Abdominal pain is pain that originates from organs located between the chest and groin. It may also be due to referred pain from a condition in another area of the body.

The abdomen contains organs including the stomach, liver, pancreas, gallbladder, kidneys, intestines and ovaries. Abdominal pain may be caused by disorders in these organs, including inflammation, infection and obstruction. In other cases it may be caused by digestive, reproductive, metabolic or other disorders. The pain may also result from an infection or disorder somewhere else in the body, such as strep throat or a heart attack.

In most cases, however, abdominal pain is the result of a minor condition. Overeating, increased acid, gas, constipation and ovulation are common causes of discomfort.

In addition to affecting the stomach area, abdominal pain can cause discomfort in other areas, such as the chest, neck and shoulder. This is the result of the pain traveling down nerve pathways through the body.

To determine the cause of abdominal pain, physicians may take a medical history and perform a physical examination. A number of tests may also be performed to help identify and rule out conditions that may be causing the pain. These may include blood tests, urine tests, endoscopy, ultrasound, x-rays and CAT scan. In some cases, laparoscopy or other types of surgery are also required. Even with all the testing, sometimes it may not be possible to find the cause of the abdominal pain, and symptomatic treatment is usually done in these cases.

Because abdominal pain is often the result of a mild condition, many patients are able to treat their pain with home remedies and over-the-counter medications, such as antacids or acetaminophen. Other conditions are more serious and may require medical attention. Physicians may treat more severe causes of abdominal pain with prescription medication or, in some cases, surgery.

Patients should contact their physician when abdominal pain is severe, frequent, constant (lasting one week or more) or worsening. Pain accompanied by fever, vomiting and a number of other symptoms is also a cause for concern. Patients with abdominal pain who are vomiting blood or experiencing pain in the neck, chest, back or shoulder should seek emergency medical attention.

Abdominal pain is pain felt anywhere between the chest and groin. This area is a common source of pain.

The abdomen contains a number of organs, including:

• Stomach
• Small intestine
• Large intestine (colon), including the appendix
• Liver
• Pancreas
• Gallbladder
• Spleen
• Adrenal glands
• Kidneys
• Ureters
• Urinary bladder
• Ovaries, fallopian tubes and uterus (women)
• Prostate gland (men)

Most of the abdominal organs are contained in a bag-like membrane known as the peritoneum. The abdomen also contains the aorta (the major artery from the heart), other blood vessels, nerves and the lower end of the esophagus. Abdominal pain can originate in any of these areas.

Pain felt in the abdomen can also originate in another area of the body, such as the chest. An infection somewhere else in the body (e.g., influenza, strep throat) can trigger abdominal pain. It may also be caused by an organ in the chest, such as the lungs (e.g., pneumonia) or the heart (e.g., a heart attack).  Sometimes nerve impingement in the back can also cause abdominal pain.

The pelvic region, including the urinary bladder, uterus, prostate and other organs, comprises the lower abdomen. This area is often considered separately from the abdomen.

Abdominal pain is common and many times does not result from a serious condition. In other cases, however, medical treatment is necessary. The intensity of the pain is not always an indicator of the seriousness of a condition. Gas, for example, is a mild condition that can cause severe abdominal pain. On the other hand, life-threatening conditions, such as colorectal cancer and appendicitis, can cause mild pain in the abdomen.

In general, patients should contact their physician when:

• The pain is severe, frequent or constant (lasting one week or more)
• The pain worsens
• The pain is accompanied by:
  
  
• • Shortness of breath
  • Dizziness
  • Bleeding
  • Vomiting
  • Bloating (lasting more than two days)
  • Diarrhea (lasting more than five days)
  • Painful urination (dysuria) or increased urination (polyuria)
  • Pain in the shoulder blades and nausea
  • Menstruation
  • Pregnancy
  • Loss of appetite
  • Unexplained weight changes
  • Fever over 100 degrees Fahrenheit (37.7 degrees Celsius) for adults or 100.4 degrees Fahrenheit (38 degrees Celsius) for children

Patients should seek emergency medical treatment when:

• The abdominal pain comes on suddenly and is sharp
• The abdominal pain is accompanied by:
  
  
• • Pain in the chest, neck or shoulder
  • Vomiting blood or feces
  • Blood in the stool
  • Swollen and tender abdomen
  • Hard-feeling and tender abdomen
  • An inability to pass stool or urine

Abdominal pain can travel down nerve pathways through the body. As a result, the pain can appear at body sites near or far from the abdomen. This type of pain is known as referred pain. For example, the appendix is an organ in the right lower abdomen, but in the initial phase of appendicitis, pain is usually referred to around the umbilicus (navel).

A person suffering from abdominal pain may also experience:

• Neck pain
• Shoulder pain
• Back pain
• Chest pain
• Pelvic pain
• Groin pain, such as testicular and scrotal pain
• Sexual pain
• Buttock pain
• Leg pain

Uncommonly, people with abdominal migraine may in some cases experience the headache typical of other types of migraines.

Many factors can lead to abdominal pain. This includes common digestive and eating conditions, such as hunger, overeating, eating spicy or greasy foods, gas, constipation, diarrhea, vomiting, indigestion, heartburn, food poisoning and food allergies.

It is commonly caused by disorders in the abdominal organs, including:

• Gastritis (inflammation of the lining of the stomach) or gastroenteritis (inflammation of the lining of the stomach and intestines, popularly misnamed "stomach flu").
  
  
• Appendicitis. Inflammation of the appendix.
  
  
• Hepatitis (inflammation of the liver) or other liver conditions.
  
  
• Esophagitis (inflammation of the esophagus) or other esophageal conditions.
  
  
• Cholecystitis. Inflammation of the gallbladder.
  
  
• Pancreatitis. Inflammation of the pancreas.
  
  
• Peritonitis. Inflammation of peritoneum, an abdominal membrane.
  
  
• Gallstones (cholelithiasis), kidney stones (nephrolithiasis) or bladder stones (cystolithiasis).
  
  
• Intestinal obstruction. Partial or complete blockage of the bowel.
  
  
• Diverticulosis (the presence of small protruding pouches in the inner lining of the intestine) and diverticulitis (inflammation of these pouches.
  
  
• Gastroesophageal reflux disease (GERD). A condition in which food and liquid back up from the stomach into the esophagus.
  
  
• Peptic ulcer. Erosion of the lining of the stomach or upper part of the small intestine by digestive juices.
  
  
• Bowel disorders, such as inflammatory bowel disease (e.g., Crohn’s disease, ulcerative colitis) or irritable bowel syndrome.
  
  
• Malabsorption conditions (inability to digest or absorb certain nutrients), including lactose intolerance, celiac disease (gluten intolerance) or metabolic disorders such as glycogen or lipid storage diseases.
  
  

Other potential causes of abdominal pain include:

• Stress or anxiety.
  
  
• An infection elsewhere in the body or a generalized infection. Examples include strep throat, pneumonia, influenza, urinary tract infections and sexually transmitted diseases.
  
  
• Straining or tearing of abdominal muscles.
  
  
• Hernia. The protruding of an organ or tissue through an abnormal opening. Types that may cause abdominal pain include hiatal hernia (protrusion of part of the stomach through an opening in the diaphragm into the chest cavity) and umbilical hernia (protrusion of part of the small intestine through a weak area in the abdominal muscles, most common in infants and painful only in some cases.
  
  
• Heart attack.
  
  
• Somatization disorder. A condition in which psychological problems cause a person to make a number of physical complaints.
  
  
• Cancer (e.g., colon, stomach, pancreatic).
  
  
• Sickle cell anemia crisis. Blockage of blood vessels by abnormally shaped blood cells.
  
  
• Cystic fibrosis. Inherited disease in which abnormal production of mucus damages organs.
  
  
• Dissecting (leaking) or ruptured abdominal aortic aneurysm.
  
  
• Abdominal migraine, also known as periodic syndrome. Condition, most common in children, marked by recurrent bouts of abdominal pain, often accompanied by nausea, loss of appetite and vomiting. Unlike other migraines, this condition seldom involves headaches, although they often develop later in life.
  
  
• Gastroparesis. Form of autonomic neuropathy (damage to the autonomic nerves, which control regulatory and other functions), most common in people with diabetes, that slows digestion.
  
  
• Parasitic infections.
  
  
• Gastrointestinal or liver pain from HIV/AIDS.
  
  
• Drug abuse. Cocaine, for example, can cause heart problems, chest pain and abdominal pain.

Less common causes of abdominal pain include:

• Colorectal polyp. Abnormal growth in the lining of the colon or rectum. These polyps are common but usually painless.
  
  
• Diabetic ketoacidosis. Emergency condition involving severe hyperglycemia and accumulation of toxic wastes (ketones) produced when fat rather than glucose is burned for energy.
  
  
• Porphyria. Group of disorders in which enzyme abnormalities impair production of the blood pigment heme and chemical precursors of heme build up in the body.
  
  
• Rectal or anal fissure. A tear in the lining of the rectum or anus.
  
  
• Intussusception. Condition in which one part of the small intestine folds into another; this rarely occurs after infancy.
  
  
• Behcet's disease. Inflammatory condition that most often causes joint pain, eye inflammation and sores in the mouth, genitals and skin, and in rare cases causes sores in the digestive tract that produce abdominal pain.

Abdominal pain may also result from chronic disorders that can cause pain through the body, such as systemic lupus erythematosus, myositis, chronic fatigue syndrome, fibromyalgia, sarcoidosis, polymyalgia rheumatica or myofascial pain syndrome.

In women, abdominal pain may also be caused by:

• Ovulation. Many women experience pain in either side of the lower abdomen around the time of ovulation. Ovulatory pain is also known as mittelschmerz.
  
  
• Menstruation and premenstrual syndrome (PMS).
  
  
• Miscarriage. Loss of a pregnancy due to natural causes.
  
  
• Ectopic pregnancy. Implantation of a fertilized egg in tissue outside the uterus.
  
  
• Endometriosis. A condition in which the cells that make up the lining of the uterus are found outside the uterine cavity.
  
  
• Uterine fibroids. Noncancerous tumors that can form in the uterus.
  
  
• Ovarian cysts. Fluid-filled structures within or on an ovary. Causes of ovarian cysts include an endocrine disorder called polycystic ovarian syndrome (PCOS).
  
  
• Pelvic inflammatory disease. Infection of the lining of the uterus, the fallopian tubes, or the ovaries.
  
  
• Ovarian cancer or other gynecologic cancers.

In men, lower abdominal pain may be caused by prostate disorders (prostatitis, benign prostatic hyperplasia, prostatodynia or cancer) or referred pain from the testicles.

Physicians trying to determine the cause of a patient’s abdominal pain will typically first obtain the patient’s medical history and perform a physical examination.

Sometimes it may be difficult to make a diagnosis, causing the patient frustration. Patients should be prepared to describe the pain and answer a number of other questions. They may be asked to complete a pain assessment.

Physicians may begin their evaluation by asking about the exact location of the pain. Although the presence of a large number of organs can make it difficult to pinpoint the cause of abdominal pain, determining the location of the pain can help shorten the list.

Pain in different areas of the abdomen can suggest a number of causes, including:

In addition to asking the patient about the location of their abdominal pain, physicians may ask a number of other questions, including:

• Is the pain focused in a specific location or all over (generalized or diffuse)?
  
• Is it severe, sharp or cramping? Constant or periodic?
  
• Does it change intensity?
  
• How often does the pain occur?
  
• Is it worsening?
  
• Has there been an injury recently?
  
• Are any other symptoms occurring at the same time (e.g., fever, vomiting)?
  
• Does the pain cause insomnia or awakening at night?
  
• Does it increase in times of stress?
  
• Has similar pain occurred in the past? If so, how long have the episodes lasted?
  
• How does food or drink affect the pain?
  
• Does the pain increase after straining efforts?
  
• Does sexual activity, urination, defecation or menstruation affect it?
  
• Is pregnancy a factor?
  
• Does the pain radiate to the back, shoulder blade, groin, buttocks or legs?
  
• Does it change when lying on the back or belly or side?
  
• What medications are being taken?
  
• Is there a family history of bowel disorders?

In addition, women may be asked about their menstrual history and use of contraception. Women and men may be asked about their sexual history. This will help physicians determine if certain conditions, such as ectopic pregnancy, pelvic inflammatory disease or sexually transmitted diseases, should be ruled out. In some cases, a pregnancy test will be ordered.

During the physical examination, physicians will try to determine if the pain is localized or diffuse. The physician will take the patient's vital signs to look for changes in blood pressure and heart rate. The patient’s temperature may also be taken to determine if fever is present. In addition, the physician may examine the eyes and skin for signs of jaundice, the lungs for signs of consolidation (filling of the airways with liquid or tissue) and the heart for murmurs and rubs (sounds caused by friction).

Physicians will examine the abdomen visually and possibly listen for bowel sounds. They may also touch (palpate) the abdomen to look for masses and localized tenderness. Rectal examinations may be performed on men with prostate pain and on patients with acute abdominal pain, and pelvic exams may be performed on women with acute lower abdominal pain. Patients may also be examined for hernia and signs of nerve and muscle wall injury.

In addition to the medical history and physical examination, there are a number of tests commonly used to identify and rule out conditions that may be causing abdominal pain. These include:

• Blood tests. These tests determine the amount of any given substance in a blood sample. Blood tests commonly performed to evaluate abdominal pain include complete blood count (CBC), liver tests (e.g., liver enzyme tests, bilirubin) and tests of pancreatic enzymes (e.g., amylase and lipase).
  
  
• Urine tests. These tests involve physically or visually examining a urine sample. During an evaluation of abdominal pain, urine may be checked for blood or infection.
  
  
• Stool tests. These tests examine the stool for evidence of a number of conditions. During an evaluation of abdominal pain, stool may be checked for blood, infection or worm infestation.
  
  
• Ultrasound of the abdomen. This procedure uses high-frequency sound waves to create images of organs and other body structures.
  
  
• X-rays of the abdomen. An x-ray is a painless test in which an image is created of part of the body. It uses low doses of electromagnetic radiation that are reflected on film or fluorescent screens.
  
  
• CAT scan (computed axial tomography). Used to outline small structures or pathology in the abdomen. It is extensively used to rule out appendicitis in suspicious cases. It is also used to diagnose urinary stones.
  
  
• Endoscopy of the upper gastrointestinal (GI) tract (upper endoscopy). A tiny camera mounted on a flexible tube (endoscope) is inserted through the mouth and down the throat. This allows the physician to inspect the esophagus, stomach, and the upper portion of the small intestine. This brief procedure, once conducted in physicians' offices, is now generally performed in a hospital with the patient under anesthesia. When necessary, small instruments can be used to collect tissue samples through the endoscope for a biopsy or to burn the bleeding sites. Upper endoscopy is also known as an esophagogastroduodenoscopy (EGD).
  
  
• Colonoscopy. In simple terms, colonoscopy is an endoscopy of the lower GI tract. A tiny camera mounted on a flexible tube is inserted through the rectum. This allows physician to inspect the rectum and colon. It can also be used to take tissue sample for biopsy and to burn the bleeding sites.
  
  
• Capsule endoscopy.  This is a newer procedure in which the patient swallows a camera, which is usually in the form of a capsule. The camera takes the pictures and can transmit them to a computer.  It is mainly used to inspect the small intestine where it cannot be reached with traditional endoscope. 
  
  
• Upper GI (gastrointestinal) and small bowel series. This procedure requires the patient to swallow a barium-containing liquid. A set of x-rays are then taken to examine the esophagus, stomach, and small intestine.
  
  
• Barium enema. A barium-containing liquid (and in some cases air) is introduced into the rectum and colon (also known as the large intestine). The procedure is used to improve the images made by an x-ray. This enables a physician to detect changes or abnormalities in the colon.
  

In some cases, laparoscopy is required to examine the abdominal cavity and pinpoint the cause of abdominal pain. A small incision is made above or below the navel. A thin lighted tube (laparoscope) is then inserted into the abdomen. This enables physicians to view the abdominal organs.

In many cases, abdominal pain does not require immediate medical care. A number of home remedies and over-the-counter medications can be used to treat abdominal pain.

Common relief options for mild abdominal pain include:

• Sipping water or other clear liquids, or sucking on ice chips.
  
  
• Avoiding solid food for the first few hours after the appearance of the pain (six hours after vomiting). Patients can then eat small meals consisting of mild food, such as toast or applesauce.
  
  
• Trying thermotherapy, such as a hot-water bottle. This can sometimes ease even deep abdominal pain.
  
  

Many medications are available to treat the various sources of abdominal pain. Patients are advised to consult their physician before taking over-the-counter as well as prescription drugs. The medications include:

• Antacids. Neutralize excess stomach acid to ease heartburn.
  
  
• H2 blockers or proton pump inhibitors. Reduce stomach acid to relieve conditions such as gastroesophageal reflux disease (GERD).
  
  
• Acetaminophen. A common painkiller. However, acetaminophen is not recommended if the abdominal pain is due to a liver condition.
  
  
• Laxatives. Relieve constipation if diet, exercise and other lifestyle changes do not help.
  
  
• Antidiarrheals. Treat persistent diarrhea.
  
  
• Antiemetics. Relieve symptoms of or prevent nausea and vomiting.
  
  
• Prokinetics. Stimulate contractions of stomach muscles to ease conditions including GERD and gastroparesis.
  
  
• Antimicrobials. Group that includes antibiotics to fight bacterial infections, antivirvals to fight viral infections and antiparasitics to fight parasitic infections.
  
  
• Antispasmodics. Ease gastrointestinal cramps or spasms.
  
  
• Corticosteroids, aminosalicylates and other anti-inflammatories. Ease conditions such as inflammatory bowel disease.

Although these methods may provide relief for some forms of abdominal pain, such as those caused by heartburn, relief is dependent on the cause of the pain. If abdominal pain persists or worsens after trying these remedies patients should contact their physician immediately. Some causes require medical attention and prescription medications. Other causes, such as appendicitis, require immediate surgery.

Certain types of chronic abdominal discomfort can sometimes be eased with pain management methods such as cognitive behavioral therapy, stress management, biofeedback, hypnosis, acupuncture or acupressure.

In many cases abdominal pain may be prevented by:

• Eating small meals more frequently to prevent overeating
  
  
• Eating meals that are well balanced and high in fiber, including plenty of fruits and vegetables
  
  
• Limiting foods that cause gas
  
  
• Avoiding high-fat foods, fried or greasy foods, citrus fruits and juices, tomato products, caffeine, alcohol and carbonated beverages
  
  
• Keeping a food diary to identify problematic foods
  
  
• Avoiding aspirin, ibuprofen, opioids and other medications that may irritate the digestive tract, unless prescribed by a physician
  
  
• Drinking enough water
  
  
• Exercising regularly
  
  
• Avoiding meals shortly before bedtime

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about abdominal pain:

1. What may be causing my abdominal pain?
   
   
2. What tests may be used to determine the cause of my abdominal pain, and what do they involve?
   
   
3. What do my test results show?
   
   
4. Will I need follow-up tests?
   
   
5. How can I relieve my abdominal pain?
   
   
6. If medication is recommended, what side effects might I experience?
   
   
7. Will I require surgery?
   
   
8. At what point should I call you or seek emergency treatment for abdominal pain?
   
   
9. How can I tell the difference between minor conditions and something serious?
   
   
10. How can I prevent abdominal pain?