Facts and Definition of Abdominal Pain in Adults
- Abdominal pain is the feeling of pain in a person's stomach, upper or lower abdomen, and can range in intensity from a mild stomach ache to severe acute pain.
- Causes of symptoms of abdominal pain vary and may include gallbladder disease, ulcers of the stomach, food poisoning, diverticulitis, appendicitis, cancers, gynecologic (for example, fibroids, cysts, sexually transmitted diseases - STDs, and vascular problems.
- Some women experience abdominal pain during pregnancy.
- Abdominal pain can be acute or chronic and include sharp pain as well as dull pain.
- The location of the abdominal pain may be in the upper right or left side (quadrant), lower right or left side, and upper, middle, and lower.
- The cause of abdominal pain is diagnosed by a combination of history (questions the doctor asks you about your problem), physical examination (examination by a doctor), and testing (for example, X-rays and blood tests).
- Treatment for abdominal pain depends upon the cause and may include anything from observation, medications and procedures that include endoscopy, and surgery.
- The prognosis for abdominal pain depends on the cause and the promptness of medical care and diagnosis.
Type and Location of the Abdominal Pain
The type and location of pain may help the doctor find the cause. The intensity and duration of pain must also be considered when making a diagnosis. A few general characteristics of abdominal pain are:
- What the pain feels like: Abdominal pain can be sharp, dull, stabbing, cramp-like, knifelike, twisting, or piercing. Many other types of pain are also possible.
- How long the pain lasts: Abdominal pain can be brief, lasting for a few minutes, or it may persist for several hours and longer. Sometimes abdominal pain comes on strongly for a while and then lessens in intensity for a while. Is the pain continuous or does it come and go?
- Events that trigger pain: The pain may be worsened or relieved by certain events, such as worse after meals, better with a bowel movement, better after vomiting, or worse when lying down. Do certain foods trigger the pain?
- Location of the pain - The location often will help your doctor diagnose the cause of the pain.
Abdominal Pain Causes and Location (Right, Left, Lower, Upper)
Abdominal pain is caused by
- inflammation (appendicitis, diverticulitis, colitis),
- by stretching or distention of an organ (for example, gallstones, hepatitis),
- by loss of the supply of blood to an organ (for example, ischemic colitis).
What are Symptoms of Abdominal Pain in Adults?
Abdominal pain is a symptom. It may mean that the person has a medical problem that needs treatment.
Abdominal pain may go along with other symptoms. Keep track of your symptoms because this will help the doctor find the cause of your pain. Make a special note if there is sudden abdominal pain, severe abdominal pain after, eating or abdominal pain with diarrhea.
What Are the Causes of Abdominal Pain in Adults?
Many acute (short-duration) and chronic (long-duration) diseases cause abdominal pain.
The diseases that most people are concerned about having are gastritis, appendicitis, kidney stones, gallbladder pain disease, duodenal and gastric ulcers, infections, and pregnancy-associated problems since these are the most common. Doctors also are concerned about ruptured blood vessels, heart attacks, liver and pancreas inflammation, kidney stones, problems with the blood circulation to the intestine, diverticulitis, cancers, and other diseases.
Abdominal pain may not arise from the abdomen.
- Some heart attacks and pneumonias can cause abdominal pain, and even nausea.
- Diseases of the pelvis or groin can also cause abdominal pain in adults.
- Testicular problems often can cause lower abdominal pain.
- Certain skin rashes, such as shingles, can feel like abdominal pain, even though the person has nothing wrong inside their body.
- Even some poisonings and bites, such as a black widow spider bite, can cause severe abdominal pain.
What are Some of the Causes of Abdominal Pain by Location?
Abdominal pain can occur in any area of the abdomen. You might experience pain in one area of the abdomen although the cause for the pain is in a different area. Some diseases can cause pain in multiple areas of the abdomen. Below are the usual pain patterns associated with diseases, but please note that this does not include all diseases and conditions, and the below do not hold true all of the time.
Pain in the Upper Abdomen
- Stomach Ulcers
Pain in the Upper Right Side
- Gallbladder Disease
- Liver Inflammation (Hepatitis)
Pain in the Upper Left Side
Pain in the Lower Right Side
- Other diseases and conditions of the uterus
- Right Ovarian Inflammation or Torsion
- Right Ovarian Cyst
Pain in the Lower Left Side
- Left Ovarian Inflammation or Torsion
- Left Ovarian Cyst
Pain in the Lower Abdomen
From the above it is apparent that abdominal pain can have many causes, some linked directly to the abdomen and others caused by non-abdominal disease. Sometimes the cause of abdominal pain is not determined, and the you may be asked to return the next day to recheck and you possibly may need more tests. In some cases, no specific cause is determined, and the pain gets better in hours or days.
When Should an Adult Seek Medical Care for Abdominal Pain?
Call or see a doctor if the affected person has any of the following:
- Abdominal pain that lasts more than six hours or continues to worsen
- Severe abdominal pain
- Abdominal pain after eating
- Pain that stops a person from eating
- Pain accompanied by vomiting more than three or four times
- Abdominal pain during pregnancy
- Pain that worsens when a person tries to move around
- Pain that starts all over, but settles into one area, especially the right lower abdomen
- Pain that awakens a person up at night
- Pain with vaginal bleeding or pregnancy, even if a female only thinks she might be pregnant
- Pain accompanied by fever over 101 F (33.3 C)
- Pain along with inability to urinate, move the bowels, or pass gas
- Any other pain that feels different from a simple stomach ache
- Any other pain that alarms a person, or concerns them in any way
If the person has any of the following, or cannot reach their doctor, go to a hospital emergency department:
- Very severe pain
- Pain so bad the affected person passes out or almost passes out
- Pain so bad the affected person cannot move
- Pain and vomiting blood, or any vomiting that lasts more than six hours
- Pain and no bowel movement for more than three days
- Pain the person thinks might be in their chest, but they aren't sure
- Pain that seems to come from the person's testicles
What Kind of Doctor Treats Abdominal Pain in Adults?
Abdominal pain can be treated by a variety of doctors depending on the cause of the pain. It is usually best to start off with a primary care physician who can start the process of diagnosing the origin of the pain. Depending on the final diagnosis you will be treated by a primary care doctor (i.e. ulcers, infection) or referred to a surgeon (appendicitis, ovarian torsion), gastroenterologist, or gynecologist. If the pain is severe you might end up in the emergency department where an emergency medicine physician will be the first one to take care of you.
What Questions will the Doctor ask about my Abdominal Pain?
Diagnosing the cause of abdominal pain is one of the hardest tasks for a doctor. Sometimes all that the professional can do is be sure that the pain does not require surgery or admission to the hospital.
The healthcare professional may ask these or similar questions to try to determine what is causing the patient's pain. Some may seem unrelated to the patient's current condition, but it is important to try to answer them as completely as possible. The answers to these questions can help the healthcare professional find the cause of the patient's pain more quickly and easily.
- How long have you had the pain?
- What were you doing when it started?
- How did you feel before the pain started?
- Have you felt OK over the last few days?
- What have you tried to make the pain better? Did it work?
- What makes the pain worse?
- Where is the pain located?
- Does the pain make you want to stay in one place or move around?
- How was the ride to the hospital? Did riding in the car hurt you?
- Is the pain worse when you cough?
- Have you thrown up?
- Did throwing up make the pain better or worse?
- Have your bowel movements been normal?
- When was your last bowel movement?
- Are you passing gas?
- Do you feel you might have a fever?
- Have you had a pain like this before? When? What did you do for it?
- Have you ever had surgery? What surgery? When?
- Are you pregnant? Are you sexually active? Are you using birth control?
- Have you been around anyone with symptoms like this?
- Have you traveled out of the country recently?
- When did you eat last? What did you eat?
- Did you eat anything out of the ordinary?
- Did your pain start all over your stomach and move to one place?
- Does the pain go into your chest? Into your back? Where does it go?
- Can you cover the pain with the palm of your hand, or is the hurting area bigger than that?
- Does it hurt to breathe?
- Do you have any medical problems such as heart disease, diabetes, or AIDS?
- Do you take steroids? Pain medicine such as aspirin or Motrin?
- Do you take antibiotics? Over-the-counter pills, herbs, or supplements?
- Do you drink alcohol? Coffee? Tea?
- Do you smoke cigarettes?
- Of course, the doctor may not need to ask all if these questions or may need to ask additional questions depending on the symptoms.
How Is the Cause of the Abdominal Diagnosed?
Physical examination will include a careful examination of the patient's abdomen, heart, and lungs in order to pinpoint the source of the pain.
- The doctor will touch different parts of the abdomen to check for tenderness or other signs that indicate the source of the pain.
- The doctor may do a rectal exam to check for small amounts of blood in the stool or other problems such as a mass or internal hemorrhoids.
- If the patient is a man, the doctor may check the penis and testicles.
- If the patient is a woman, the doctor may do a pelvic exam to check for problems in the uterus, Fallopian tubes, and ovaries.
- The doctor also may look at the patient's eyes for yellow discoloration (jaundice) and in the mouth to be sure the patient is not dehydrated.
Laboratory tests may or may not help to determine the cause of the abdominal pain. Combined with the information gained from the questions the patient was asked and the physical examination performed by the doctor, certain blood or urine tests may be ordered and could assist in determining the diagnosis.
- One of the most important tests is to see if a woman is pregnant.
- A raised white blood cell count may mean infection or may just be a reaction to the stress of pain and vomiting.
- A low red blood count (hemoglobin) may mean that a patient is bleeding internally, but most conditions that involve bleeding are not painful.
- Blood in the urine, which may not be visible to the eye, suggests that a patient may have a kidney stone.
- Other blood tests, such as liver enzymes and pancreas enzymes, can help determine which organ the cause of the pain, but they do not point to a diagnosis.
Radiology studies of the patient's abdomen can be useful, but are not always necessary or helpful.
- Occasionally, an X-ray will show air outside of the bowel, meaning that something has ruptured or perforated.
- An X-ray also can help diagnose bowel obstruction.
- Sometimes X-rays can show a kidney stone.
Ultrasound is a painless procedure useful in finding some causes of abdominal pain.
- This may be done if the doctor suspects problems with the gallbladder, pancreas, liver, or the reproductive organs of women.
- Ultrasound also assists in the diagnosis of problems with the kidneys and the spleen, or the large blood vessels that come from the heart and supplies blood to the lower half of the body.
Computerized tomography (CT scan) provides useful information about the liver, pancreas, kidneys and ureters, spleen, and small and large intestine.
The patient and doctor should discuss the need for an X-ray or CT scan and their associated radiation exposure before proceeding with any radiological examination.
MRI is usually less helpful then a CT scan when the abdomen is examined, although with certain problems and symptoms your healthcare professional may order an MRI rather than a CT scan or in follow up to any of the above examinations.
The doctor may perform no tests at all. The cause of the patient's pain may be clear without any tests and may be known not to be serious. If the patient does undergo tests, the professional should explain the reason, contraindications, and the results to them.
What Home Remedies Soothe Abdominal Pain in Adults?
Abdominal pain without fever, vomiting, vaginal bleeding, passing out, chest pain, or other serious symptoms often get better without special treatment.
- If the pain persists or if a person believes the pain may represent a serious problem, they should see a doctor.
- A heating pad or soaking in a tub of warm water may ease pain.
- Over-the-counter (OTC) antacids, such as Tums, Maalox, or Pepto-Bismol, also can reduce some types of abdominal pain. Activated charcoal capsules also may help.
- Acetaminophen (common brand names are Arthritis Foundation Pain Reliever, Aspirin Free Anacin, Panadol, Tylenol) may help. This product should be avoided if liver disease is suspected. Patients should try to avoid aspirin or ibuprofen (common brand names are Advil, Motrin, Nuprin, Pamprin IB) stomach or intestinal ulcer disease is suspected; these drugs can make the pain worse.
What is the Medical Treatment for Causes of Abdominal Pain in Adults?
The patient's treatment will depend on what the doctor thinks is causing the abdominal pain.
The patient may be given IV (intravenous) fluids. The doctor may ask the patient not to eat or drink anything until the cause of the pain is known. This is done to avoid worsening certain medical conditions (for example adding food to the stomach if there is a ruptured ulcer) or to prepare the patient in case they need to have surgery. (An empty stomach is better when general anesthesia is needed.)
The patient may be given pain medication.
- For pain caused by bowel spasm, they may be given a shot in the hip, arm, or leg.
- If the patient is not throwing up, they may receive a drink that has antacid in it or pain medication.
- Although the patient's pain may not go away completely, they have the right to be comfortable and should ask for pain medicine until they are made comfortable.
Is Surgery Necessary for Some Causes of Abdominal Pain in Adults?
Some types of abdominal pain require surgical treatment.
- If the patient's pain comes from an infected internal organ, such as the appendix or gallbladder, they will be admitted to a hospital and will require hospitalization, observation, and finally possibly surgery.
- Bowel obstruction sometimes requires surgery, depending on what is causing the obstruction, how much bowel is obstructed, and whether or not the obstruction is temporary.
- If the patient's pain comes from a ruptured or perforated organ, such as the bowel or stomach, they will need immediate surgery and will be taken directly to an operating room.
Do I Need to Follow-up with My Doctor After Having Abdominal Pain?
If the person is allowed to go home after their evaluation, they may be given instructions about what they can and cannot eat and drink and which medications they may take. The person may be told to return to the emergency department if certain conditions develop.
If the person is given no specific instructions they should follow these recommendations:
- As soon as you feel like eating, start with clear liquids.
- If clear liquids cause no further pain or vomiting, progress to "bland" foods such as crackers, rice, bananas, applesauce, or toast.
- If your symptoms don't return in a few days return to your normal diet.
Patients should return to the emergency department or doctor in the following situations.
- The pain worsens or if the patient starts vomiting, has a high fever, or cannot urinate or move their bowels
- Any symptom that worsens or is alarming
- Abdominal symptoms are not better in 24 hours
Can Abdominal Pain in Adults be Prevented?
If the cause of the pain determined a person should follow the instructions specific for the diagnosis.
- If, for example, an ulcer causes the pain, the person must avoid nicotine, caffeine, and alcohol.
- If it is caused by gallbladder disease, the person should avoid greasy, fatty, and fried foods.
What is the Outlook for an Adult with Abdominal Pain?
Overall, many types of pain go away without surgery and never determining the cause, and most people need only relief from their symptoms.
Medical causes of abdominal pain generally have a good outcome, but there are exceptions.
Surgical causes of abdominal pain have varying outcomes depending on the severity of the condition and the person's underlying medical condition.
- If the patient has uncomplicated appendicitis requiring surgery or uncomplicated gallstones, they should recover from the surgery with no long-term problems.
- If the patient has a ruptured appendix or infected gallbladder, recovery may take longer.
- Abdominal pain from a perforated ulcer or blocked bowel may mean major surgery and a long recovery.
For problems with a major blood vessel, such as rupture or blood clot, the prognosis may be less poor.
In general, the older the person is and the more underlying conditions they have, the worse the outcome of a surgical intervention.
Reviewed on 11/14/2017
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.