18 Causes of Stomach Pain

What your doctor might ask you

To narrow the possibilities of what’s causing the pain, your doctor may ask you a series of questions.

What other symptoms do you have?

• Vomiting—Often occurs with viral stomach infections such as norovirus. Vomiting can also occur with an obstruction or blockage in your intestines.
• Diarrhea—Can occur with intestinal tract infections such as Salmonella, E. coli, C. difficile, or with lactose intolerance or celiac disease. Diarrhea is a hallmark of inflammatory bowel disease (Crohn’s and ulcerative colitis), and irritable bowel syndrome.
• Fever—Usually signals an infection.
• Blood—When in either vomit or stool, it often means you have a serious condition such as an ulcer or diverticulitis, infectious diarrhea, or inflammatory bowel disease.
• Back pain—Pain from abdominal organs are sometimes “referred” to the back. Severe or perforated stomach ulcers, pancreatitis, kidney stones, and aortic dissection can cause back pain.

Where is the pain?

• Upper abdomen (under the rib cage, in the middle, left, or right side) may suggest issues with your pancreas, gallbladder, stomach, or spleen.
• Around the belly button (in the center of the abdomen). Appendicitis pain often starts here and then moves to your lower right abdomen.
• Lower abdomen pain may be from your small or large intestines, kidneys, or bladder.
• Lower right abdomen. Appendicitis often causes intense pain here.

When does the pain occur?

• Does it happen after eating? It may mean you have a peptic ulcer or gallstones.
• Does it come and go? You may have a chronic condition like irritable bowel syndrome.

How severe is the pain?

Severe pain usually indicates that something serious is happening.

Have you traveled recently?

Some gut infections can be picked up while traveling and eating foods in certain parts of the world (typhoid in undeveloped countries, for example). Certain activities, like swimming in freshwater, can cause a Giardia infection.

1. Heartburn/GERD

Symptoms

• Burning pain in the chest
• Dysphagia (feeling like food is stuck in the esophagus)
• Cough
• Bitter taste in the mouth

Heartburn or GERD (gastroesophageal reflux disease) occurs when contents from the stomach back up into the esophagus. Since stomach contents are acidic, it can damage the lining of the esophagus. Chronic untreated GERD can lead to more serious complications such as esophagitis (inflammation of the esophagus), strictures (narrowing of the esophagus), and esophageal cancer.

Treatment includes medications that reduce acid in the stomach such as ranitidine or omeprazole. Lifestyle and diet modifications like avoiding tomatoes, citrus, and alcohol, can also help improve symptoms.

2. Peptic ulcers

Symptoms

• Sharp or burning pain in the middle of the upper abdomen
• Pain 2 to 3 hours after eating
• Pain that wakes you up at night (more common for duodenal ulcers)
• Heartburn or indigestion
• Nausea
• Bloody or dark stool
• Loss of appetite
• Weight loss

Peptic ulcers are open sores in the lining of the stomach. They can also occur in the first part of the small intestines, the duodenum. When stomach acid touches the sores, it can be painful.

For most people, ulcers are caused by an infection from a bacteria called H. pylori. Chronic use of medications called NSAIDs (ibuprofen such as Advil) can also cause ulcers. Severe ulcer disease can lead to serious complications like bleeding from the stomach or perforation.

If you have H. pylori, you will be given antibiotics. If NSAIDs are causing the ulcers, you should stop taking them if possible. Serious complications from ulcers may require surgery.

3. Gastritis

Symptoms

• Burning or achy pain in the upper abdomen
• Nausea
• Vomiting
• Symptoms improve OR become worse after eating
• Feeling full early after eating

Gastritis is an inflammation of the inside of the stomach. It can be sudden or chronic (long term). Sudden gastritis can be caused by bacterial or viral infections, drugs, alcohol, allergy, radiation, or trauma. Chronic gastritis can be caused by H. pylori infection, long-term use of certain medications such as NSAIDs, or autoimmune disorders.

4. Stomach flu

Symptoms

• Watery diarrhea
• Crampy abdominal pain
• Nausea
• Vomiting
• Fever

Viral stomach infections, also called stomach flu, are commonly caused by norovirus or rotavirus. Rotavirus is more common in children, though most children in the U.S. now get a vaccine to prevent this infection. Infections usually go away on their own, but they can cause severe dehydration.

There is no specific treatment for stomach flu. It’s important to drink a lot of fluids. You may need to be admitted to the hospital if you become too dehydrated.

5. Hiatal hernia

Symptoms

• Burning in chest and upper abdomen
• Discomfort in the upper abdomen or chest
• Difficulty swallowing
• Regurgitation of undigested food
• Feeling full shortly after eating
• Bloody or dark stool

Hiatal hernia happens when a portion of the stomach passes up through the diaphragm into the chest cavity. Most hiatal hernias are small and do not cause symptoms. Hiatal hernias can also slide back-and-forth. Large hernias may cause complications.

Antacids or acid blockers may be used to treat mild hiatal hernias. Large hernias, especially if there are complications such as bleeding, may require surgery.

6. Gallstones

Symptoms

• Sudden pain that comes and goes 1 to 5 hours after a meal
• Pain in the middle of the upper abdomen
• Pain after a fatty meal
• Nausea or vomiting
• Pain in the right shoulder

Gallstones form in the gallbladder from concentrated components of bile, a fluid made by the liver to help digest fats. They only cause pain if they become lodged in the bile duct (tube) when the gallbladder releases bile. In some severe cases, a stuck gallstone can cause inflammation or infection of the gallbladder (called cholecystitis).

Gallstones are usually diagnosed with an abdominal ultrasound. Surgery to remove the gallbladder is often required to treat painful gallstones, especially if it’s happening often.

7. Pancreatitis

Symptoms

• Pain in the upper abdomen, usually coming on suddenly and may be worse after eating
• Pain is dull and worsens over time
• Pain goes to the back
• Nausea and vomiting
• Fever
• Fast pulse

Other long-term symptoms

• Weight loss
• Oily poop

Pancreatitis is inflammation of the pancreas, an organ that makes digestive enzymes and insulin. Inflammation of the pancreas can cause digestive enzymes to leak out, which causes severe pain.

The most common causes are gallstones stuck in the bile duct in the pancreas and drinking too much alcohol. Certain medications can also cause pancreatitis. But many cases have no apparent cause. Chronic pancreatitis can lead to severe complications such as pancreatic cysts, infection, scarring, and pancreatic cancer.

Pancreatitis is usually diagnosed with blood work, but imaging studies like an ultrasound or CT scan are often checked too.

8. Irritable bowel syndrome

Symptoms

• Frequent abdominal pain (once per week or more)
• Changes in poop habits or appearance
• Diarrhea or constipation or both
• Gas and bloating
• Pain may get better after a bowel movement

Irritable bowel syndrome (IBS) is a common, chronic disorder of the gut (primarily the large intestine) that causes abdominal pain and changes in your bowel movements. There are three types of IBS, based on whether you have diarrhea, constipation, or both.

Although there is no cure for IBS, there are many treatments available to address symptoms.

You may be told to avoid foods that trigger symptoms. Certain medications may also help with relaxing the intestines. Strategies to relieve stress and depression are also helpful.

9. Inflammatory bowel disease

Symptoms

• Crampy abdominal pain
• Diarrhea, sometimes with blood or mucus
• Decreased appetite
• Fatigue
• Weight loss

Inflammatory bowel disease (IBD) refers to diseases that cause inflammation of the intestines due to an abnormal immune system response. The two major types of IBD are Crohn's disease and ulcerative colitis. Symptoms can be very serious and debilitating. Severe inflammation in the lining of the gut can cause sores, blockages, and perforations, leading to serious infections.

Treatment for IBD usually starts with medications to help decrease inflammation and control the immune system. Over time, surgery is often required when parts of the intestine or colon are too damaged and need to be removed or if there are complications like blockages.

10. Appendicitis

Symptoms

• Abdominal pain—may start around the belly button and move to the lower right abdomen
• Pain does not go away and worsens with movement
• Nausea
• Vomiting right after pain starts
• Loss of appetite
• Fever

Appendicitis, or inflammation of the appendix, is common and most often affects people between the ages of 10 and 30, though it can happen at any age. It can lead to severe infection, especially if the appendix formed an abscess or bursts inside the belly.

In children, appendicitis can usually be diagnosed from just the symptoms alone. Sometimes, imaging like an ultrasound or CT scan is needed. Appendicitis is an emergency and is treated with surgery and antibiotics.

11. Lactose intolerance

Symptoms

• Bloating and gas
• Crampy abdominal pain
• Diarrhea or “loose stools”
• Nausea
• Symptoms occur after eating dairy

Lactose intolerance occurs when people are unable to digest lactose, a sugar found in milk. It happens in people who do not have enough of the enzyme, lactase, to break down lactose. It is more common in people of Asian, South American, and African descent. Lactose intolerance can also happen after injury to the small intestines, such as during an infection or after chemotherapy.

Lactose intolerance can be avoided by not eating dairy foods. Many dairy products are now also available in “lactose-free” versions, which have added lactase to break down the sugar. Lactase pills (Lactaid) are a supplement to take while eating dairy products.

12. Celiac disease and gluten sensitivity

Symptoms

• Severe abdominal pain
• Bloating and gas
• Diarrhea
• Fatigue
• Weight loss
• Symptoms occur after eating foods with wheat, barley, rye, or gluten

Non-GI symptoms

• Anemia
• Decreased bone density
• Itchy blistered skin
• Neurologic symptoms

Celiac disease is caused by a specific immune reaction to gluten, a protein found in wheat, barley, and rye. The immune reaction causes inflammation to the small intestines, which prevents absorption of nutrients. Over time, complications can develop from not being able to absorb nutrients.

There is a specific test for celiac disease and the inflammatory damage to the small intestines can usually be seen using an endoscope (camera in the intestines).

Some people do not test positive for celiac disease though they have reactions to gluten. This is known as non-celiac gluten sensitivity. Research is still being conducted to understand the exact cause.

The main treatment for people with celiac disease or non-celiac gluten sensitivity is to avoid gluten, which is not just in obvious wheat-based foods like bread and pasta. It is added to many products to thicken or coat foods.

Severe disease that does not get better may need treatment by specialists.

13. Bacterial infections

Symptoms

• Crampy abdominal pain
• Diarrhea, which may be bloody
• Fever
• Nausea

Many bacteria in contaminated foods or water can cause infection of the GI tract. These include Salmonella, Listeria, Campylobacter, pathogenic E. coli, Vibrio, Yersinia, and Shigella.

Some infections get better on their own and do not need treatment. Some infections may be treated with antibiotics, depending on the bacteria. It’s important to try to stay hydrated by drinking a lot of fluids.

14. Diverticulitis

Symptoms

• Abdominal pain, often in the lower left side, and can last for days
• Nausea
• Vomiting
• Fever
• Bloating

People on Western diets can often develop little outpouchings in the colon called diverticula, which form because of weaknesses in the wall of the colon. These outpouchings can sometimes become inflamed, infected, or cause other complications such as blockages, fistulas (holes between two different parts of the intestines), or rupture.

Treatment of diverticulitis depends on how bad it is and if there are serious complications. In mild cases, you may be treated with antibiotics and some fasting or a liquid diet. In complicated cases, surgery may be required to fix blockages and fistulas or drain abscesses. If there is too much damage, parts of the colon may have to be removed.

15. Bowel obstruction

Symptoms

• Crampy abdominal pain
• Constipation
• Not passing gas
• Vomiting
• Fever
• Swelling of the abdomen

Bowel obstruction occurs when anything from the inside or outside of the intestines causes a blockage of the intestines. A permanent blockage can cause serious complications such as rupture of the intestines, life-threatening infection of the belly, and permanent damage to the intestines.

Causes can include inflammatory bowel disease, scarring from previous surgeries, severe constipation, cancer, hernias, or twisting of the intestines (volvulus).

Treatment depends on the severity and causes of the obstruction. Surgery is often required to fix the cause of the blockage. If any part of the intestines has become too damaged, such as from inflammation or lack of blood flow, it may have to be removed.

16. Kidney stones

Symptoms

• Severe, sudden pain in the side or back
• Pain radiating to the lower abdomen
• Pain comes and goes (renal colic)
• Nausea
• Vomiting
• Blood in urine
• Fever and chills

Kidney stones are mineral deposits that form in the kidneys. They can cause pain when they pass through the thin ureters, thin tubes that transport urine from the kidneys to the bladder.

Kidney stones can be caused by not drinking enough water regularly, which makes urine more concentrated with minerals and salts. Certain medication and genetic factors can also increase the risk of getting stones.

Most kidney stones can be seen on a CT scan or ultrasound. Treatment depends on the symptoms and severity. Smaller stones may pass with the help of pain relievers, fluids, and a medication that helps relax muscles of the ureter.

Larger stones may be broken up using ultrasound or extracted using a tool called a ureteroscope. Very large stones may have to be removed with open surgery.

17. Cancers

Cancer of any organ in the abdomen is always a serious condition. Many cancers cause pain by compressing organs, damage to organs, causing inflammation in the abdomen, or other effects. Symptoms can vary depending on which organs have cancer.

• Stomach cancer
• Pancreatic cancer
• Liver cancer
• Cancer of the bile duct (cholangiocarcinoma)
• Colon cancer

18. Gynecologic conditions

Normal and abnormal conditions of the female reproductive system can cause abdominal pain. Severe pain in women who are pregnant may be a sign of something serious. Some causes of abdominal pain in women include:

• Normal menstruation related symptoms, including dysmenorrhea and mittelschmerz
• Ectopic pregnancy
• Miscarriage
• Fibroids
• Endometriosis
• Polycystic ovarian syndrome
• Pelvic inflammatory disease
• Sexually transmitted infections
• Tubo-ovarian abscess
• Complications from contraceptive devices

Other possible conditions

Some less common problems in the abdomen can cause severe abdominal pain and require immediate treatment or even emergency surgery.

• Hepatitis
• C. difficile infection
• Aortic dissection
• Mesenteric ischemia
• Ischemic colitis
• Bowel rupture or perforation
• Umbilical hernia
• Peritonitis
• Ruptured or enlarged spleen
• Food allergies
• Kidney infection
• Bladder infection

When to call the doctor

Go to the doctor if you also experience:

• Diarrhea
• Vomiting
• Fever
• Yellowing of the skin or eyes (jaundice)
• Bloody vomit
• Bloody or dark stool
• Pain that does not go away
• Unintentional weight loss

Should I go to the ER for stomach pain?

You should go to the emergency department if you have any of these signs of a more serious problem:

• Pain that shoots to your back
• High fever (102°F or above)
• Severe nausea bad enough that you can’t eat or take essential medications
• Vomiting blood or having bloody or black stool
• Severe, sudden belly pain that doesn’t going away
• Feeling like your abdomen is becoming hard
• Severe pain in the abdomen with any movement
• Vaginal bleeding or severe of abdominal pain in pregnancy
• Dizziness or lightheadedness
• Fainting or severe drop in blood pressure
• Fast pulse
• A history of heart attack