When to Worry About Abdominal Pain

Find out when stomach pain is serious and when you can ride it out.

Rob Lamberts, MD,
August 24, 2010
Episode #060

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Stomach PainIn previous articles I’ve given mystery symptoms and shown how doctors make the diagnosis. But something needs to happen before the doctor can make a diagnosis: the patient has to come in. Deciding when to worry about symptoms is one of the hardest decisions. One one side, you don’t want to feel foolish coming in for something small; on the other side, you don’t want sit at home with a serious problem.

When to Worry About Abdominal Pain

So I am starting a series called, “When to Worry….” I’ll try to give you guidelines as to when a symptom is worrisome, and when it is OK to wait. Let me emphasize, however, that this is general advice that doesn’t apply to all circumstances. It is far better to be seen for a problem that ends up not being serious than to sit at home with a dangerous condition.

It’s two in the morning and you wake up with pain in your abdomen, or perhaps it is your child that wakes you up with a stomach ache. When should you seek immediate help, when should you make a doctor’s appointment, and when is it OK to wait? 

Anatomy of the Abdomen

The abdomen is divided up into five sections. The location of the pain can sometimes help in determining whether pain is worrisome or not. Here are the main regions:

Upper right quadrant: The right upper quadrant contains the liver and gallbladder, which are protected by the lower right part of the ribcage. The large intestine, or colon, also spends a little time in this section.

Upper left quadrant: The left upper quadrant contains part of the stomach and the spleen. The colon spends time here as well.

Upper middle section: Between these two sections, in the upper middle of the abdomen, is a section known as the epigastrium. This is an important section because it contains the most of the stomach, part of the small intestine, and the pancreas--all of which can cause pain.

Right lower quadrant: This quadrant contains more colon and the last part of the small intestine, where the appendix resides. In women, one of the ovaries is in this section.

Lower left quadrant: The other ovary lives in the left lower quadrant, along with the last part of the colon.

What Causes Abdominal Pain?

There are a few common problems that are caused by certain troublemakers in the abdomen. I’ll give you the list of the “abdomen’s most wanted,” and where they tend to hang out.

The appendix: This is a small tube that can become infected and cause a dangerous problem. Appendicitis pain usually starts around the naval, but then settles in the right lower quadrant. This is true the majority of time, but not all the time. More on this later.

The gallbladder: This organ is a sack that collects a digestive juice called bile. It can get infected or get stones, and usually causes pain in the right upper quadrant.

The stomach and first part of the small intestine: Ulcers can form in these organs, causing bleeding, pain, and occasionally a perforation, leaking stomach acid into the abdominal cavity. Ulcers usually cause pain in the middle above the belly button.

The pancreas: This organ puts out strong digestive juices. These juices are so strong that they can actually digest abdominal organs if the juice gets in the wrong place.

The colon: Pain from the colon can occur at nearly any place in the abdomen, although the most serious condition, an infection called diverticulitis usually causes pain in the left lower quadrant.