Abdominal Pain: What You Should Know

Abdominal (stomach) pain is common, and most people experience it at some point in their lifetime. While abdominal pain typically stems from minor issues and resolves independently, certain red flags like intense, persistent pain may signal a serious condition.

This article reviews the causes of abdominal pain by quadrant (section or area), diagnosis, treatment, and when to see a healthcare provider. 

Common Causes of Abdominal Pain

Common causes of abdominal pain include digestive issues, viruses, appendicitis, gallbladder, and kidney problems. The location, onset, and duration of pain can help differentiate causes. 

What Causes Abdominal Pain After Eating?

Abdominal pain after eating can stem from the following causes, each of which is characterized by pain and additional symptoms:

• Constipation or diarrhea: Cramping
• Food allergies or food intolerance: Cramping, bloating, nausea
• Food poisoning: General abdominal pain, nausea, vomiting, or diarrhea a few hours after eating
• Gas: Cramping or sharp pain, bloating
• Indigestion: Epigastric or upper middle abdomen discomfort

Inflammation-Related Causes

Inflammation-related causes of abdominal pain and accompanying characteristics include:

• Gastroesophageal reflux disease (GERD): Backward flow of stomach acid, epigastric pain, heartburn, or indigestion
• Inflammatory bowel disease (IBD): Cramping, diarrhea
  
• Peptic ulcer disease: Stomach lining sores, epigastric pain
• Urinary tract infection (UTI): Achy lower abdomen
• Viral gastroenteritis: Stomach flu, cramping pain
  

Female Reproductive Cycle-Related Causes

People with a uterus may have menstrual cramps (achy pain that occurs due to period bleeding) or ovulation pain (brief cramping on one side midway through the menstrual cycle). Other female reproductive conditions that can contribute to abdominal pain include:

• Ectopic pregnancy: Severe pain, often on one side, vaginal bleeding, and dizziness.
• Endometriosis: Intense cramping or pain with sexual intercourse.
• Ovarian cancer: Persistent dull pain, urinary discomfort, or bloating.
• Ovarian cysts: Dull ache or sharp, sudden jolts of pain on one side.
• Pelvic inflammatory disease (PID): Aching or cramping.
  
• Uterine (endometrial) cancer: Persistent, achy pain, back pain, abnormal vaginal bleeding, or pain with sexual intercourse.

What Are the More Serious Causes of Abdominal Pain?

When abdominal pain stems from a severe cause, the pain's location may indicate a problem with an organ in that area. Healthcare providers look for clues about the cause of your pain based on four quadrants in your abdomen, each containing organs that correspond to specific abdominal symptoms.

Right Upper Quadrant

Right upper quadrant pain may be due to problems with the following:

• Bile ducts: Carry digestive fluid from the liver to the gallbladder
• Gallbladder: Located under the liver
• Intestines: Carry food from the stomach to the anus
• Liver: Located under the right rib cage

Hepatitis (liver inflammation), bile duct stones or strictures (narrowing), and cancers of the gallbladder, bile ducts, or liver might cause: 

• A dull ache or pressure 
• Digestive problems
• Jaundice (yellowing skin and eyes)
  
• Weight loss

Gallstones or cholecystitis (gallbladder inflammation) may cause:

• Fever 
• Nausea and vomiting
• Sudden, intense pain that may radiate to the back or shoulders
  

Duodenal ulcers (sores in the small intestine) can lead to burning pain between meals and at night. Large bowel (intestine) obstructions cause severe cramping, bloating, and the inability to pass gas or stool.

Left Upper Quadrant

Left upper quadrant pain may be due to problems with the following:

• Pancreas: Located behind the stomach
• Spleen: Located beneath the ribcage on the left side
• Stomach: Located above the intestines

Health conditions related to left upper quadrant pain might include and are characterized by the following:

• Bile reflux: Burning pain, heartburn, nausea, and vomiting (especially with meals).
• Gastritis: Burning pain, nausea, and vomiting (with or without blood).
• Pancreatitis: Sudden, severe, persistent pain that may radiate to the back. 
• Pancreatic cancer: Deep, dull pain, weight loss, and fatigue.
• Splenomegaly: Discomfort or fullness, especially after eating, and left shoulder pain.
• Stomach cancer: Dull pain, weight loss, nausea, and fullness after eating.
  
• Stomach ulcer: Burning pain, typically between meals and at night, bloating, nausea, and vomiting.
  

Lower Abdomen

Lower abdominal pain may be due to the following conditions and include additional symptoms: 

• Abdominal aortic aneurysm (AAA): Deep, sudden, severe pain that may radiate to the back
• Appendicitis: Sudden, severe, sharp pain around the belly button that typically moves to the lower right abdomen that typically worsens with time (within 24–48 hours), movement, and releasing pressure from the right lower abdomen
• Colon (large intestine) cancer: Persistent dull pain, constipation, diarrhea, bloating, or fullness
• Diverticulitis: Constant, sharp, localized pain, fever, bloating, nausea, constipation, or diarrhea
• Functional dyspepsia (digestive disorder): Persistent, burning pain, bloating, or fullness
• Hernia: Dull ache or sharp pain
• Inflammatory bowel disease (IBD): Cramping, diarrhea (sometimes bloody), and weight loss 
• Intestinal ischemia syndrome: Severe cramping after eating
• Irritable bowel syndrome (IBS): Cramping and bloating
• Kidney infections: Deep, achy, severe pain, back pain, fever, chills, and urination pain
  
• Kidney stones: Intense sharp or cramping pain in the lower or upper abdomen, back, sides, or groin, nausea, vomiting, and blood in the urine 
  
• Large or small bowel obstruction: Cramping or intense waves of sharp pain that worsen over time 
• Mesenteric lymphadenitis: Cramping, fever, and diarrhea
• Peritonitis: Intense, constant pain that worsens with movement or touch, a rigid belly, fever, nausea, and vomiting
  
• Small intestine cancer: Persistent cramping and fullness that gets worse
  

Other Causes of General Abdominal Pain

Causes of general abdominal pain may include:

• Abdominal bloating
• Abdominal muscle strain
• Shingles (reactivation of the chickenpox virus)
• Stress
  
• Traumatic injuries
• Visceral (internal organ) hypersensitivity 

How Is Abdominal Pain Diagnosed?

Abdominal pain diagnosis occurs through a medical history, physical exam, and tests. The provider may ask questions about your pain, including:

• Does the pain stay in one place, or does it move?
• What does the pain feel like?
• What makes it better?
• What is the duration of pain? Does it come and go? Has it worsened over time?
• Where is the pain located?
  
• Do you have any other symptoms?

A healthcare provider may order additional diagnostic tests, such as blood, urine, stool tests, imaging, such as X-rays, a computed tomography (CT) scan, or ultrasound, and endoscopy (colonoscopy) if they cannot diagnose you based on your medical history and a physical exam.

How Do You Relieve Abdominal Pain?

While you may be able to treat mild abdominal pain at home, serious causes require immediate medical treatment like antibiotics or surgery. 

Drinking only clear liquids for a day or two can help with a virus or digestive problems. Menstrual cramps may resolve with heat or over-the-counter (OTC) pain medication. Antacids or Prilosec (omeprazole) may help with indigestion. A balanced, fiber-rich diet, regular exercise, and stress management can help prevent recurrent pain. Identify potential food allergies or intolerances by keeping a food diary.

When to Contact a Healthcare Provider

Contact a healthcare provider promptly for these red flags that may indicate a serious condition:

• Abdominal pain alongside cancer treatment 
• Abnormal vaginal bleeding
• Blood in the urine or stool 
• Intense, persistent pain
• Pain with urination or sexual intercourse
• Persistent bloating, nausea, vomiting, or diarrhea for more than a few days
  
• Persistent fever, over 100.4 degrees F
• Poor appetite
  
• Vaginal bleeding during pregnancy
• Unexplained weight loss
  

Summary

Abdominal pain can stem from mild to severe conditions. The pain location may provide clues about underlying conditions. Mild conditions typically resolve with home remedies or OTC medications. However, persistent pain may indicate serious conditions that require immediate medical attention.