Abdominal Pain: Causes, Symptoms, Treatment

Abdominal Pain: Causes, Symptoms, Treatment
Photo source: Getty images

Abdominal pain can be dull, sharp and in the form of cramps. It accompanies various abdominal diseases and other health problems. So, what does it mean?

Abdominal pain is a symptom of diseases of the abdominal organs (organs of the digestive system). However, in a figurative form, it also occurs with other health problems.

The nature of the pain may be dull, sharp, stinging or stabbing, or burning, sometimes with cramps and colicky pain. 

It is localized to a specific place, or its source cannot be pinpointed, or it radiates, even to the back, chest or other places. 

It occurs after meals, fasting, at night or as morning abdominal pain.

Various questions arise, such as which quadrant it comes from, what provokes it and whether it recurs, but also what associated problems accompany it.

Examples are lack of appetite, increase in body temperature, vomiting, diarrhoea or cessation of wind and absence of stools.

What could be behind the abdominal pain?
And what will help against abdominal pain? 
What does it mean if it hurts above the abdomen or below the navel and lower abdomen? 
Or, if it occurs on the left or right side?
And lots of other information in the article about this symptom...

Dividing the abdomen into quadrants

The abdomen is divided into several quadrants. This also helps find a possible cause. 

How is the abdomen divided into quadrants?

Two imaginary lines are drawn across the navel, one horizontal and the other vertical. The division looks like this:

  1. epigastric, is the area above the umbilicus and below the sword-shaped process of the sternum
    • pravé hypochondrium - under the right rib cage
    • ľavé hypochondrium - under the left rib cage
  2. around the navel - mesogastrium, or the periumbilical area
    • right mesogastrium
    • left mesogastrium
  3. below the navel - hypogastrium
    • right hypogastrium to right inguinal region 
    • left hypogastrium to left inguinal region
    • hypogastrium over sponou  

Important details about abdominal pain

In addition to the location of the pain, several pieces of information are important for this symptom.


When did the pain start and how long has it lasted? Is it acute, i.e. does it last for minutes, hours? Or is it chronic, i.e. present for more than 3 months?

Pain can be recurrent, i.e.it returns in multiple consecutive periods with a pause present between recurrences.

  1. acute abdominal pain - sudden onset and are intense, may have a violent course
  2. chronic abdominal pain - dull, moderate intensity, persisting for more than 3 months
  3. recurrent - three episodes of pain in a three-month period


Its intensity is also important. It can be mild, which can be endured. However, the flip side is intense, excruciating pain that even painkillers can't relieve.


Let's continue with the character of the pain

Is the pain dull?
Sharp - stinging, stabbing? 
Colicky, i.e. wavy with alternating intensity? 

Does it repeat and come back? 


Where is it localised? And therefore in what quadrant? 

  1. epigastrium - the upper central region of the abdomen
  2. mesogastrium - in the middle and around the navel
  3. hypogastrium - below the umbilical region


It's placed in one place / radiates + pain shoots from one place to another, such as when:

• Gallbladder colic emanates from the epigastrium,
directed under the right rib cage,
sometimes below the right shoulder blade.

• Inflammation of the pancreas from the epigastrium striated under the left rib arch, including below the left scapula.

- Renal colic from the shank in men up to the testicles or in women to the labia.

• Inflammation of the appendix, popularly the appendix, begins in the suprapubic area, moves through the umbilicus area until it ends in the right lower abdomen.

• Diverticulitis of the colon in the sigmoid region is accurately localized similarly to appendicitis, but on the left side of the hypogastrium.


What caused the pain and what preceded it?

Does it occur repeatedly after a meal, or at midnight, at night or in the morning? Is it triggered by faeces or urination? Is it aggravated by movement or has it arisen after an accident? 


Is it accompanied by other symptoms?

Examples of common abdominal pain complaints are:

  • lack of appetite
  • nausea, vomiting
  • increase in body temperature, fever
  • lack of passing gas
  • lack of passing stool
  • constipation
  • diarrhea
  • overflow of intestinal contents and strikingly intense peristalsis
  • bloating, increased flatulence, flatulence, belching
  • sweating, cold sweat
  • skin pallor
  • bleeding from the gastrointestinal tract during stool or vomiting
  • pain outside the abdomen, such as in the head, chest
  • changes in stool colour
  • frequent urination and changes in urine colour
  • fatigue, malaise
  • fainting
Abdominal pain and nausea, heaviness, man holding his abdomen
Abdominal pain, the stomach feels full and bloated. Photo: Getty images

Table: distribution of abdominal pain according to the nature and triggering cause

Pain type Description
Pain type
Visceral abdominal pain - the basis is the irritation of receptors in smooth muscle
  • visceral - organ, splanchnic or vegetative pain
  • stretching or contraction and spasm of the muscles of the organs, intestines and bile ducts as well as the ureters
  • in bulging of the liver or spleen
  • in ischaemia, i.e. the lack of blood supply to the organ
  • during organ contraction
  • in distension and stretching of the hollow organ
  • there is no exact location, the pain spreads through vegetative pathways
  • radiating to other parts
  • vague, dull, burning, colicky in the larger part of the body
  • the person is pointing with the whole hand (not a finger)
  • the characteristics of the discomfort may change during the course of
  • walking and strolling helps
  • the location may not reflect the exact location of the problem
    • epigastrium - stomach, liver, gallbladder, pancreas
    • mesogastrium - small intestine, colon from the appendix + ascending and transverse parts
    • hypogastrium - the rest of the colon
Somatic abdominal pain - arise from irritation of the peritoneum, i.e. the peritoneum, as well as from irritation of the skin and subcutaneous tissue
  • somatic - parietal
  • it is caused by irritation during advanced inflammation and subsequent spillage of contents into the abdomen, causing irritation of the peritoneum by gastric or intestinal contents, bile, urine, inflammatory effusions
  • appendicitis is a good example:
    • the pain starts in the abdomen and in the area around the navel
    • progression of the condition and progression of inflammation indicates irritation of the peritoneum
    • the pain shifts and localizes precisely to the right lower abdomen
    • typical course of appendicitis, especially in children and young
  • the pain is sharp, cutting, stabbing
  • precisely localized - corresponds to the damaged organ, intestine
  • the affected person points accurately with his finger
  • pain persists and is even aggravated by any movement
  • the affected person does not change position, breathes shallowly and does not speak, tries not to cough
Triggering cause
Visceral pain
  • caused by diseases and damage to a specific organ, parts of the digestive tract
Functional pain
  • has no organic cause and therefore no structural damage to the organ, tissue
  • non-organic and psychogenic causes
  • functional abdominal pain = functional disorders of the digestive tract
  • also called FGID - Functional gastrointestinal disorders
  • examples:
    • irritable bowel syndrome
    • functional diarrhoea or constipation
    • functional meteorism
  • their basis is disturbed interaction between the digestive system and the CNS (central nervous system - brain)
  • resulting in disturbances of motility (bowel movements), hypersensitivity (hypersensitivity), changes in mucosal and immune functions and disturbances of microflora to immunity
  • they are associated with persistent or excessive stress and other psychological factors

Sudden abdominal episodes

Sudden abdominal episodes are acute diseases of the abdomen and abdominal organs, which are characterized by a sudden onset, have a rapid course and require urgent surgical intervention.

Early diagnosis and early treatment are important in sudden abdominal episodes.

In addition to abdominal pain, which is acute and intense, it is accompanied by difficulties such as:

  • nausea
  • vomiting
  • stopping the passage of stool and winds

Causes are categorised into inflammatory, ileal and traumatic.

  1. inflammatory, acute:
    • appendicitis
    • pancreatitis
    • cholecystitis
    • diverticulitis
  2. ileus = intestinal blockage
    • mechanical - obstructive, when the intestine is blocked by a foreign body (gallstone), adhesion, tumor, also as oppression of the intestine from the outside
    • vascular / ischemic - in blood disorders, embolism, thrombosis, aneurysm
    • neurogenic - spastic and paralytic, when the innervation of the intestine is disturbed
    • bleeding into the gastrointestinal tract, in dissection and rupture of aortic aneurysm
  3. injury - are also caused by trauma, blunt or penetrating
Digestive problems and anatomical view of the digestive system
Abdominal pain is common due to indigestion. Photo: Getty images

1. Abdominal pain in the middle, above the navel and around the navel?

Probably every person has experienced the difficulties that set in after eating. A disproportionate load of bites and daily running, inappropriate and heavy food. It puts a strain on the digestive system and the body of man in general. 

This is an example of a non-serious transgression caused by us.

However, there may be a disease behind the problem. 

Examples are diseases at the level of the oesophagus, stomach and small intestine. However, they can also be directed to a given site from another part.

In addition, apart from diseases affecting the digestive tract, the problem may also have a basis in another organ system

Heaviness in the epigastrium

  • inflammation of the oesophagus
  • inflammation of the stomach
  • Helicobacter pylori
  • upper dyspeptic syndrome
  • gastroesophageal reflux
  • inflammation of the gallbladder
  • gallbladder stone
  • ulcer disease of the stomach and duodenum - ruptured ulcer
  • inflammation of the pancreas
  • intestinal blockage - ileus
  • splenic infarction
  • inflammation of the appendix - subsequently moves through the area around the belly button to the right lower abdomen
  • other diseases in the chest cavity
    • myocardial infarction
    • endocarditis - inflammation of the heart
    • pleurisy
    • pneumonia

Abdominal pain after eating occurs with gastric ulcer, mostly within 1 hour.

Late pain more than 2 hours after eating, often at night, is typical of a duodenal ulcer. It is relieved by further food intake.

Pain in the mesogastrium may be a sign of:

  • gastritis - inflammation of the stomach
  • stomach ulcer
  • chronic pancreatitis
  • Crohn's disease
  • enteritis - inflammation of the small intestine
  • chronic appendicitis
  • hernia - abdominal hernia
  • irritable bowel syndrome
  • diseases of the spine
  • other diseases with impaired blood circulation
    • hypertension
    • diabetes
    • fat metabolism disorder
    • smoking
    • porphyria
    • hemochromatosis
    • tuberculosis
    • tumour
    • inflammation of blood vessels
    • injury

2. Left-side abdominal pain

Have you ever felt pain in the upper abdomen? It could be a pancreatic disease. The most common forms are acute and chronic inflammation. Typical is moving from the area above the navel, under the left rib arch to below the left shoulder blade.

Pancreas - inflammation of the pancreas = pancreatitis.

The most serious form is pancreatic cancer.

Read more in the articles:

Alternatively, it may be non-specific inflammatory bowel disease (IBD). This term combines ulcerative colitis and Crohn's disease.

Or is it the other way around?

Does it hurt in the bottom left area? It could be diverticulosis and diverticulitis (inflammation).

It occurs due to normal bloating and flatulence.

Outside the digestive system, it occurs as renal colic. This type of pain may be caused by kidney stones that irritate the kidney or the urinary tract.

Urinary tract infections are common in women.
So are inflammation of the ovaries and ovarian cysts.
Ectopic pregnancy is also dangerous.

Among the diseases that are thought of less is ovarian torsion. In this case, there is a disturbance of blood supply and sharp acute pain that can radiate to the back.

3. Right-side pain

Do you feel any pain above and to the right that is radiating under the right rib cage?

Both the liver and the gallbladder are located in this section.

The liver tissue as such is not painful, however, pain can be felt when the liver envelope is expanded. Do you remember from school and physical education when we used to get a twinge right under our ribs during a long run? The increased blood supply to the organ and the stretching of its sheath meant exactly this discomfort.

The gallbladder and bile ducts can be affected by inflammation and gallstones are also common.

Alternatively, it also occurs in gastroduodenal perforation, i.e. a rupture of gastoduodenal ulcer.

What about bottom right?

Will you or your child suffer from lower right abdominal pain. Most of the time we immediately think of appendicitis, technically appendicitis. And that's right, it's one of its typical symptoms. 

Learn more: 

As with problems on the left: it can be right-sided renal colic, inflammation of the intestines, ovarian or ectopic pregnancy and others.

Najzávažnejším ochorením je rakovina. Príkladom je rakovina hrubého čreva a iné.

4. Cramps, diarrhoea or constipation and abdominal distention

In this case, there may be functional problems such as irritable bowel syndrome.

Especially in the elderly, a general decrease in mobility, lack od fluids, bad diet, comorbidities and treatment are possoble causes of constipation.

In the context of infectious intestinal diseases, these are mainly:

  • salmonellosis
  • shigellosis
  • campylobacter infections
  • viral hepatitis, especially type A

5. Abdominal problems can stay "hidden"

Pain radiates within the nerve pathways to other parts of the body. So it is on a global level within the human organism, and therefore within the abdomen.

The following source of pain are indirect signs: 

  • under the shoulder blade
  • between the shoulder blades
  • under the ribs
  • flanks
  • lower back
  • groin area
  • the testicles, the labia

6. Pain in the abdomen during pregnancy

Pregnancy, as a period of great change, is perceived sensitively. However, not only hormonal changes, but also physical ones are involved in the occurrence of abdominal pain.

They occur at the beginning during and in the last stage. In the beginning as the first symptom of fertilization and pregnancy, later as a consequence of fetal growth and uterine distension with pressure on surrounding organs and structures, and of course at the time of delivery.

Pain in the lower abdomen, a drop in the abdomen and its hardening, pressure on the uterus up the spine and on the anus as with a bowel movement, all this can mark the start of childbirth. Naturally, next is the loosening of the mucus plug, the drainage of amniotic fluid to the presence of bleeding.

In addition, other named health problems also occur throughout the period, ranging from indigestion, heartburn and others. 

Serious complications lead to reasons such as: 

  • ectopic pregnancy
  • preeclampsia
  • miscarriage/abortion
  • premature birth

Also, abdominal pain during ovulation and menstrual cycles, and painful menstruation. The pain may return during menopause.

7. Abdominal pain in children

Up to 90-95% of cases of abdominal pain in children do not have an organic cause. Mostly, these are psychogenic difficulties and functional causes of abdominal pain.

Other examples include pain that recurs in our children on Mondays, or as morning stomach pain. It is advisable to look for psychogenic factors and mental strain and stress. 

Similarly, the day of the week, and especially Monday and early morning hours, tend to be a risk factor for a number of diseases, not just digestive diseases.

However, there are more serious reasons to think about, especially if you observe the following warning signs:

  1. pain in a child under 4 years of age
  2. pain that the child localizes elsewhere than around the belly button
  3. radiating pain
  4. pain that woke the child from sleep
  5. slow development and weight loss of the child
  6. slowing to cessation of growth
  7. vomiting
  8. fever
  9. the development of difficulties after an accident

Learn more:
A child is not a miniature of an adult! What are the differences?

Just as some diseases may progress differently in children than in adults, so it is with the elderly. Why is this so? It is a combination of several factors. Long-term illnesses, their treatment and decline in brain function, and an overall lower response to pain (also in addition to drug therapy).

8. Summary

Typical and atypical, early and late, sudden and prolonged, sharp, dull and crampy, before or after meals, and as a morning pain, above the navel, below and around the navel, on the left and on the right, or in the middle and below the ribs. All this and much more, just as you have just read. 

Table: summary of important information

Some warning signs
  • sudden onset of sharp, stabbing pain
  • burning, dull or colicky pain
  • shocking to excruciating pain
  • nausea (feeling like vomiting) and vomiting (especially in children)
  • lack of appetite
  • cessation of passing wind and lack of bowel movements
  • distended, large belly
  • diarrhea
  • tenesmus, painful anus
  • weakness, malaise, fainting
  • discharge of blood from the anus and genitals in women
  • blood in the urine and urination disorders
Possible causes
  • digestive tract
    • inflammation of the stomach, intestines, pancreas, Crohn's disease and ulcerative colitis
    • ileus 
    • ulcer
    • lactose intolerance, celiac disease, histamine and other intolerances
    • gallbladder, liver, pancreas
    • constipation
  • urinary system and kidneys - inflammation, stones 
  • gynaecological - inflammation, menstruation, pregnancy, tumours
  • abdominal wall - muscles (stretching and injury), shingles, trauma
  • chest pain, for heart and respiratory problems
  • vascular - aortic dissection, thrombosis and embolism
  • from the spine as radiculopathy in disc disease and back pain up to the abdomen
  • metabolic diseases, diabetes, porphyria, uraemia
  • functional disorders, dyspepsia and the like
  • side effects of medicines
  • migraine
  • systemic lupus erythematosus
Medical examination
  • history taking
  • sonogram, ultrasound
  • X-ray
  • CT and MRI
  • examination of blood, urine, stool
  • body temperature, blood pressure, pulse, glycaemia, CRP
  • physical examination - visual, tapping, palpation, auscultation


How can I relieve abdominal pain?

You can probably already guess that it is impossible to answer this question in a simple way.

It is necessary to find out what the cause of the difficulty is, which will determine the required therapy. 

fshare on Facebook

Interesting resources

  • Patterson JW, Dominique E (14 November 2018). "Acute Abdomenal". StatPearls. PMID 29083722.
  • Viniol A, Keunecke C, Biroga T, Stadje R, Dornieden K, Bösner S, et al. (October 2014). "Studies of the symptom abdominal pain--a systematic review and meta-analysis". Family Practice31 (5): 517–29. 
  • Hung, Alex; Calderbank, Tom; Samaan, Mark A.; Plumb, Andrew A.; Webster, George (1 January 2021). "Ischaemic colitis: practical challenges and evidence-based recommendations for management". Frontline Gastroenterology12 (1): 44–52. 
  • Spangler R, Van Pham T, Khoujah D, Martinez JP (2014). "Abdominal emergencies in the geriatric patient". International Journal of Emergency Medicine7: 43. 
  • Moore KL (2016). "11". The Developing Human Tenth Edition. Philadelphia, PA: Elsevier, Inc. pp. 209–240. ISBN 978-0-323-31338-4.
  • Hansen JT (2019). "4: Abdomen". Netter's Clinical Anatomy, 4e. Philadelphia, PA: Elsevier. pp. 157–231. ISBN 978-0-323-53188-7.
  • Drake RL, Vogl AW, Mitchell AW (2015). "4: Abdomen". Gray's Anatomy For Students (Third ed.). Churchill Livingstone Elsevier. pp. 253–420. ISBN 978-0-7020-5131-9.
  • Neumayer L, Dangleben DA, Fraser S, Gefen J, Maa J, Mann BD (2013). "11: Abdominal Wall, Including Hernia". Essentials of General Surgery, 5e. Baltimore, MD: Wolters Kluwer Health.
  • Bickley L (2016). Bates' Guide to Physical Examination & History Taking. Philadelphia, Pennsylvania: Lippincott Williams & Wilkins. ISBN 9781469893419.
  • ANP-BC, Karen M. Myrick, DNP, APRN, FNP-BC; ANP-BC, Laima Karosas, PhD, APRN, FNP-BC (6 December 2019). Advanced Health Assessment and Differential Diagnosis: Essentials for Clinical Practice. Springer Publishing Company. p. 250. ISBN 978-0-8261-6255-7.
  • Cartwright SL, Knudson MP (April 2008). "Evaluation of acute abdominal pain in adults". American Family Physician77 (7): 971–8. 
  • Tytgat GN (2007). "Hyoscine butylbromide: a review of its use in the treatment of abdominal cramping and pain". Drugs67 (9): 1343–57. 
  • Sherman SC, Cico SJ, Nordquist E, Ross C, Wang E (2016). Atlas of Clinical Emergency Medicine. Wolters Kluwer. ISBN 978-1-4511-8882-0.
  • Skiner HG, Blanchard J, Elixhauser A (September 2014). "Trends in Emergency Department Visits, 2006-2011". HCUP Statistical Brief #179. Rockville, MD: Agency for Healthcare Research and Quality.
The aim of the portal and content is not to replace professional examination. The content is for informational and non-binding purposes only, not advisory. In case of health problems, we recommend seeking professional help, visiting or contacting a doctor or pharmacist.