- Abdominal (belly) pain is pain or discomfort that is felt in the part of the trunk below the ribs and above the pelvis.
- It comes from organs within the abdomen or organs adjacent to the belly.
- It is caused by inflammation, distention of an organ, or by loss of the blood supply to an organ.
- In irritable bowel syndrome (IBS) it may be caused by contraction of the intestinal muscles or hyper-sensitivity to normal intestinal activities.
- Symptoms associated with it may include:
- The cause of abdominal pain is diagnosed on the basis of its characteristics, the physical examination, and testing. Occasionally, surgery is necessary for diagnosis.
- The medical diagnosis of the cause is challenging because the characteristics may be atypical, tests are not always abnormal, diseases causing pain may mimic each other, and the characteristics of the pain may change over time.
- Medical treatment depends upon the patient’s history of disease or other health conditions that may be the cause.
What is abdominal pain?
Abdominal pain is felt in the abdomen. The abdomen is an anatomical area that is bounded by the lower margin of the ribs and diaphragm above, the pelvic bone (pubic ramus) below, and the flanks on each side. Although pain can arise from the tissues of the abdominal wall that surround the abdominal cavity (such as the skin and muscles), the term abdominal pain generally is used to describe discomfort originating from organs within the abdominal cavity. Organs of the abdomen include the stomach, small intestine, colon, liver, gallbladder, spleen, and pancreas.
Technically, the lowermost portion of the area described previously, is the pelvis, which contains the urinary bladder and rectum, as well as the prostate gland in men, and the uterus, Fallopian tubes, and ovaries in women. Often, it can be difficult to know if lower abdominal pain is coming from the lower abdomen or pelvis (pelvic pain).
Occasionally, pain may be felt in the belly even though it is arising from organs that are close to, but not within, the abdominal cavity, for example, conditions of the lower lungs, the kidneys, and the uterus or ovaries. On the other hand, it also is possible for pain from organs within the belly to be felt outside of the it. For example, the pain of pancreatic inflammation may be felt in the back. These latter types of pain are described as “referred” because it does not originate in the location that it is felt. Rather, the cause is located away from where it is felt (i.e., it is referred to a different area).
Picture of the organs and glands in the abdomen.
What causes abdominal pain?
Abdominal pain is caused by inflammation of an organ (for example, appendicitis, diverticulitis, colitis), by stretching or distention of an organ (for example, obstruction of the intestine, blockage of a bile duct by gallstones, swelling of the liver with hepatitis), or by loss of the supply of blood to an organ (for example, ischemic colitis).
To complicate matters, however, abdominal pain also can occur without inflammation, distention or loss of blood supply. An important example of the latter is the irritable bowel syndrome (IBS). It is not clear what causes the belly pain in IBS, but it is believed to be due either to abnormal contractions of the intestinal muscles (for example, spasm) or abnormally sensitive nerves within the intestines that give rise to painful sensations inappropriately (visceral hyper-sensitivity). This often is referred to as functional pain because no recognizable specific abnormality to account for the cause of the pain has been found – at least not yet.
Quick GuideWhat’s Causing Your Abdominal Pain?
Abdominal Pain Causes
Abdominal pain is a common symptom, and most people have experienced some sort of abdominal pain (belly or stomach pain). Causes of more serious causes of abdominal pain include:
- Bloody stools
- Black tarry stools
- Painful urination
- Lack of urination
- Abrupt cessation of bowel movements
Signs, symptoms, locations, types, and severity of abdominal pain
Doctors will ask you a variety of questions about your belly pain in order to help find the possible causes of it, for example:
How did the pain begin?
- If it comes on suddenly, this may suggest a problem with an organ within the belly; for example, the interruption of the supply of blood to the colon (ischemia) or obstruction of the bile duct by a gallstone (biliary colic).
Where is the pain located?
- Appendicitis typically causes discomfort in the middle of the abdomen, and then moves to the right lower abdomen, the usual location of the appendix.
- Diverticulitis typically causes discomfort in the left lower abdomen where most colonic diverticuli are located.
- Discomfort from the gallbladder (biliary colic or cholecystitis) typically is felt in the middle, upper abdomen or the right upper abdomen near where the gallbladder is located.
What is the type and pattern of the pain?
- Is it severe, crampy, steady; or does it wax and wane? Obstruction of the intestine initially causes waves of crampy pain due to contractions of the intestinal muscles and distention of the intestine. True cramp-like pain suggests vigorous contractions of the intestines.
- Obstruction of the bile ducts by gallstones typically causes steady (constant) upper belly pain that lasts between 30 minutes and several hours.
- Acute pancreatitis typically causes severe, unrelenting, steady pain in the upper abdomen and upper back.
- The pain of acute appendicitis initially may start near the umbilicus, but as the inflammation progresses, it moves to the right lower abdomen.
- The character of pain may change over time. For example, obstruction of the bile ducts sometimes progresses to inflammation of the gallbladder with or without infection (acute cholecystitis). When this happens, the characteristics change to those of inflammatory pain.
How long does the pain last?
- The discomfort of IBS typically waxes and wanes over months or years and may last for years or decades.
- Biliary colic lasts no more than several hours.
- The pain of pancreatitis lasts one or more days.
- The pain of acid-related diseases – gastroesophageal reflux disease (GERD) or duodenal ulcers – typically occurs over a period of weeks or months that is worse followed by periods of weeks or months during which it is better (periodically).
- Functional pain may show this same pattern of periodicity.
What makes the pain worse?
- Pain due to inflammation (appendicitis, diverticulitis, cholecystitis, and pancreatitis) typically is aggravated by sneezing, coughing or any jarring motion. Individuals with inflammation prefer to lie still.
- What health conditions make abdominal pain worse or better?
What relieves the pain?
- The pain of IBS and constipation often is relieved temporarily by bowel movements and may be associated with changes in bowel habit.
- Pain due to obstruction of the stomach or upper small intestine may be relieved temporarily by vomiting which reduces the distention that is caused by the obstruction.
- Eating or taking antacids may temporarily relieve ulcer pain from the stomach or duodenum because both food and antacids neutralize the acid that is responsible for irritating the ulcers and causing the pain.
- Pain that awakens a patient from sleep is more likely to be due to non-functional causes and is more significant.
- Other associated symptoms that accompany abdominal pain may suggest:
- Fever suggests inflammation or infection.
- Diarrhea or rectal bleeding suggests an intestinal cause.
- Fever and diarrhea suggest inflammation of the intestines that may be infectious or non-infectious.
- How is the cause of abdominal pain diagnosed?
- Doctors determine the cause of the pain by relying on:
- Its characteristics, physical signs, and other accompanying symptoms
- Findings on physical examination
- Medical laboratory, radiological, and endoscopic testing
How is the cause of abdominal pain diagnosed?
Doctors determine the cause of the pain by relying on:
- Characteristics, physical signs, and other accompanying symptoms
- Findings on physical examination
- Laboratory, radiological, and endoscopic testing