When abdominal pain is serious and when it's not

When you have a persistent or severe stomach ache, it can be difficult to know whether you should wait to see if it improves on its own, visit your doctor or go to the emergency room. London gastroenterologist, Dr Andrew Millar, gives us a quick overview of some of the causes of abdominal pain and explains when it is time to visit a specialist.

What exactly is abdominal pain?

Firstly, it is important to distinguish between discomfort and pain. Pain in the abdomen, also known as a stomach ache, can vary depending on how you perceive it. It can feel achy, campy or dull and either stops you from doing things or changes your behaviour. Discomfort, on the other hand, is unpleasant and doesn’t typically stop you from doing things.

Abdominal pain occurs in the abdominal cavity – between the chest and pelvic regions. The pain can sometimes radiate to the spine. This pain is usually caused by an inflammation or infection of the organs inside your abdomen, or by a groin, hip or even a heart problem. In order to get to the bottom of the nature of your stomach pain, you will need to be assessed by a specialist.  

What are some non-serious causes of abdominal pain?

Some causes of abdominal pain are quite common and typically don’t require medical attention or medication. These might include:

• Constipation
• Excess wind
• Spasm
• Overeating
• Food intolerance
• Minor infections
• Diarrhoea
• Acid reflux
• Menstrual cramps
• Stress

When should someone be concerned about their abdominal pain?

If the pain is causing you a lot of discomfort, making you lie down or you are experiencing recurrent pain, then you should see a doctor or specialist about this. When you visit a doctor, they will assess the location and the pattern of the pain.

The doctor will want to know if you have experienced this type of pain before and if it’s unusual for you. For someone who doesn’t usually experience abdominal pain and then suddenly having it can be a cause for concern.

They may also want to know if there is any associated weight loss or blood loss, which can indicate a serious underlying cause. Pain that causes severe nausea, fever, passing blood, stops you from eating, or keeps you awake at night can be an indication of something dangerous that needs treating.

You should always try to describe your symptoms, or combination of symptoms, to your doctor as accurately as you can, so they can pinpoint where the pain is coming from and what’s causing it. 

How can a doctor find the cause of abdominal pain?

Most of the time, various tests are used to diagnose the cause of the pain if the doctor cannot figure out the cause from examination alone and suspects there is something wrong. Tests may include:

• Blood test
• Stool test
• Endoscopy and CT scan

How is abdominal pain treated?

Following a diagnosis, the doctor will come up with a treatment plan depending on the cause. Treatments can range from medication for infections and inflammation to changing your lifestyle and diet.

For example, if the patient is suffering from irritable bowel syndrome (IBS), the patient will usually be treated with a dietary approach first. It is not uncommon to refer patients on to see a dietician or nutritionist in these cases. Similarly, food intolerance can cause stomach-ache so adjustments in your diet will be necessary. There are also times when a small infection needs to simply run its course, so over-the-counter pain relievers may be suggested here.

In rare circumstances, a patient might need to have surgery, especially if the pain is being caused by a hernia, blockage or appendicitis.

When do you need to call an ambulance?

• If your pain is in the lower right abdomen and tender to touch, and you are also experiencing a fever or vomiting, then this might be a sign of appendicitis. This usually begins with mid-abdominal pain that eventually moves to the right lower abdomen
• If you are vomiting blood
• If you are pregnant and have pain in your belly and are bleeding
• If you are struggling to breathe and have associated chest pain

The information in this article should not be used to self-diagnose. If you are worried about anything, you should get in contact with your GP or a health specialist.

If you would like to book a consultation with Dr Andrew Millar, visit his Top Doctors profile and check his availability.