Abdominal Pain: Causes & When to Be Concerned

Viral (norovirus) infection

Norovirus infection is caused by the highly contagious Norwalk virus. It spreads when any trace of stool or vomit from an infected person contaminates food or drink, or gets onto any surface. Anyone who consumes the food or drink, or touches the surface and then their mouth, will become infected.

Norovirus brings on severe gastrointestinal upset which is very unpleasant but rarely dangerous. Symptoms include diarrhea, vomiting, stomach pain, fever, and body aches for one to three days. The greatest risk is dehydration due to the severity of the symptoms.

Because norovirus is, indeed, a virus, antibiotics will not help. The best treatment is good supportive care, which means providing plenty of fluids along with mild pain relievers until the patient recovers. Do not give aspirin to children.

If the dehydration does not improve quickly, medical help should be sought. Doctors can provide IV fluids through recovery.

The best prevention is frequent and thorough handwashing, as well as washing all fruits and vegetables. All foods must be properly cooked, especially shellfish.

Stomach ulcer

A peptic ulcer or gastric ulcer is an open sore that forms when inflammation occurs in the stomach lining.

This stomach inflammation is caused by the bacteria Helicobacter pylori (H. pylori) and by prolonged use of pain relievers such as ibuprofen or aspirin. Chronic inflammation allows acid to damage the stomach lining and an ulcer may form.

Smoking, drinking alcohol, stress, and spicy foods may aggravate ulcers, but do not cause them.

Symptoms include burning pain in the stomach; heartburn; nausea; and bloating.

The pain may be worse between meals or at night. Antacids will only work for a short time. There may be dark red blood in the vomit or stools.

Left untreated, ulcers may bleed and cause anemia. They may perforate the stomach and cause peritonitis (serious infection of the abdominal cavity.)

Diagnosis is made through physical examination and by testing breath and stool for H. pylori. Endoscopy is sometimes used.

Treatment involves a course of antibiotics to kill the bacteria, and medication to block excess acid and heal the stomach.

Rarity: Uncommon

Top Symptoms: fatigue, nausea, loss of appetite, moderate abdominal pain, abdominal cramps (stomach cramps)

Symptoms that never occur with stomach ulcer: pain in the lower left abdomen

Urgency: Primary care doctor

Normal variation of constipation

Constipation means bowel movements which have become infrequent and/or hardened and difficult to pass.

There is wide variation in what is thought "normal" when it comes to frequency of bowel movements. Anywhere from three times a day to three times a week is considered normal.

As long as stools are easy to pass, laxatives should not be used in an effort to force the body to a more frequent schedule.

Constipation is usually caused by lack of fiber in the diet; not drinking enough water; insufficient exercise; and often suppressing the urge to have a bowel movement.

A number of medications and remedies, especially narcotic pain relievers, can cause constipation.

Women are often affected, due to pregnancy and other hormonal changes. Young children who demand low-fiber or "junk food" diets are also susceptible.

Constipation is a condition, not a disease, and most of the time is easily corrected. If simple adjustments in diet, exercise, and bowel habits don't help, a doctor can be consulted to rule out a more serious cause.

Rarity: Common

Top Symptoms: abdominal pain (stomach ache), nausea, stomach bloating, constipation, constipation

Symptoms that always occur with normal variation of constipation: constipation

Symptoms that never occur with normal variation of constipation: vomiting

Urgency: Self-treatment

Menstrual cramps

Menstrual cramps, also called dysmenorrhea, are actually contractions of the uterus as it expels its lining during a woman's monthly period.

A certain amount of mild cramping is normal, triggered by hormone-like substances called prostaglandins. However, painful cramps may be caused by underlying conditions such as endometriosis, uterine fibroids, high prostaglandin levels, or pelvic inflammatory disease (PID.)

Severe cramping may be present, as well as nausea, headache, and dull pain that radiates to the low back and thighs. It is most common in women under age 30 who smoke, have heavy and irregular periods, and have never given birth.

An obstetrician/gynecologist (women's specialist) can do tests for underlying conditions such as those mentioned above. Women over age 25 who suddenly begin having severe cramps should see a doctor to rule out the sudden onset of a more serious concern.

Treatment of mild cramping can be done with heating pads to the abdomen and with over-the-counter pain relievers such as ibuprofen. Birth control pills, which regulate the menstrual cycle, are often effective in lessening cramps.

Rarity: Common

Top Symptoms: abdominal pain (stomach ache), abdominal cramps (stomach cramps), painful periods, lower back pain, abdominal pain that shoots to the back

Symptoms that always occur with menstrual cramps: abdominal pain (stomach ache)

Symptoms that never occur with menstrual cramps: being severely ill, disapearance of periods for over a year

Urgency: Self-treatment

Irritable bowel syndrome (IBS)

Irritable bowel syndrome is commonly known as IBS. Normally, the muscles of the colon, or large intestine, contract and relax to push food along. It's thought that in IBS, the muscles randomly contract either too strongly or too weakly and therefore cause alternating bouts of diarrhea or constipation.

The exact cause is not known. Food allergy/intolerance; stress; hormonal imbalance; and infection or bacterial overgrowth in the colon may play a role, as well as an overly sensitive gastrointestinal nervous system.

Pre-menopausal women who suffer from depression or lead very stressful lives may be most susceptible.

Symptoms vary among individuals, and often come and go. These include abdominal pain and cramping; bloating; gas; diarrhea; and constipation. IBS is not associated with serious illness such as cancer, but symptoms may interfere with quality of life.

Diagnosis is made through patient history, physical examination, and ruling out any other cause. Imaging may also be done.

Treatment begins with improved diet and stress management. Antibiotics, antidepressants, and other medications may be attempted.

Intestinal inflammation (diverticulitis)

When the passage of food through the colon becomes sluggish, the food can stagnate, increase in bulk, create pressure, and cause diverticula – or pouches – to form in the walls of the large intestine. If these pouches become inflamed, the condition is called diverticulitis.

Risk factors are a low-fiber diet, smoking, obesity, chronic constipation, and lack of "good" bacteria in the gut.

Patients over 50, with a previous history of inflammatory disease of the colon, are most susceptible.

Symptoms include persistent abdominal pain; fever; nausea and vomiting; and constipation sometimes alternating with diarrhea.

Left untreated, diverticulitis can lead to intestinal blockage and scarring. Rupture of an inflamed pouch can result, leading to peritonitis. These are medical emergencies. If suspected, take the patient to the emergency room or call 9-1-1.

Diagnosis is made by ruling out other conditions through physical examination; blood, urine, and stool tests; and CT scan.

Less serious cases are treated with a high-fiber diet, fluids, probiotics, antibiotics, and lifestyle management. Others may require intravenous antibiotics and/or surgery.

Rarity: Uncommon

Top Symptoms: abdominal pain (stomach ache), nausea, loss of appetite, diarrhea, constipation

Symptoms that never occur with intestinal inflammation (diverticulitis): pain below the ribs, pain in the upper right abdomen

Urgency: Hospital emergency room

Indigestion (dyspepsia)

Indigestion, also called upset stomach, dyspepsia, or functional dyspepsia, is not a disease but a collection of very common symptoms. Note: Heartburn is a separate condition.

Common causes are eating too much or too rapidly; greasy or spicy foods; overdoing caffeine, alcohol, or carbonated beverages; smoking; and anxiety. Some antibiotics, pain relievers, and vitamin/mineral supplements can cause indigestion.

The most common symptoms are pain, discomfort, and bloating in the upper abdomen soon after eating.

Indigestion that lasts longer than two weeks, and does not respond to simple treatment, may indicate a more serious condition. Upper abdominal pain that radiates to the jaw, neck, or arm is a medical emergency.

Diagnosis is made through patient history and physical examination. If the symptoms began suddenly, laboratory tests on blood, breath, and stool may be ordered. Upper endoscopy or abdominal x-ray may be done.

For functional dyspepsia – "ordinary" indigestion – treatment and prevention are the same. Eating five or six smaller meals per day with lighter, simpler food; managing stress; and finding alternatives for some medications will provide relief.

Rarity: Common

Top Symptoms: nausea, stomach bloating, dyspeptic symptoms, bloating after meals, vomiting

Symptoms that always occur with indigestion (dyspepsia): dyspeptic symptoms

Symptoms that never occur with indigestion (dyspepsia): vomiting (old) blood or passing tarry stools, rectal bleeding, bloody diarrhea, fever

Urgency: Self-treatment

Gallstones

Gallstones are small, pebble-like, mineral deposits that can form inside the gallbladder. They may cause no symptoms unless they become lodged in a duct leading out of the gallbladder.

Gallstones are thought to be caused by high cholesterol, which can form into crystals in the gallbladder; by cirrhosis, or scarring, of the liver; or by incomplete emptying of the gallbladder.

Most susceptible are women over age 40. Other risk factors are obesity, lack of exercise, poor diet, and rapid weight loss as with gastric bypass surgery.

Symptoms include sudden sharp pain in the center or upper right abdomen, in the right shoulder, and in the upper back. There may also be nausea and vomiting, yellowing of skin and eyes, and fever and chills.

It's important to see a medical provider for these symptoms. Gallstones can lead to pain, infection, and further complications.

Diagnosis is made through physical examination, CT scan, blood tests, and sometimes specialized scans to examine the gallbladder system.

Treatment usually involves surgery to remove the stones and sometimes the gallbladder itself.

Appendicitis

Appendicitis is an inflammation of the appendix, the small, finger-shaped pouch projecting off the colon on the lower right side of the abdomen.

The inflammation is caused by anything blocking or irritating the appendix opening or walls, such as hard stool or damage from other bowel disease. The blocked appendix can quickly swell with bacteria and pus.

Appendicitis is most common from ages 13-30, but can happen to anyone.

Symptoms include sudden, severe pain in the abdomen that begins near the navel and soon moves to the lower right side. There may be low-grade fever; nausea and vomiting; feeling bloated; and constipation or diarrhea.

If not treated, an infected appendix can rupture and cause a life-threatening infection of the abdomen called peritonitis. This is why appendicitis is a medical emergency. If suspected, take the patient to the emergency room or call 9-1-1.

Diagnosis is made through patient history, physical examination, blood and urine tests, and imaging such as ultrasound or x-ray.

An inflamed appendix must be surgically removed as soon as possible.

Acute pancreatitis

Acute pancreatitis is the inflammation of the pancreas, which creates and releases insulin and glucagon to keep the sugar levels in your blood stable. It also creates the enzymes that digest your food in the small intestine. When these enzymes accidentally get activated in the pancreas, they digest the pancreas itself, causing pain and inflammation.

You should go to the ER. There, diagnosis is made by physical examination, imaging, and blood tests. Treatment typically involves intravenous (IV) fluids and medicines to control the pain.

Rarity: Rare

Top Symptoms: constant abdominal pain, nausea or vomiting, being severely ill, severe abdominal pain, fever

Symptoms that always occur with acute pancreatitis: constant abdominal pain

Urgency: Hospital emergency room

Other abdominal pain causes

Abdominal pain can also occur due to the following.

• Bowel issues: Both diarrhea and constipation can cause abdominal pain symptoms. If your bowel movements are less than normal, you can expect some form of abdominal pain.
• Stress: Many diseases can come from mental and physical distress. Anxiety and panic disorders are connected to abdominal pain as well.
• Internal injuries: Internal bleeding, stomach ulcers, and tearing in any of the stomach muscles, lining, or nearby organs can cause severe abdominal pain that should be treated as soon as possible.

Why does my stomach hurt?

Your stomach may hurt for a variety of reasons. Indigestion due to a large meal, a lack of food, or gas are the most common reasons. The most common pathologic reasons is a "stomach bug" or an infection of the stomach that usually resolves in seven to 10 days. If your stomach pain does not resolve, you should visit a healthcare provider for an evaluation.

Why does the top of my stomach hurt?

The top of your stomach may hurt because of heartburn or reflux of stomach acid into the bottom portion of the esophagus. The stomach is divided into different regions. The top of the stomach is called the "cardia" and this region connects to the esophagus, the tube that food travels through. The cardia can cause pain when stomach acid splashes up through the opening between the esophagus and stomach and burns the lower end of the esophagus.

What causes sharp pain in the stomach?

Sharp pain in the stomach can be caused by indigestion, stomach or intestinal infection, ulcer, or a stomach tumor. Indigestion and stomach infections usually self-resolve and are much more common. Many sharp stomach pains are benign, and if they happen infrequently, they can be ignored. "Infrequently" is considered not frequently enough to be remembered. Additionally, sharp pains may also come from intense muscle contractions associated with vomiting. However, in this case, it is best to treat the cause of vomiting as the sharp pains will diminish as vomiting stops.

What causes pain in the lower abdomen?

Pain in the lower left abdomen and pain in the lower right abdomen can be caused by problems with the descending colon, rectum, or genitalia. To determine the cause of pain in the lower abdomen, it is important to recall what activities have occurred recently. Have you been constipated? Have you had trouble urinating? Have you been sick in any way recently? Have you eaten anything unusual or taken any prescribed or illicit drugs recently? Pain in the lower abdomen is commonly caused by stretching or tension placed on organs. Whether muscle contractions during an upset stomach, stretching of bowel from constipation, or an overfull bladder pressing on other organs, lower abdominal pain is commonly caused by stretching of an organ irritating a nerve. The other common cause of lower abdominal pain is inflammation which can occur in the setting of infection or, more rarely, malignancy.

Why does my stomach hurt after I eat?

Your stomach may hurt after you eat if you haven't eaten in a long time, if you've eaten a particularly large meal, or if you have an ulcer, tumor, or other mass that is not protected from stomach acid by mucus within the stomach. Stomach pain after eating is most commonly caused by the normal contractions/motions of the stomach as it churns and breaks down food with stomach acid. If you have damage to the stomach or a mass of some sort, these motions can aggravate that point of tenderness causing additional stomach pain. Gas is also a common cause of stomach pain after eating. An antacid or fizzy drink may help you belch, releasing the gas and discomfort.

Questions your doctor may ask about abdominal pain

• Have you experienced any nausea?
• Any fever today or during the last week?
• How would you describe the nature of your abdominal pain?
• Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?

Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.