Abdominal Pain in Adults

Abdominal pain can range from mild stomach ache to severe acute pain. The pain is usually nonspecific and can be caused by a variety of conditions. Many organs are found within the abdominal cavity. Sometimes the pain is directly related to a specific organ such as the bladder or ovary. Usually, the pain originates in the digestive system. For example, the pain can be caused by appendicitis, diarrheal cramping, or food poisoning. 

The type and location of pain may help the physician find the cause. The intensity and duration of pain must also be considered when making the diagnosis. A few general characteristics of abdominal pain are as follows:

• Abdominal pain can be sharp, dull, stabbing, cramplike, knifelike, twisting, or boring. Many other types of pain are possible.



• Abdominal pain can be brief, lasting for a few minutes and then going away, or it can be constant. Sometimes abdominal pain comes on strongly for a while and then lessens for a while.



• Sometimes abdominal pain can hurt so much you throw up, but it stays intense. Other times, you will feel better after you throw up.



• Abdominal pain can make you want to stay in one place and not move a muscle. Or the pain can make you so restless you want to pace around trying to find "just the right position."

Many acute (short-term) and chronic (long-term) diseases cause abdominal pain. 

• Diseases people worry about most are appendicitis, gallbladder disease, ulcers, infections, and pregnancy problems.

• Doctors also worry about these, in addition to ruptured blood vessels, heart attacks, liver and pancreas inflammations, kidney stones, problems with circulation to the intestine, diverticulitis, and more.

Abdominal pain may not come from the abdomen.

• Some heart attacks and pneumonias can cause abdominal pain.

• Diseases in the pelvis or groin can also cause your abdomen to hurt.

• Certain rashes, such as shingles, can feel like abdominal pain, even though you have nothing wrong inside your body.

• Even some poisonings, such as a black widow spider bite, can cause severe abdominal pain.

The cause of abdominal pain is found only about half the time. The rest of the time, no specific cause is found, but the pain gets better in hours or days. If the pain persists, a cause is usually found.

Abdominal pain is a symptom. It may mean that you have a medical problem that needs treatment.

Abdominal pain may go along with other symptoms. Try to keep track of the symptoms, because this will help the health care provider find the cause of your pain.

Call or see your health care provider if you have any of the following:

• Abdominal pain that lasts more than 6 hours or is getting worse

• Pain that stops you from eating

• Pain and vomiting more than 3 or 4 times

• Pain that worsens when you try to move around

• Pain that starts all over, but settles into one area, especially the right lower abdomen

• Pain that wakes you up at night

• Pain with vaginal bleeding or pregnancy, even if you only think you might be pregnant

• Pain and fever over 101°F

• Pain along with inability to urinate, move your bowels, or pass gas

• Any other pain that feels different from a simple stomach ache

• Any other pain that alarms you or concerns you in any way

If you have any of the following, or cannot reach your health care provider, go to a hospital emergency department:

• The "worst pain of your life" or very severe pain

• Pain so bad you pass out or almost pass out

• Pain so bad you cannot move

• Pain and vomiting blood, or any vomiting that lasts more than 6 hours

• Pain and no bowel movement for more than 3 days

• Pain that reminds you of pain you had before, when you ended up needing surgery

• Pain that you think might be in your chest, but you're not sure

• Pain that seems to come from your testicles

Diagnosing the cause of abdominal pain is one of the hardest things for a health care provider to do.

• Sometimes all the provider can do is be sure that the pain does not require surgery or admission to the hospital.

• A diagnosis of "abdominal pain without peritonitis" means that you don't need surgery or antibiotics.

The health care provider may ask these or similar questions to try to determine what causes your pain. Some may seem silly, but try to answer them as honestly and completely as you can. The answers to these questions can help your health care provider find the cause of your 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 the last few days?

• What have you tried to make the pain better? Did it work?

• 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?

• 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 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 for you to breathe?

• Do you have heart disease? Diabetes? AIDS?

• Do you take steroids? Pain medicine such as aspirin or Motrin?

• Do you take antibiotics? Over-the-counter pills or herbs?

• Do you drink alcohol? Coffee? Tea?

• Do you smoke cigarettes?

• Do you use cocaine or other drugs?

Physical examination will include a careful examination of your abdomen, heart, and lungs to try to pinpoint the source of the pain.

• The examiner will touch different parts of the abdomen to check for tenderness or other signs that indicate the source of the pain.

• The examiner may do a rectal exam to check for hidden blood or other problems.

• If you are a man, the doctor may check your penis and testicles.

• If you are a woman, the doctor may do a pelvic exam to check for problems in your womb, ovarian tubes, and ovaries.

• The doctor also may look at your eyes for yellowing (jaundice) and your mouth to be sure you are not dehydrated.

Laboratory tests do little to help find the cause of abdominal pain. However, certain blood or urine tests may be ordered.

• The most important test 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 blood count (hemoglobin) may show that you are bleeding internally, but most conditions that involve bleeding are not painful.

• Blood in the urine, which may not be visible to the eye, may suggest you have a kidney stone.

• Other blood tests, such as liver enzymes and pancreas enzymes, can help determine which organ is involved, but they do not point to a diagnosis.

Radiology studies of your abdomen are even less useful.

• Occasionally, an x-ray will show air outside of your 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 health care provider suspects problems with the gallbladder or gallstones, pancreas, liver, or the reproductive organs of women.

• Ultrasound also assists diagnosis of problems with the kidneys and the spleen or the large blood vessels that come from the heart and supply the lower half of your body.

CT scan is a special type of x-ray that provides good information about the liver, pancreas, kidneys and ureters, spleen, and small and large intestine, including diseases such as appendicitis and diverticulitis.

The health care provider may perform no tests at all. The cause of your pain may be clear without tests and known not to be serious. If you do undergo tests, the provider should explain the results to you.

Most abdominal pain goes away without treatment.

|Self-Care at Home|

Abdominal pain without fever, vomiting, vaginal bleeding, passing out, chest pain, or other serious symptoms often gets better without special treatment.

• If the pain persists or if you believe the pain may represent a serious problem, you should see your health care provider.

• A heating pad or soaking in a tub of warm water may ease your pain.

• Over-the-counter 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, Liquiprin, Tylenol) may help. Try to avoid aspirin or ibuprofen (common brand names are Advil, Motrin, Midol, Nuprin, Pamprin IB). These drugs can make some types of stomach ache worse.

|Medical Treatment|

Your treatment will depend on the source of what the doctor thinks is causing your abdominal pain.

You may be given IV fluids. Your health care provider may ask you not to eat or drink anything until the cause of your pain is known.

You may be given pain medication.

• For pain caused by bowel spasm, you may be given a shot in the hip, arm, or leg.

• If you are not throwing up, you may receive a drink that has antacid in it or pain medication.

• Although your pain may not go away completely, you have the right to be comfortable and should ask for pain medicine until you are made comfortable.

An emergency department professional may ask another specialist such as a gynecologist, gastroenterologist, surgeon, or urologist to look at you.

|Surgery|

Some types of abdominal pain require surgical treatment.

• If your pain comes from an infected internal organ, such as the appendix or gallbladder, you will be admitted to a hospital and will need surgery.

• Bowel obstructions sometimes require surgery, depending on what is causing the obstruction.

• If your pain comes from a ruptured or perforated organ, such as your bowel or stomach, you will need immediate surgery and will be taken directly to an operating room.

|Follow-up|

If you are allowed to go home after your evaluation, you may be given instructions about what you can and cannot eat and drink and which medications you may take. You may be told to return to the emergency department if certain conditions occur.

If you are given no specific instructions, then follow these:

• 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.

• You may return to normal diet in a few days if your symptoms do not return.

Go back to the emergency department in any of these situations:

• Your pain worsens or if you start vomiting, get a high fever, or cannot urinate or move your bowels.

• You have any symptom that seems worse or alarms you.

• Your abdominal symptoms are not better in 24 hours.

|Prevention|

If the diagnosis is determined, you should follow the instructions specific for that diagnosis.

• If, for example, an ulcer causes the pain, you must avoid nicotine, caffeine, and alcohol.

• If it is caused by gallbladder disease, you have to avoid greasy, fatty, and fried foods.

|Outlook|

Overall, most pain goes away without surgery, 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 you have uncomplicated appendicitis or uncomplicated gallstones, you should recover from the surgery with no long-term problems.

• If you have a ruptured appendix or infected gallbladder, your 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 clot, the prognosis is poor.

For information about disorders of the digestive system that might cause abdominal pain, see the following Web sites. After you have seen your health care provider, you should have a better idea of what is causing your pain. Many diseases have their own Web sites.

|Web Links|

American Academy of Family Physicians Family Health and Medical Guide, Abdominal Pain, Short-Term 

American College of Gastroenterology, Patient Information

American Gastroenterological Association

National Digestive Diseases Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health

abdomen, acute abdomen, adhesions, belly pain, diverticulitis, gripes, stomach ache, tummy ache, appendicitis, gallbladder disease, ulcer, infection, ruptured blood vessel, heart attack, liver inflammation, pancreas inflammation, kidney stone, kidney stones, circulation to the intestine, abdominal pain, abdominal pain in adults, diarrhea, food poisoning, acute stomach pain, stomach pain, diarrheal cramping

Author: Joseph R Lex, Jr, MD, Assistant Professor, Department of Emergency Medicine, Temple University Hospital.

Editors: Scott H Plantz, MD, FAAEM, Research Director, Assistant Professor, Department of Emergency Medicine, Mount Sinai School of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, ; Anthony Anker, MD, FAAEM, Attending Physician, Emergency Department, Mary Washington Hospital, Fredericksburg, VA.