What is abdominal pain?

Abdominal pain^[1] is pain that occurs anywhere in the abdomen (the region of the body between the diaphragm and pelvis). This pain is commonly referred to as a stomachache, bellyache, or tummy ache.Just about everyone experiences abdominal pain from time to time. Usually, this pain is mild and short-lived and isn’t a cause for concern. However, the severity of your pain may not always reflect^[2] the severity of the underlying problem causing it: severe acute stomach pain may be the result of a common condition like viral gastroenteritis (a stomach virus), while some life-threatening illnesses, including appendicitis and colon cancer, may cause little to no pain. Abdominal pain often comes and goes. When this is the case, it is referred to as acute (short-lived). Some people, however, may experience recurrent abdominal pain for weeks, months, or years. Chronic (long-lasting) abdominal pain may be the result of gastrointestinal diseases, such as inflammatory bowel disease (IBD). Ultimately, a range of factors and conditions may cause abdominal pain. While everyday issues, such as constipation and lactose intolerance, may cause mild to moderate stomach discomfort, abdominal pain may also be the sign of a more serious condition, such as gastroesophageal reflux disease (GERD) or cancer. Abdominal pain may not even be caused by a problem in the belly, as is the case with menstrual cramps and even heart attacks.

Chronic functional abdominal pain (CFAP)

Gastrointestinal (GI) disorders—disorders that affect the digestive tract—commonly cause abdominal pain. This is usually the result of diarrhea or constipation (often seen in irritable bowel syndrome [IBS]) or damage to the intestinal walls (as occurs in Crohn’s disease and ulcerative colitis). One much less common disorder that causes recurrent abdominal pain is known as chronic functional abdominal pain^[3] (CFAP). Unlike these conditions, CFAP is not associated with changes in bowel patterns. Rather, it is a functional GI disorder that results from hypersensitive nerve impulses in the gut and brain. The pain associated with CFAP can be severe, in some cases becoming debilitating, interfering with all aspects of day-to-day life, and resulting in a lower quality of life.

Causes of abdominal pain

There are many different potential causes^[4] of abdominal pain. The most common of these, including indigestion, gas pain, and pulled or strained abdominal muscles, usually aren’t a cause for alarm. Common, less serious causes of abdominal pain include^[5]:

• Indigestion
• Heartburn
• Food allergies or intolerance (e.g., lactose intolerance)
• Diarrhea
• Constipation
• Irritable bowel syndrome (IBS)
• Viral gastroenteritis (stomach virus)
• Food poisoning

Other potentially serious causes of abdominal pain include:

• Bowel obstruction or blockage
• Appendicitis (swelling or infection of the appendix)
• Pancreatitis (swelling or infection of the pancreas)
• Cancer of the colon, stomach, or other organs
• Kidney stones
• Inflammatory bowel disease (IBD); includes Crohn’s disease and ulcerative colitis
• Gastroesophageal reflux disease (GERD)
• Ulcers (raw or open sores) in the GI tract
• Diverticulitis (inflammation and infection of the colon)
• Ischemic bowel (decreased blood supply to the intestines)
• Abdominal aortic aneurysm (weakening and bulging of the body’s major artery)

Some abdominal pain may not even result from problems in the abdomen: heart attacks, pneumonia, skin rashes (such as shingles), menstrual cramps, and conditions in the pelvis or groin can all cause abdominal pain. Other causes of abdominal pain not originating in the abdomen include:

• Urinary tract infection (UTI)
• Endometriosis (a disorder in which the tissue that lines the uterus grows outside the organ, including on the ovaries, fallopian tubes, or intestines)
• Pelvic inflammatory disease (PID)
• Ectopic (tubal) pregnancy
• Ruptured ovarian cyst

Chronic abdominal pain

Different types of abdominal pain (acute and chronic) may have different causes. While acute abdominal pain may be caused by any of the above conditions, chronic abdominal pain (pain that is present for more than three months) is more commonly caused by^[6]:

• GERD
• Gastritis (inflammation of the stomach lining)
• Celiac disease
• Irritable bowel syndrome (IBS)
• Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis
• Strained abdominal muscles
• Endometriosis
• Ovarian cysts
• Mittelschmerz (one-sided pain during ovulation)
• Pelvic inflammatory disease (PID)
• Angina (chest pain caused by reduced flow of blood to the heart)
• Gallstones
• Peptic ulcers
• Hiatal and inguinal hernia
• Functional dyspepsia
• Sickle cell anemia

Progressive abdominal pain causes

Progressive abdominal pain refers to abdominal pain that worsens steadily (progresses) over time. This type of abdominal pain is usually serious, and people who experience it often develop other related symptoms. Common causes^[7] of progressive abdominal pain include:

• Crohn’s disease
• Cancer (including cancers of the gallbladder, kidney, liver, pancreas, and stomach, as well as non-Hodgkin’s lymphoma)
• Hepatitis
• Splenomegaly (enlarged spleen)
• Uremia (buildup of waste products in the blood)
• Lead poisoning
• Tubo-ovarian abscess (an abscess, or collection of pus, affecting a fallopian tube and ovary)

Abdominal pain symptoms

Most cases of abdominal pain aren’t severe. However, the type of pain experienced—even in mild cases of abdominal pain—can vary greatly. Abdominal pain may^[8]:

• Come and go in waves or be constant
• Be brief or long-lasting
• Occur in a short-lived episode (acute) or recur frequently (chronic)
• Feel sharp or stabbing
• Be dull or crampy
• Make you want to stay still, or make you so restless that you shift around trying to find the “right position” to help relieve the pain
• Make you vomit

Abdominal pain may also be described as:

• Generalized: Generalized abdominal pain is felt in more than half of the abdomen. This type of pain is common in the case of stomach viruses, gas, or indigestion. Generalized pain that worsens may indicate a blockage in the intestines.
• Localized: Localized abdominal pain is limited to one region of the abdomen. This is more likely to be indicative of a problem in an organ, such as the stomach, appendix, or gallbladder.
• Cramp-like: In most cases, cramp-like abdominal pain isn’t the sign of a serious issue. This is often caused by gas or bloating and is frequently followed by diarrhea. Menstrual cramps are another common cause of this type of abdominal pain.

Cramp-like pain may indicate a more serious problem if it occurs more and more frequently, lasts for longer than 24 hours, or is accompanied by a fever.

• Colicky: Colicky pain is commonly caused by kidney stones and gallstones. This type of abdominal pain is often severe and comes and goes in waves, starting and stopping abruptly.

As previously stated, nearly everyone has abdominal pain from time to time. Most cases of stomach pain aren’t a cause for concern. It’s important, however, to know what types of stomach pain may warrant medical attention. In general^[9], pain located near the center of the abdomen is less likely to indicate a serious problem than pain further away from the center. Additionally, localized pain that’s chronic or progressive is often the sign of a more serious underlying disease. You should contact your healthcare provider immediately^[10] if you experience abdominal pain that’s so severe that you can’t move without worsening your pain or that you’re unable to sit still and find a comfortable position. You should also contact your provider if your abdominal pain does not improve within 24–28 hours, becomes more severe and frequent, occurs with nausea/vomiting, and/or lasts for one week or longer. Additionally, seek prompt medical attention if your abdominal pain is accompanied by:

• Fever over 100°F (37.7°C) in adults or 100.4°F (38°C) in children
• Persistent nausea/vomiting
• Diarrhea lasting for more than 5 days
• Bloating lasting for more than 2 days
• Abdominal swelling
• Severe tenderness when touching the abdomen
• Frequent urination or burning sensation during urination
• Weight loss or prolonged reduced appetite
• Prolonged vaginal bleeding
• Yellowed skin

Seek emergency medical care or dial 911 if your stomach is tender or rigid to the touch or if you have abdominal pain and:

• Have shoulder, neck, or chest pain (may be a sign of heart attack)
• Recently injured your abdomen
• Have pain in or between your shoulder blades accompanied by nausea
• Have difficulty breathing
• Have bloody stools or are vomiting blood
• Are unable to pass stool (especially if you are also vomiting)
• Are pregnant or could be pregnant
• Are currently being treated for cancer