Portsmouth Regional Hospital - February 07, 2019

You probably don't think about the internal workings of your belly much — unless they're red-flagging you with sharp pain, aches, or cramping. Even then, you may dismiss the discomfort or pain as just transient gas — or some other minor intestinal disturbance — and simply wait for it to go away.

But you don't have to live with the pain. Whether your abdominal pain or discomfort is a sharp, short-term annoyance or a chronic hurt that dogs you regularly, you have options for making it go away. The first step is figuring out what's causing the pain so that you can treat the source.

What's Going On in There?

Sometimes it's difficult to determine the root cause of a bellyache. The source of the pain could be any one of a number of structures and organs within your abdomen, including your appendix, kidneys, liver, reproductive organs, and aorta;, or it could be caused by any of the organs involved in digestion, such as your stomach, pancreas, gallbladder, or intestines. You also have a myriad of muscles, tendons, and other connective tissue located in this region of the body. Abdominal pain could even be caused by problems completely unrelated to the abdomen, such as a heart attack or pneumonia.

So if you have abdominal pain, and it's chronic, moderate to severe, or in any way worrisome to you, it's best to get a doctor's opinion on what might be amiss. Otherwise, it's just a guessing game.

To determine when to see your doctor, ask yourself the following questions:

  • Are these symptoms limiting your daily functions or activities?
  • Are you losing weight, or do you have fevers, chills, sweats, bleeding or dark bowel
  • Are there other unexplained symptoms in addition to abdominal pain, such as blurred vision, oral ulcers, rashes or easy bruising?

If the answer to any of these questions is yes, you would likely benefit from an evaluation.

Your doctor will ask you questions about your pain — questions that, combined with your medical history and physical exam, are designed to help pinpoint the possible causes of your symptoms.

Tell Your Doctor:

  • When the pain began
  • Where the pain is located
  • What kind of pain it is (sharp, dull, throbbing, etc.)
  • How severe the pain is
  • Whether the pain is in a specific location or all over
  • How frequently you feel the pain
  • What makes it worse
  • What makes it better
  • How the pain is affecting your life

Is It Serious?

Abdominal pain can vary greatly, from minor to excruciating. But here's the kicker: Sometimes excruciating pain can result from something pretty harmless. For example, most people know what it's like to be doubled over with gas pain. Yet some serious problems, such as celiac disease or colon cancer, may not cause you too much discomfort in the early stages.

So don't judge your problems solely by the severity of your pain. Severe, incapacitating pain is always a reason to see your doctor right away. But for mild to moderate pain, consider the following red flags as well, and call your doctor if you experience them:

  • Abdominal discomfort that lasts a week or longer
  • Abdominal swelling
  • Bloating that lasts longer than 2 days (not associated with PMS)
  • Diarrhea for more than 3 days
  • Fever with your pain
  • Pain that develops during pregnancy (or possible pregnancy)
  • Prolonged poor appetite
  • Tenderness of the abdomen
  • Unexplained weight loss
  • Black, tarry stool
  • Thin, ribbon-like stool

Signs that you need to see a doctor immediately include a rigid abdomen; a high fever with your pain (over 101°F); bloody diarrhea or vomit; an inability to pass stool, gas, or urine; or pain that is incapacitating, lasts several hours, is accompanied by vomiting, or might be symptomatic of a medical emergency, such as a heart attack.

Here are some of the other causes your doctor may check for.

Inflammatory bowel disease (IBD)

Inflammatory bowel disease, whether it be Crohn’s disease or ulcerative colitis, can cause abdominal cramps and pain, unwanted weight loss or diarrhea.

While ulcerative colitis only occurs in the innermost lining of the colon or large intestine, Crohn’s disease can affect any area of the gastrointestinal (GI) tract, from the mouth to the anus. With both conditions, inflammation and ulcers develop because the immune system thinks viruses, bacteria and other substances are foreign objects. Medications such as anti-inflammatory drugs and antibiotics can help relieve symptoms, though sometimes surgery is needed when other treatments aren’t helping enough.

Certain medications and alcohol

A burning sensation in the stomach may indicate peptic ulcers: open sores in the innermost lining of your stomach or small intestine. Ulcers occur when something damages the lining—either medications or an infection with certain bacteria like Helicobacter pylori—and then stomach acid causes further damage.

Paradoxically, certain nonsteroidal anti-inflammatory medications like Advil, Motrin, Aleve and aspirin may cause inflammation, as can some antibiotics and steroids. Alcohol and tobacco can worsen ulcers, and increase your risk of them, too.

Antacids, antibiotics and acid blockers may be suggested if you have ulcers.


Pain on the right side of the abdomen that gets worse as time goes on may be a sign of appendicitis, or inflammation of the appendix. Other appendicitis symptoms include loss of appetite, vomiting and constipation. Treatment will almost always be an appendectomy, which is a surgery to remove the infected organ.

Endometriosis of the bowel

Patients who have a mother with a history of endometriosis come in with heavy rectal bleeding during periods. In addition to abdominal pain, these women show signs of endometriosis of the bowel, endometriosis on the surface of the bowel or bowel wall. Not all patients who have this condition will have a family history of endometriosis, though.

Other symptoms may include pain and straining when trying to pass a bowel movement and severe pelvic pain during sex. Painkillers can alleviate symptoms, and surgery such as laparoscopy can be used to remove affected areas of the bowel.


Peritonitis, an irritation that happens when blood, body fluids or pus collects in the abdominal cavity, can cause abdominal pain that can be worse when you move around, and tenderness when the belly is touched. It can also cause your belly to look bloated and can also cause bowel trouble and excessive fatigue. Peritonitis is a very serious health condition; antibiotics will help clear up the infection and keep it from spreading. Surgery may be needed to remove the infected tissue and repair damage, especially if the rupture involves the appendix, stomach or colon.

Smart Self-Care

For mild cases of abdominal pain or discomfort, or for a little relief from the pain until you see your doctor, here are six self-help steps you can try. They may help relieve some, but not all, instances of gastrointestinal pain.

  • Drink plenty of water, but take infrequent, small sips.
  • Avoid foods that are known to exacerbate some causes of abdominal pain, such as gas, diarrhea, constipation, or heartburn. This includes greasy foods, spicy foods, citrus, tomato products, dairy products, and chocolate.
  • Cut back on foods and beverages that contain alcohol or caffeine.
  • Avoid medications known to irritate the stomach lining, such as nonsteroidal anti-inflammatory drugs (NSAIDs). If your prescription medications cause stomach upset, speak to your doctor before discontinuing them.
  • For pain related to stomach acid, try over-the-counter antacids. Gas pain may be relieved with antacids that contain simethicone and activated charcoal.
  • After pain subsides, eat a bland diet for a day or so.

Some digestive problems are minor and can be remedied with self-care. Others may require prescription treatments or — although rare — may constitute a potential medical emergency. The first step: Speak with your healthcare provider so you can get an accurate diagnosis. If you have regular abdominal troubles, make an appointment today.

Seek help when you have symptoms

Any persistent abdominal pain is worth seeing your healthcare provider about. It’s especially important to see a doctor right away if you’re having tarry, dark bowel movements since these signs may indicate you have bleeding in your GI tract, or if you’re experiencing unexplained weight loss, fevers, chills, sweating, nausea or a loss of appetite.

Typically, your doctor will examine your abdomen perhaps even preform a rectal exam, and you may need additional testing with abdominal x-rays or other imaging, blood work, and even perhaps a colonoscopy or upper endoscopy. Based on the location of your abdominal pain and sensitivity and the results of the testing, your healthcare provider will determine and review a treatment plan that’s right for you


Content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Have Questions?

(888) 421-1080

Need a Physician?

Make an Appointment