When to Worry About Abdominal Pain

Find out when stomach pain—from upper abdominal pain to middle stomach pain—is serious and when you can ride it out.

Rob Lamberts, MD,
August 30, 2016
Episode #060

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When Should You Worry About Abdominal Pain?

It’s better to get checked out by a doctor for nothing than to stay at home with something more serious.

Location is important, but the nature of the pain itself is even more so. Here are some of the things that make stomach pain more worrisome:

  • Severity: Pain that wakes you up out of your sleep or stops you in your tracks is always worth worrying about.

  • Persistence: Pain that’s continuous or lasting more than 10 minutes is more worrisome than intermittent, brief pain.

  • Tenderness: Doctors use the term tenderness to describe pain you feel when the body part is pressed upon. From a patient’s perspective, tenderness is when movement makes the pain worse. If your abdominal pain gets worse when you move or push on a spot, that’s worrisome.

  • Loss of appetite: When a serious problem happens in the abdomen, the body shuts down digestion. Things stop moving through the digestive tract and you feel nauseated and don’t want to eat. It’s rare for someone with appendicitis, for example, to want to eat anything. Significant weight loss as a result of this appetite slump is especially worrisome.

  • Vomiting: Vomiting becomes a concern when it is intractable, meaning without halting enough to be able to consume liquids to replace it. When vomiting is prolonged or severe, doctors worry about dehydration, which is a common reason for hospitalization and/or ER visits when patients experience abdominal pain. If you cannot keep any fluid down to replace the fluid that is being regurgitated, then it may require a visit to the ER for IV fluid replenishment.

  • Blood in bowel movements: Painless bleeding is not a big concern, as it’s usually from hemorrhoids. But bleeding along with abdominal pain is a symptom that causes concern.

  • Melena: The word melena describes black, tar-like bowel movements. That is a sign of bleeding from the gastrointestinal tract that started in the upper gastrointestinal tract, like the stomach. The blood in the stomach turns black by the time it reaches the rectum. If something is causing enough bleeding to cause melena, it is usually something bad, like a bleeding ulcer. Melena is serious, and people with it should go directly to the emergency room. That is true even if there is no pain.

  • Dizziness: If you are getting dizzy or light-headed with abdominal pain, it may mean your blood pressure is dropping. Get seen right away for this.

When Don’t You Need to Worry About Abdominal Pain?

The reassuring signs are the flip-side of the worrisome signs:

  • Mild pain

  • Pain isn’t worse with pressing or movement

  • Pain isn’t associated with a lack of appetite

  • Pain doesn’t interfere with regular activity

Furthermore, the passage of stool and gas shows that the digestive tract is working, which is also reassuring. That’s why surgeons ask people if they are passing gas after they perform abdominal surgery.

The Quick and Dirty Tip

The bottom line, of course, is that it’s better to get checked out by a doctor for nothing than to stay at home with something more serious. 

It’s also vital to point out that certain patient populations are considered higher risk when it comes to abdominal pain: those who are immune compromised or have HIV, women (due to a more complex female anatomy), and the elderly. According to previous studies, people over age 65 have a particularly higher risk of death or complications from abdominal pain because they are more likely to have vague or non-specific symptoms. Therefore, if you are in this group, it’s best to err on the side of seeing your doctor.

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Catch you next time! Stay Healthy!

*Please note that all content here is strictly for informational purposes only.  This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider.  Please always seek a licensed physician in your area regarding all health related questions and issues.

Sanaz Majd, MD, also contributed to this article, which was updated on August 30, 2016.

Stomach image courtesy of Shutterstock.


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