Abdominal pain in adults

About abdominal pain

Abdominal pain is pain felt anywhere from below your ribs to your pelvis. It is also known as tummy pain or stomach pain. The abdomen houses many organs, including your stomach, liver, pancreas, small and large bowel, and reproductive organs. There are also major blood vessels in the abdomen.

Serious causes of abdominal pain include appendicitis and pregnancy problems. However, most abdominal pain is harmless and goes away without surgery.

Most people only need relief from their symptoms. Sometimes, abdominal pain can stop and the cause will never be known, or the cause may becomes more obvious with time.

When to see a doctor about abdominal pain

Go straight to your doctor or the emergency department of the nearest hospital if you have any of the following:

• severe pain
• pain lasting for several hours
• pain or vaginal bleeding if you are pregnant
• pain in your scrotum if you are a male
• pain and vomiting or shortness of breath
• pain and vomiting blood
• blood in your bowel motions or urine
• pain that spreads to your chest, neck or shoulder
• fever and sweats
• become pale and clammy
• unable to pass urine
• unable to move your bowels or pass gas
• any other concerns.

Symptoms of abdominal pain in adults

The type of pain can vary greatly. When abdominal pain occurs, it can:

• be sharp, dull, stabbing, cramp-like, twisting or fit many other descriptions
• be brief, come and go in waves, or it can be constant
• make you throw up (vomit)
• make you want to stay still or make you so restless that you pace around trying to find ‘just the right position’
• vary from a minor problem to one needing urgent surgery.

Causes of abdominal pain in adults

There are many reasons why you may have pain in your abdomen. People often worry about appendicitis, gallstones, ulcers, infections and pregnancy problems. Doctors also worry about these, as well as many other conditions.

Abdominal pain may not come from the abdomen. Some surprising causes include heart attacks and pneumonia, conditions in the pelvis or groin, some skin rashes like shingles, and problems with stomach muscles like a strain. The pain may occur along with problems in passing urine or with bowel motions, or period problems.

With so many organs and structures in the abdomen, it can be hard for a doctor to be absolutely sure about the cause of your problem.

The doctor will ask you several questions and then examine you carefully. The doctor may perform no further tests. The cause of your pain may be quite clearly not serious. Another scenario may be that the doctor is unable to find a cause, but the pain gets better within hours or days. The doctor will assess whether the pain requires surgery or admission to hospital.

Diagnosis of abdominal pain in adults

To diagnose abdominal pain, doctors and healthcare professionals are likely to ask you the following questions:

Where is the pain?

Doctors and other health professionals will first ask you where you feel the pain. Pain above the umbilicus (belly button) but below the ribcage on the right may be gallstone pain. Gallstone pain may spread (or radiate) to the right shoulder or the back.

Pain from kidney stones is felt in the right side or left side, more in the back than the front of the abdomen, and tends to radiate downwards into the groin on the same side.

Pain in the very centre of the abdomen is more likely to be coming from the intestines, however in males, testicular pain is also felt in the centre of the abdomen.

When did the pain start?

Abdominal pain is ‘acute’ if present for less than a day or 2, ‘persistent’ if longer than a day or 2, and ‘chronic’ if present for more than 2 weeks.

How severe is the pain?

Health professionals will usually ask you to rate the pain or give a pain score out of 10. Mild pain might be rated 3 to 4, noticeable and unpleasant (like a toothache) but not severe enough to interfere with usual activity.

Severe pain stops all other activities (like labour pain in childbirth). Gallstone or kidney stone pain is often severe.

Does the pain come and go?

Abdominal pain that comes and goes in waves is called colic, and comes from the contraction of a hollow organ such as the bowel, the gallbladder or the urinary tract. Pain from other organs may be constant – for example stomach ulcers, pancreatitis or pain from an abdominal infection.

Have you had this pain before?

Gallstone pain and kidney stone pain will often recur every few months.

Period pain can be severe and may indicate an underlying problem such as endometriosis or pelvic inflammatory disease, while pain in the middle of the menstrual cycle can be due to an ovarian follicle.

What events led up to the pain?

This is an important question as it might point to the cause of the pain. Examples are trauma such as a sporting injury or car accident, recent medication such as anti-inflammatories or antibiotics, or heavier than usual alcohol intake, which might trigger pancreatitis.

Are there associated features?

Blood in the urine, together with flank pain (pain between the pelvis and the ribs), point to kidney stones.

Vomiting with pain in the centre of the abdomen can point to a small bowel obstruction. Severe constipation with pain in the side may point to a large bowel obstruction.

Do you have a history of previous surgery or radiation therapy to the abdomen?

Recent surgery to the bowel or other abdominal organs might result in complications, such as infection, that could cause abdominal pain.

Scarring to the tissue surrounding the bowel, or adhesions, can be caused by surgery or radiation therapy and trigger bowel obstruction.

Examinations and tests

If examinations and tests are needed, these may include:

• a rectal exam to check for hidden blood or other problems
• a check of the penis and scrotum
• a pelvic exam to check for problems in the womb (uterus), fallopian tubes and ovaries, and a pregnancy test
• a blood test to look for infection (which causes a raised white cell count) or bleeding (which causes a low blood count or haemoglobin)
• other blood tests may look at enzymes in the liver, pancreas and heart to sort out which organ may be involved
• a urine test to look for a urine infection or blood (if there is a kidney stone)
• an ECG (an electrical tracing of the heart) to rule out a heart attack
• other tests, including x-ray, ultrasound or CT scan
• an endoscopy – an examination where a flexible tube with a light and video camera at the tip is used to examine some internal organs without the need for surgery. Different names are used depending on which organ is being looked at
• sometimes you may be referred to another doctor to help find the cause of the problem.

If you do have tests, the doctor will explain the results to you. Some results may take a number of days to come back and these will be sent to your local doctor.

Treatment for abdominal pain in adults

Your treatment depends on what is causing your pain, but may include:

• Pain relief – your pain may not go away fully with painkillers, but it should ease.
• Fluids – you may have fluids given into a vein to correct fluid loss and rest your bowel.
• Medicines – for example, you may be given something to stop you vomiting.
• Fasting – your doctor may ask you not to eat or drink anything until the cause of your pain is known.

Taking care of yourself at home

Most abdominal pain goes away without special treatment. Be guided by your doctor, but there are some things you can do to help ease the pain, including:

• Place a hot water bottle or heated wheat bag on your abdomen.
• Soak in a warm bath. Take care not to scald yourself.
• Drink plenty of clear fluids such as water.
• Reduce your intake of coffee, tea and alcohol as these can make the pain worse.
• When you are allowed to eat again, start with clear liquids, then progress to bland foods such as crackers, rice, bananas or toast. Your doctor may advise you to avoid certain foods.
• Get plenty of rest.
• Try over-the-counter antacids, to help reduce some types of pain.
• Take mild painkillers such as paracetamol. Please check the packet for the right dose. Avoid aspirin or anti-inflammatory drugs unless advised to take them by a doctor. These drugs can make some types of abdominal pain worse.

Where to get help

• Your GP (doctor)

Need treatment today?

Need treatment today, but it’s not life-threatening and you can’t get a GP appointment, there are services available:

• Urgent Care Clinics – provide care for conditions that require treatment today but not an emergency response (extended hours)
• Nurse-on-Call Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)

Emergency care

• In an emergency, always call triple zero (000)
• Emergency department of your nearest hospital