladder infection.

• Uterine fibroids: These noncancerous growths in and around the uterus may not cause symptoms, but in some women they are very painful. Treatments include hormone therapy and surgery.

In some cases, abdominal pain may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These include:

• Abdominal abscess

• Abdominal aortic aneurysm (specifically, aortic dissection)

• Acute congestive heart failure

• Ascites (fluid in the abdominal cavity)

• Bowel obstruction

• Cancer

• Ectopic pregnancy

• Gastrointestinal hemorrhage (bleeding)

• Kidney failure

• Liver failure

• Occlusion, embolism, or thrombosis of the mesenteric artery

• Perforated peptic ulcer

• Peritonitis

• Portal hypertension

• Pulmonary embolism, if pain on upper-left or upper-right side

The location of abdominal pain (and other accompanying symptoms) can help diagnose its cause. Pain concentrated in a specific area is more likely than generalized pain to be caused by a specific organ, such as the appendix for lower right-side abdominal pain. Generalized and localized pain may be constant or may come and go in waves.

Causes of generalized pain, felt over more than half of the abdomen/belly area, include (but are not limited to):

• Bowel problems

• Food allergy, intolerance, sensitivity or poisoning

• Gas

• Indigestion (upset stomach, stomachache)

• Inflammatory bowel disease (IBD)

• Stress or anxiety

• Viral gastroenteritis (stomach flu)

The upper abdomen includes the stomach, liver, spleen, part of the pancreas, gallbladder, parts of the small intestine, and parts of the large intestine (colon). Upper abdominal pain causes include:

• Abdominal abscess or mass

• Abdominal aortic aneurysm

• Bowel diseases, including cancer, inflammation, infection or obstruction

• Celiac disease

• Colitis

• Diverticulitis

• Enlarged spleen

• Gallbladder disease or stones

• Gastritis and stomach flu

• GERD (gastroesophageal reflux disease) and indigestion

• Heart attack (upper left-sided abdominal pain)

• Inflammatory bowel disease

• Irritable bowel syndrome

• Kidney stones or infection

• Liver disease, such as hepatitis

• Pancreatitis

• Peptic ulcer

The lower abdomen includes the appendix (lower-right side), large intestine, parts of the urinary tract, and the reproductive organs. Lower abdominal pain causes may overlap with those of pelvic pain. Lower abdominal pain causes include:

• Appendicitis

• Bladder infection

• Bowel diseases, including cancer, inflammation, infection or obstruction

• Colitis

• Constipation

• Diverticulitis

• Ectopic pregnancy

• Endometriosis

• Hernia

• Inflammatory bowel disease

• Irritable bowel syndrome

• Kidney stones

• Menstrual cramps

• Ovarian cysts

• Prostatitis

• Uterine fibroids

The left side of the abdomen includes the spleen, pancreas, and left lobe of liver; part of the stomach; parts of the urinary tract (e.g., left kidney and ureter) and reproductive tract (e.g., left ovary); parts of the small intestine/bowel; and the sigmoid colon and left descending colon. Left side abdominal pain causes include:

• Bowel diseases, including cancer, inflammation, infection or obstruction

• Diverticulitis

• Ectopic pregnancy

• Enlarged spleen

• Heart attack

• Kidney problems

• Ovarian cyst

• Pancreatitis

• Peptic ulcer

• Pulmonary embolism

The right side of the abdomen includes the appendix (lower-right side), gallbladder; the large, right lobe of the liver; part of the stomach; parts of the urinary tract (e.g., right kidney and ureter) and reproductive tract (e.g., right ovary); parts of the small intestine/bowel; and right side of colon.

• Appendicitis

• Bowel diseases, including cancer, inflammation, infection or obstruction

• Ectopic pregnancy

• Gallstones and other gallbladder conditions

• Kidney problems

• Liver disease

• Ovarian cyst

• Pulmonary embolism

Common causes of gastrointestinal abdominal pain, such as gas, indigestion (dyspepsia), constipation, and upset stomach, will likely resolve within a few hours up to day, even without treatment. You can try over-the-counter (OTC) drugs for faster relief. Your doctor or pharmacist can help you select the right medicine. OTC options include:

• Antacids and acid reducers

• Antigas products like Maalox

• Anti-nausea medicine

• Stool softeners for constipation

Other gastrointestinal causes of abdominal pain, such as food poisoning, gastritis or peptic ulcer, may also resolve after the stomach or intestinal lining has a chance to heal. Medical treatments may include:

• Antibiotics for bacterial causes

• Acid reducers and acid blockers

• Pepto-Bismol

• Electrolyte replacement fluids in case of vomiting or diarrhea, to prevent dehydration

Treatment options for other causes of abdominal pain depend on the cause. Treatment of chronic conditions, such as inflammatory bowel syndrome, will most likely involve a combination of medications, lifestyle changes, and perhaps surgery at some point. Acute conditions, such as bowel obstruction, appendicitis, or gallstones, may involve hospital care and possibly surgery to repair or remove the diseased tissue.

Getting an accurate medical diagnosis is the first and safest step to relieve abdominal pain, because a doctor or other healthcare provider can perform an exam and order tests to rule out serious causes. However, if you have generalized abdominal pain and suspect it is due to minor gastrointestinal issues, consider these home remedies:

• Baking soda for heartburn (1 teaspoon in 8 ounces of water)

• Ginger to aid digestion and reduce nausea (ginger root is best; try steeping some in hot water or tea)

• Heated (not hot) compress on your belly for cramp-like pain

• Liquid diet of broth and watered-down, non-caffeinated sports drinks

• Lying reclined on your left side, which can help you pass gas

• Modifying your diet to exclude problem foods, such as dairy products, beans, broccoli, and potential allergens

• Blackstrap molasses for constipation (1 tablespoon a day)

• Tylenol for pain or fever

You should see a doctor for abdominal pain if it is severe or for mild abdominal pain lasting more than a week (even if it comes and goes throughout the day or days). So-called “red flag” symptoms that may indicate a serious or life-threatening condition include:

• Abdomen is stiff or hard and tender when you or someone else touches it

• Blood in stool or vomit

• Constipation with vomiting

• Difficulty breathing

• Dizziness

• High fever (higher than 101 degrees Fahrenheit)

• Increasing fatigue, lethargy or weakness

• Pulsating mass in abdomen (sign of aortic dissection, which is a medical emergency; call 911)

• Rapid pulse or rapid breathing

• Severe pain spreading from the original location, such as to your chest, arm, neck, jaw or shoulder

• Yellow skin and eyes (jaundice)

To help diagnose the cause of abdominal pain, questions your doctor may ask you include:

• Describe your abdominal pain. Does it feel dull or sharp and stabbing?

• Rate your pain on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain you’ve ever experienced.

• Is it constant or does it come and go?

• Where do you feel the pain?

• What other symptoms are you experiencing, such as fever, vomiting or nausea?

• How long have you had this bout of abdominal pain?

• Have you traveled recently?

• What medications, herbs and supplements are you taking?

• Is there any possibility you might be pregnant?

• Are you sexually active?

• Do certain foods or activities seem to make it worse?

• Have you taken any over-the-counter medications for your pain? What is the effect?

In many cases, doctors and other providers can determine or at least suspect the cause just by your symptoms. For example, abdominal pain with painful urination and fever suggests a bladder infection. Imaging exams and blood and urine tests may be necessary to pinpoint the cause of abdominal pain and determine the best treatment.

The cause of abdominal pain can be difficult to diagnose in some cases. If you have continued abdominal pain without a diagnosis, seek a second opinion.

Complications of abdominal pain depend on the underlying cause, but can range from missed school or work to malnutrition to life-threatening infections. Getting an accurate diagnosis and following your treatment plan will help you avoid complications. Over time, abdominal pain can lead to serious complications including:

• Anemia due to blood loss

• Dehydration due to loss of fluids

• Organ failure

• Poor nutrition due to nausea and loss of appetite

• Poor quality of life

• Vitamin deficiencies