What abdominal pain is and how it varies
Abdominal pain is a sensation from any organ in the belly: the stomach, intestines, gallbladder, pancreas, liver, kidneys, urinary tract and, in women, the uterus and ovaries. It can be dull, burning, cramping or sharp, sudden or building up. Where it hurts is only a guide: the organs lie close together, and pain often spreads to another part of the body. So it cannot be diagnosed from a text, but you can judge how urgent it is.
Pain in the upper abdomen and under the ribs
Burning or heaviness in the upper abdomen after eating, with nausea and belching, is more often tied to the stomach: gastritis, indigestion, reflux or an ulcer. If it keeps coming back or disturbs your sleep, see a general practitioner or a gastroenterologist. For heartburn, see Heartburn.
Pain under the right ribs, especially after fatty food, is sometimes linked to the gallbladder. If a fever, chills or yellow skin or eyes join it, you need help quickly (see Jaundice).
Pain around the navel
Pain in the middle of the belly happens with bloating and intestinal infections, but also at the start of appendicitis. If it gradually moves to the lower right and gets worse, call for medical help promptly.
Abdominal pain on the lower right
The cecum and appendix sit in the lower right abdomen. The classic picture of acute appendicitis is pain that begins around the navel or in the upper belly, shifts to the lower right within hours, worsens with walking, coughing and bumps, and comes with nausea, loss of appetite and a mild fever. But not every pain on the lower right is appendicitis. Intestinal and urinary problems can cause it too, and in women so can the ovaries and fallopian tubes. If pain on the lower right is building, do not wait for days and do not try to test for appendicitis by pressing on the belly: seek urgent care.
Abdominal pain on the left
Pain in the lower left is more often tied to the bowel: constipation, trapped gas, irritable bowel syndrome or inflamed pouches in the colon wall. In women, ovarian problems can cause it, and in anyone the urinary tract and kidneys can. If it keeps returning, comes with a change in stools or bloating, see a gastroenterologist, and do not delay if severe pain comes with a fever. We have separate pages on Bloating, Constipation and Diarrhea.
Pain in the upper left, under the ribs, may reflect the stomach or pancreas, and occasionally the heart. If it comes with chest pressure, shortness of breath or a cold sweat, call 112.
Lower abdominal pain in women
In women, lower abdominal pain is often tied to the menstrual cycle: painful periods or ovulation. But it can also signal an ovarian cyst, inflammation of the ovaries and tubes, endometriosis or, in the first weeks of pregnancy, an ectopic pregnancy, which needs urgent care. If pain is sharp, on one side, with a missed period, spotting, weakness or fainting, do not wait. Pain with a fever or unusual discharge is also a warning sign. For related symptoms, see Irregular periods and Vaginal discharge. See a gynecologist.
Abdominal pain that radiates to the back
Abdominal pain that spreads to the back occurs with pancreas, gallbladder, kidney and urinary tract problems, a stomach ulcer and spine problems. Severe pain in the upper belly that wraps around to the back, especially with repeated vomiting, needs urgent assessment. Pain in the side and lower back with frequent or painful urination and a fever can point to the kidneys: see Painful urination. If the back hurts on its own, see Back pain.
Abdominal pain in a child
Children often complain of a tummy ache with a cold, stress, constipation or an intestinal infection. But in a small child who cannot say where it hurts, constant crying, drawing the knees to the belly, refusing food and drink, drowsiness, green vomit, blood in the stool or a fever are worrying. See a pediatrician urgently in these cases. For nausea and vomiting, see Nausea and vomiting, and for poisoning, Food poisoning.
What you can do before the visit
- If the pain is severe, building or comes with warning signs, do not wait: call an ambulance (112) or go to the emergency department. It is better not to drive yourself.
- If you suspect an acute problem, do not take painkillers or laxatives and do not apply a heating pad. They blur the picture and can do harm.
- Until the cause is clear, stick to small sips of water and light food. If you are vomiting or a surgeon may need to examine you, it is better not to eat.
- Note when the pain began, where it is, how it changed, what you ate and took, your temperature and stools. It helps the doctor.
- For mild, recurring pain, keep a short diary: its link to meals, stools and periods.
How a doctor finds the cause
The doctor asks about the pain and other symptoms, then examines and palpates the belly. Blood, urine and stool tests may follow, an ultrasound of the abdomen and pelvis, and if needed endoscopy, a CT scan or a surgeon's opinion. In women, the pelvic organs are assessed, and a pregnancy test is done if pregnancy is possible. Treatment depends on the cause: sometimes a diet and watchful waiting are enough, and sometimes emergency surgery is needed.