Abdominal Pain — Causes & When to See a Doctor — Causes, Diagnosis & When to See a Doctor | MyMedicPlus

Abdominal pain is any discomfort originating between the chest and the pelvis, encompassing the stomach, small and large intestines, liver, gallbladder, pancreas, spleen, kidneys, and reproductive organs. It is one of the most common reasons people seek medical attention, accounting for approximately 5–10% of all emergency department visits worldwide. The character and location of abdominal pain carry important diagnostic significance: right lower quadrant pain classically suggests appendicitis; right upper quadrant pain points to gallbladder or liver pathology; central epigastric pain is typical of gastric or duodenal disease; and flank pain often originates from the kidneys or ureters. Pain may be sharp, cramping, colicky, burning, or dull and aching. Duration and onset — whether sudden or gradual — also guide diagnosis. While most abdominal pain is caused by benign self-limiting conditions, a subset requires urgent surgical or medical intervention. Every clinician's priority is to rapidly distinguish between conditions that can be managed conservatively and those requiring immediate action.

Gastritis and peptic ulcer disease cause epigastric burning or aching pain, often worsened by NSAIDs or Helicobacter pylori infection. Irritable bowel syndrome (IBS) produces recurrent cramping lower abdominal pain relieved by defecation, affecting up to 15% of adults. Appendicitis begins as central periumbilical pain that migrates to the right lower quadrant over 6–12 hours, often with fever and anorexia — a surgical emergency if untreated. Cholecystitis (gallbladder inflammation) causes severe right upper quadrant pain radiating to the shoulder tip, typically after fatty meals. Pancreatitis presents with severe epigastric pain radiating to the back, associated with nausea, vomiting, and elevated lipase. Kidney stones cause intense colicky loin-to-groin pain with haematuria. Bowel obstruction produces central cramping pain with distension, vomiting, and absent bowel movements. In women, ovarian cysts, ectopic pregnancy, and pelvic inflammatory disease are critical gynaecological causes that must always be considered. Gastroenteritis from viral or bacterial pathogens causes diffuse cramping with diarrhoea.

Certain features of abdominal pain demand immediate emergency evaluation without delay. Call emergency services or proceed immediately to the nearest emergency department for any of the following: sudden onset of severe abdominal pain reaching maximum intensity within seconds or minutes; pain accompanied by a rigid, board-like abdomen — a sign of peritonitis; fever above 38.5°C combined with abdominal pain, suggesting infection or perforation; vomiting blood (haematemesis) or passing black tarry stools (melaena), both indicating gastrointestinal bleeding; complete inability to pass gas or have a bowel movement combined with abdominal distension, raising concern for bowel obstruction; signs of haemodynamic shock including pallor, profuse sweating, rapid weak pulse, or collapse; abdominal pain following blunt trauma to the abdomen; lower abdominal pain with missed menstrual period in a woman of childbearing age (rule out ectopic pregnancy). Pain that progressively worsens over hours rather than fluctuating should always be treated as potentially serious until proven otherwise.

Doctors begin with a detailed history covering the onset, location, character, severity, radiation, and timing of pain, alongside associated symptoms including fever, nausea, vomiting, change in bowel habits, urinary symptoms, and menstrual history in women. Physical examination includes gentle and deep abdominal palpation for tenderness, guarding (voluntary muscle tensing), rigidity (involuntary), rebound tenderness (Blumberg sign), and organomegaly. Specific signs tested include Murphy's sign for cholecystitis and McBurney's point tenderness for appendicitis. Laboratory tests typically ordered include a complete blood count (white cell count elevation suggests infection or inflammation), liver enzymes and bilirubin, serum lipase, C-reactive protein, urinalysis (to detect kidney infection or stones), and a urine or blood pregnancy test in women. Imaging includes abdominal ultrasound as first-line for gallstones and gynaecological pathology, and contrast CT of the abdomen and pelvis when appendicitis, bowel obstruction, or other serious pathology is suspected.

Treatment of abdominal pain is directed entirely at the underlying cause, as there is no single universal approach. Mild self-limiting pain from indigestion or viral gastroenteritis is managed with rest, clear fluid intake, and a bland diet. Acid-related conditions including gastritis and peptic ulcer disease respond to antacids, H2 blockers, and proton pump inhibitors; confirmed H. pylori infection requires a course of triple therapy (antibiotics plus PPI). Antispasmodic medications such as hyoscine butylbromide provide relief for IBS-related cramping. Gallstone disease causing recurrent cholecystitis is typically managed with laparoscopic cholecystectomy. Appendicitis requires prompt surgical appendectomy to prevent rupture and peritonitis. Pancreatitis is managed with nil-by-mouth, intravenous fluids, and analgesia in hospital. Kidney stones are treated with adequate analgesia, high fluid intake, and in larger stones, urological intervention such as shockwave lithotripsy or ureteroscopy. Bowel obstruction may require surgical decompression or operative intervention depending on the degree and cause.

Many causes of abdominal pain can be prevented or their recurrence reduced through targeted lifestyle measures. Eating a high-fibre diet rich in fruits, vegetables, legumes, and whole grains promotes healthy bowel motility and reduces the risk of constipation, diverticular disease, and IBS flares. Stay well hydrated — at least 1.5–2 litres of water daily — to support digestive function and reduce kidney stone formation. Eat meals slowly, avoid overeating, limit fatty and spicy foods, and reduce alcohol intake to minimise gastritis and gallbladder inflammation. Take NSAIDs (ibuprofen, aspirin, naproxen) only when necessary and always with food; consider using a PPI if long-term NSAID use is unavoidable. Manage stress actively, as it directly worsens IBS, functional dyspepsia, and acid reflux through the gut-brain axis. Maintain a healthy body weight — obesity significantly increases the risk of gallstones, GERD, and pancreatitis. Wash hands thoroughly and practice safe food handling to prevent gastroenteritis.

Call emergency services or go to the nearest emergency department immediately if you experience sudden severe abdominal pain, a rigid abdomen, abdominal pain with high fever, vomiting of blood, passage of black or bloody stools, abdominal pain with signs of shock (cold clammy skin, rapid weak pulse, loss of consciousness), or lower abdominal pain with a missed period. Schedule an urgent same-day appointment with your doctor for abdominal pain that has been present for more than a few hours without improvement, pain that is waking you from sleep, or abdominal pain accompanied by unexplained weight loss or persistent loss of appetite. Book a routine appointment for recurring mild-to-moderate abdominal pain, bloating, or changes in bowel habits that have been present for more than two to four weeks. Pain that disrupts daily activities, eating, or work also warrants investigation. Never adopt a wait-and-see approach to abdominal pain accompanied by fever or rigidity.