Abdominal Pain: A Guide

Abdominal pain can arise from the digestive, urinary, reproductive, vascular or abdominal wall systems. It can also come from outside the abdomen. Sudden severe pain, bleeding, collapse or marked tenderness requires emergency assessment.

Abdominal pain is a symptom Abdominal pain means discomfort felt between the chest and groin. People may describe aching, cramping, burning, stabbing, pressure or pain that comes in waves. The abdomen contains the stomach, intestines, liver, gallbladder, pancreas, spleen, kidneys and major blood vessels. The pelvis also contains the bladder and reproductive organs. Pain can also arise from the abdominal wall, lower chest, spine or a general medical problem. The symptom does not identify one organ system by itself. Location provides a clue, not a map Internal organs often produce pain that is vague or difficult to localise. As inflammation reaches the abdominal lining, the pain may become easier to locate. The peritoneum is the thin lining covering many abdominal organs and the inner abdominal wall. Irritation of this lining can make movement, coughing or touch painful. Appendicitis often begins with central discomfort before moving towards the lower right abdomen. However, the location and progression can differ in pregnancy, children and older adults. Referred pain means pain felt away from its source because nerve signals enter shared pathways. Gallbladder irritation can sometimes be felt near the right shoulder, for example. Pain location therefore changes probability rather than confirming a cause. Heart, lung, urinary and reproductive conditions can overlap with digestive patterns. Timing and behaviour add information Clinicians ask whether pain began suddenly or gradually, how long it lasts and whether it is worsening. They also ask whether previous episodes followed the same pattern. Colicky pain rises and falls in waves. It can occur when a hollow organ contracts or stretches, sometimes because a stone or another blockage is present. The pattern is not a diagnosis. Kidney stones may cause renal colic, while bowel problems and other conditions can produce similar waves of pain. Biliary colic is the name for pain caused by temporary gallstone blockage. Despite the name, NHS guidance describes this pain as often constant for more than thirty minutes. Constant pain can occur with inflammation, reduced blood supply, stretching or abdominal wall pain. Severe pain can occur with kidney stones, while serious disease may initially cause less dramatic pain. Associated symptoms and context matter Vomiting, diarrhoea, constipation, bloating and blood in stool provide gastrointestinal clues. Urinary frequency, painful urination or blood in urine may support a urinary cause. Fever, shivering, faintness, breathlessness, chest pain, jaundice or unexplained weight loss can change the urgency. No associated symptom confirms the diagnosis alone. Clinicians ask whether pregnancy is possible because an ectopic pregnancy can resemble digestive or urinary illness. Vaginal bleeding, shoulder tip pain, dizziness or fainting increase concern. Sudden testicle pain can be felt with lower abdominal pain, nausea or vomiting. Testicular torsion is an emergency because twisting can cut off the blood supply. Age, previous surgery, medicines, alcohol, long term conditions and recent illness also affect the assessment. Abdominal pain is often interpreted differently in pregnancy, childhood and later life. Some patterns need immediate action Sudden severe abdominal or back pain with collapse can occur when an abdominal aortic aneurysm ruptures. An abdominal aortic aneurysm is a swelling of the body's main artery within the abdomen. Severe pain with a rigid abdomen, marked guarding or pain on light touch can indicate severe peritoneal irritation. Guarding means the abdominal muscles tighten in response to pain. Peritonitis means inflammation of the peritoneum. It can follow a perforated or ruptured organ and requires urgent hospital assessment. A swollen abdomen with vomiting and an inability to pass stool or wind can occur with bowel obstruction. Vomiting blood or passing black, sticky stool can indicate gastrointestinal bleeding. These are examples of dangerous patterns rather than a complete list. Emergency action should not wait for the exact diagnosis. Examination provides several pieces of evidence A clinician checks temperature, pulse, blood pressure, breathing, oxygen saturation and general appearance. They assess hydration, colour, alertness and whether movement worsens the pain. They look for swelling, scars, hernias and visible movement. Gentle examination identifies tenderness, guarding, rigidity, masses or enlarged organs. The examination may include the groin, testicles or pelvis when the symptom pattern requires it. Consent, privacy and an appropriate chaperone are important. Clinicians may listen for bowel sounds, but bowel sounds cannot confirm or exclude obstruction or a bowel that has stopped moving. No single examination sign provides the diagnosis. Do not repeatedly press a painful abdomen to test for appendicitis or peritonitis yourself. Worsening or severe tenderness needs professional assessment. Tests answer targeted questions A full blood count measures blood cell patterns. A raised white cell count can occur with infection, inflammation, stress and several other conditions. CRP is a blood marker that can rise with inflammation. A normal or raised result cannot confirm or exclude appendicitis or another cause by itself. Other blood tests may assess kidney, liver or pancreas related patterns. Results are interpreted with symptom timing, examination findings and changes over time. A urine test can show blood, white cells or other findings. These results can support several possibilities but do not identify the cause alone. A pregnancy test detects a pregnancy hormone. It does not show where a pregnancy is located, so pain in early pregnancy may still require urgent ultrasound assessment. Ultrasound uses sound waves and can assess selected abdominal, pelvic and vascular questions. Its usefulness depends on the organ, the person and the question being asked. A CT scan uses X rays to create detailed cross sectional images. It can assess many urgent causes, but radiation and the clinical question affect when it is used. No test always shows appendicitis. Clinicians may repeat the examination, observe the pattern or arrange further imaging when concern remains. Common and important possibilities overlap Many episodes relate to constipation, gastroenteritis, indigestion, period pain or irritable bowel syndrome. These explanations should not be assumed before urgent patterns are excluded. Other possibilities include appendicitis, gallstone disease, kidney stones, pancreatitis, bowel obstruction and urinary infection. Pelvic and reproductive causes may produce very similar symptoms. Heart attack, lower lung illness, diabetic emergencies and major blood vessel problems can also cause abdominal discomfort. The complete pattern determines which possibilities need investigation. What may happen after assessment Severe or unstable presentations are assessed in hospital immediately. Treatment begins with pain relief, fluids or other support while the cause is investigated. A suspected appendicitis pattern may require observation, repeated examination, blood tests and imaging. Surgery is common, but antibiotics or another plan may be appropriate in selected cases. Milder symptoms without emergency features may be managed through NHS 111, urgent primary care, pharmacy advice or planned review. The pathway depends on the whole presentation. When to get help Call 999 or go to A&E if abdominal pain came on very suddenly or is severe. Also seek emergency help if the abdomen is very painful to touch. Call 999 or go to A&E for vomiting blood or material resembling coffee grounds. The same applies to bloody stool or black, sticky stool. Call 999 or go to A&E if you cannot pass urine, stool or wind, cannot breathe, have chest pain or someone collapses. Do not drive yourself. Call 999 for sudden severe abdominal or back pain with pale or grey skin, breathing difficulty, faintness or loss of consciousness. These can occur with a ruptured abdominal aortic aneurysm. Call 999 or go to A&E for severe pelvic pain with faintness, shoulder tip pain or heavy vaginal bleeding. These features can occur with internal bleeding from an ectopic pregnancy. Go to A&E immediately for sudden severe testicle pain, especially with abdominal pain, nausea or vomiting. Call 999 if safe transport is unavailable. Contact NHS 111 or request urgent GP assessment if pain is worsening, persistent or recurrent. Seek urgent advice if pregnancy is possible or bleeding, urinary symptoms or unexplained weight loss occurs. This lesson explains how clinicians assess abdominal pain. It cannot diagnose an individual episode or replace urgent medical care.

Abdominal pain patterns change probability rather than confirming an organ or diagnosis. Clinicians combine onset, location, progression, associated symptoms, examination and targeted tests before deciding what happens next.