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).

Abdominal pain facts

• 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:

• Bloating
• Belching
• Gas (flatus, farting)
• Indigestion
• Discomfort in the upper left or right; middle; or lower left or right abdomen
• Constipation
• Diarrhea
• GERD (gastro-esophageal reflux disease)
• Heartburn
• Chest discomfort

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 has been found – at least not yet.

Abdominal Pain: Symptoms & Signs

Pain in the belly (abdomen) can come from conditions affecting a variety of organs. The abdomen is an anatomical area that is bounded by the lower margin of the ribs above, the pelvic bone (pubic ramus) below, and the flanks on each side. Although abdominal pain can arise from the tissues of the abdominal wall that surround the abdominal cavity (for example, skin and abdominal wall muscles), the term abdominal pain generally is used to describe pain originating from organs within the abdominal cavity (for example, beneath the skin and muscles).

These organs include the stomach, small intestine, colon, liver, gallbladder, and pancreas. Occasionally, pain may be felt in the abdomen even though it is arising from organs that are close to but not within the abdominal cavity, for example, the lower lungs, the kidneys, and the uterus or ovaries. This latter type of pain is called “referred” pain because the pain, though originating outside the abdomen, is being referred to (felt) in the abdominal area.

Abdominal pain can be acute and sudden in onset, or the pain can be chronic and longstanding. Abdominal pain may be minor and of no great significance, or it can reflect a major problem involving one of the organs in the abdomen. The characteristics of the pain — location, timing, duration, etc. are important in diagnosing its cause. Persisting abdominal pain should be evaluated by a physician.

Various causes of abdominal pain include, but are not limited to, indigestion after eating, gallstones and gallbladder inflammation (cholecystitis), pregnancy, gas, inflammatory bowel disease (ulcerative colitis and Crohn’s disease), appendicitis, ulcers, gastritis, gastroesophageal reflux disease (GERD), pancreatitis, gastroenteritis (viral or bacterial), parasite infection, endometriosis, kidney stones (nephrolithiasis), abdominal muscle injury, abdominal hernia, lactose intolerance, gluten intolerance (celiac disease), food poisoning, menstrual cramps, peritonitis, serositis, ischemic bowel disease, vasculitis, abdominal aneurysm, abdominal organ injury from trauma, and constipation.

How is the Cause of Abdominal Pain Diagnosed?

Doctors determine the cause of abdominal pain by relying on:

• Characteristics of the pain
• Physical examination
• Exams and tests
• Surgery and endoscopy

Diagnosis – Characteristics of the Pain

Information obtained by taking a patient’s history is important in helping doctors determine the cause of pain. This includes the way the pain begins, its location, pattern, and duration. It also includes what makes the pain worse as well as what relieves it. Associated signs and symptoms, such as fever, diarrhea, or bleeding also are considered.

Characteristics of the Pain – The Way the Pain Begins

When does the pain occur? Always? More often in the morning or at night? If the pain comes and goes, about how long does it last each time? Does it occur after eating certain types of foods or after drinking alcohol? During menstruation? These are typical questions your doctor may ask that may help determine the cause. For example, abdominal pain that comes on suddenly may suggest a sudden event such as the interruption of the supply of blood to the colon (ischemia) or obstruction of the bile duct by a gallstone (biliary colic).

Characteristics of the Pain – Pattern

What type of pain are you experiencing? Is it stabbing and severe? Is it a dull ache? Does the pain also radiate into your lower back, shoulder, groin, or buttocks?

Patterns of pain can be helpful in diagnosis of abdominal pain. An obstruction of the intestine, for example, initially causes waves of crampy abdominal 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 abdominal pain. Acute pancreatitis typically causes severe, unrelenting, steady pain in the upper abdomen and upper back.

Characteristics of the Pain – Duration

How long you have had the pain can help determine the cause. The pain of IBS, for instance, typically waxes and wanes over months or years and may last for years or decades. The pain of biliary colic lasts between 30 minutes and several hours, and pancreatitis pain lasts one or more days. Acid-related diseases such as gastroesophageal reflux disease (GERD) or duodenal ulcers typically show periodicity, that is, a period of weeks or months during which the pain is worse followed by periods of weeks or months during which the pain is better.

Characteristics of the Pain – What Makes the Pain Worse?

What were you doing when it started? Is the pain worse when you cough? Does it hurt for you to breathe? Pain due to inflammation (appendicitis, diverticulitis, cholecystitis, pancreatitis) typically is aggravated by sneezing, coughing, or any jarring motion. Patients with inflammation as the cause of their pain prefer to lie still.

Characteristics of the Pain – What Relieves the Pain?

Does any activity such as eating or lying on one side relieve the pain? Does staying in one place or moving around relieve the pain? Does throwing up make the pain better or worse?

Actions and activities that provide relief can assist in diagnosis. 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 the pain of ulcers of the stomach or duodenum because both food and antacids neutralize (counter) the acid that is responsible for irritating the ulcers and causing the pain. Pain that awakens patients from sleep is more likely to be due to non-functional causes.

Diagnosis – Physical Examination

Examining the patient will provide the doctor with additional clues to the cause of abdominal pain. The doctor will determine:

• The presence of sounds coming from the intestines that occur when there is obstruction of the intestines
• The presence of signs of inflammation (by special maneuvers during the examination)
• The location of any tenderness
• The presence of a mass within the abdomen that suggests a tumor, enlarged organ, or abscess (a collection of infected pus)
• The presence of blood in the stool may signify an intestinal problem such as an ulcer, colon cancer, colitis, or ischemia.

Pelvic discomfort

The cause of abdominal pain is diagnosed on the basis of its characteristics of 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 may change over time.

Medical treatment depends upon the patient’s history of disease or other health conditions that may be the cause.

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