Abdominal pain

Alternative Names

Home Care

For mild pains:

• Sip water or other clear fluids.
• Avoid solid food for the first few hours. If there has been vomiting, wait 6 hours. Then, eat small amounts of mild foods.
• If the pain is high up in your abdomen and occurs after meals, antacids may provide some relief, especially if you feel heartburn or indigestion. Avoid citrus, high-fat foods, fried or greasy foods, tomato products, caffeine, alcohol, and carbonated beverages. You may also try H2 blockers (Tagamet, Pepcid, or Zantac) available over the counter. If any of these medicines worsen your pain, CALL your doctor right away.
• AVOID aspirin, ibuprofen, and narcotic pain medications unless your health care provider prescribes them. If you know that your pain is not related to your liver, you can try acetaminophen (Tylenol).

When to Contact a Medical Professional

Call 911 if you:

• Have sudden, sharp abdominal pain
• Have chest, neck, or shoulder pain
• Are vomiting blood or have blood in your stool (especially if maroon or dark, tarry black)
• Have a rigid, hard abdomen that is tender to touch
• Are unable to pass stool, especially if you are also vomiting

Call your doctor if you have:

• Bloating that persists for more than 2 days
• Diarrhea for more than 5 days
• Abdominal discomfort that lasts one week or longer
• Fever (over 100°F for adults or 100.4°F for children) with your pain
• A burning sensation when you urinate or frequent urination
• Pain in your shoulder blades and nausea
• Pain that develops during pregnancy (or possible pregnancy)
• Prolonged poor appetite
• Unexplained weight loss

From your medical history and physical examination, your doctor will try to determine the cause of your abdominal pain. Knowing the location of pain and its time patten will help, as will the presence of other symptoms like fever, fatigue, general ill feeling, nausea, vomiting, or changes in stool.

During the physical examination, the doctor will test to see if the pain is localized to a single area (point tenderness) or whether it is diffuse. He or she will be checking to see if the pain is related to inflammation of the peritoneum (called peritonitis). If the health care provider finds evidence of peritonitis, the abdominal pain may be classified as an "acute abdomen", which may require surgery right away.

Your doctor may ask the following questions about your abdominal pain:

• Is the pain all over (diffuse or generalized) or in a specific location?
• What part of the abdomen is affected? Lower or upper? Right, left or middle? Around the navel?
• Is the pain severe, sharp or cramping, persistent or constant, periodic and changing intensity over minutes?
• Does the pain awaken you at night?
• Have you had similar pain in past? How long has each episode lasted?
• How often do you have the pain?
• Does it occur within minutes following meals? Within 2 to 3 hours after meals?
• Is it getting increasingly more severe?
• Does it occur during menstruation (dysmenorrhea)?
• Does the pain go into your back, middle of the back, below the right shoulder blade, or your groin, buttocks, or legs?
• Does the pain get worse after lying on the back?
• Does the pain get worse after eating or drinking? After greasy foods, milk products, or alcohol?
• Does the pain get worse after stress? After straining efforts?
• Does the pain get better after eating or a bowel movement?
• Does the pain get better after milk or antacids?
• What medications are you taking?
• Have you had a recent injury?
• Are you pregnant?
• What other symptoms are occurring at the same time?

Diagnostic tests that may be performed include:

• Barium enema
• Upper GI and small bowel series
• Blood, urine, and stool tests
• Endoscopy of upper GI (gastrointestinal) tract (EGD)
• Ultrasound of the abdomen
• X-rays of the abdomen

Prevention

For prevention of many types of abdominal pain:

• Eat small meals more frequently.
• Make sure that your meals are well-balanced and high in fiber. Eat plenty of fruits and vegetables.
• Limit foods that produce gas.
• Drink plenty of water each day.
• Exercise regularly.

For prevention of symptoms from heartburn or gastroesophageal reflux disease:

• Quit smoking.
• Lose weight if you need to.
• Finish eating at least 2 hours before you go to bed.
• After eating, stay upright for at least 30 minutes.
• Elevate the head of your bed.

References

American Academy of Pediatrics Subcommittee on Chronic Abdominal Pain. Chronic Abdominal Pain in Children. Pediatrics. 2005; 115(3): 812-815.

Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa: WB Saunders; 2006.

Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery, 17th ed. St. Louis, Mo: WB Saunders; 2004.

Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 6th ed. St. Louis, Mo: Mosby; 2006.