9 Causes of Acute Abdominal Pain
Acute abdominal pain is severe abdominal (belly) pain that develops all of the sudden and does not go away. Unlike cramps or an upset stomach, acute abdominal pain can be so intense that you may not be able to rest or relax.
The pain may just be in one part of the belly or it may affect the entire area. You’ll likely also have other symptoms like nausea, vomiting, bloody stool, dizziness, feeling lightheaded, or fever.
Most causes of acute abdominal pain are very serious and considered medical emergencies. If you are showing severe abdomen pain, go to the ER right away.
Acute abdominal pain can have several causes, all of which are considered medical emergencies and require immediate medical care. Some of these conditions are life-threatening and require emergent surgery; others are still urgent and may progress to life-threatening conditions if left untreated. —Dr. Bina Choi
- Severe abdominal pain around the belly button or in the right lower abdomen.
- The pain is sensitive to touch.
- Not wanting to eat
- Generally feeling unwell
- Increased gas
Appendicitis is an inflammation of the appendix. The appendix is a small pouch in the lower right side of your intestines.
The inflammation occurs when something blocks the appendix, which causes irritation, infection, and swelling of the appendix.
Go to the ER immediately if you have symptoms of appendicitis. Without immediate treatment, the appendix may rupture and the infection can spread throughout the body. A ruptured appendix is a life-threatening condition.
Appendicitis is usually treated with antibiotics and by surgically removing the appendix.
- Upper abdominal pain, often with back pain
- Not wanting to eat
- Shortness of breath (rare)
Pancreatitis is an inflammation of the pancreas. The pancreas is an organ involved in digestion and it regulates sugar in your body.
Pancreatitis often needs to be monitored in a hospital. You may need IV fluids, pain medication, a blood transfusion, and antibiotics.
Despite treatment, some people develop complications, such as an abscess (pocket of pus) in the pancreas that needs to be treated surgically.
3. Cholecystitis and cholangitis
- Constant pain in the upper right abdomen
- May have yellowing of skin or eyes
- May have dizziness
- May have confusion, altered mental status
Cholecystitis and cholangitis are conditions of the gallbladder and its ducts that are responsible for transporting bile. Bile helps in the digestion of fats and is stored in the gallbladder. The blockage can cause irritation and infection in the area behind the blockage.
Both conditions need to be treated with IV antibiotics at a hospital. Treatment for cholecystitis can include surgery to remove the gallbladder.
Treatment for cholangitis requires an emergency procedure to drain the obstructed bile, which relieves pressure and inflammation.
- Pain in the left or right lower part of abdomen
Diverticulitis is an inflammation of diverticula, small pouches that can form in the walls of your colon.
Normally, diverticula don’t cause any symptoms. But a small hole or tear (perforation) can form and cause irritation, leading to diverticulitis. The condition is more common in middle-aged and elderly people.
Diverticulitis ranges in severity. When mild, it can be treated with antibiotics. If severe, it can cause life-threatening complications and must be treated in the hospital. You may need IV antibiotics, a procedure to drain the area of infection, or surgery to remove the affected parts of the intestines.
Many of these are not simple diagnoses based on your symptoms or physical exam. They often require lab tests, imaging, and/or exploratory surgery to determine the cause. —Dr. Choi
5. Ovarian torsion
- Sudden, severe pain in the left or right lower abdomen or pelvis
- You may have pain may radiate to your groin or back
Ovarian torsion is a twisting of the ligaments that hold the ovary in place. It tends to occur when ovaries grow too large, such as with cysts, pregnancy, or a tumor. When this occurs, blood supply to the ovary may be blocked. You may be able to feel this blockage when you press on your pelvis.
Go to the ER immediately. Left untreated, the reduced blood flow can cause the tissue of the ovary to die.
Ovarian torsion is treated with surgery to untwist the ovary. If an ovarian cyst is what caused the ovary to become twisted, the surgeon will remove it. If the ovary has been seriously damaged from lack of blood flow, it may have to be removed.
6. Rupture or perforation of an organ
- Sudden, severe, and constant abdominal pain that hurts more when you move
- Hardness and stiffness of the abdomen
- Pain that feels worse when you press on your abdomen and gets better when you stop
- Vaginal bleeding
- Pain that travels to the back or side
- Loss of consciousness
A ruptured or perforation of an organ in your abdomen may cause the contents of the organ to leak and cause irritation of the lining of the abdomen.
Possible causes include:
- Ruptured appendix
- Perforated intestine
- Perforated stomach (you may feel pain in your shoulder blade)
- Perforated esophagus (you may feel pain in your chest and have difficulty swallowing)
- Ruptured diverticulitis
- Ruptured ovarian cyst
- Ruptured ectopic pregnancy (a fertilized egg that has grown outside the uterus)
- Ruptured aorta
- Ruptured spleen
Go to the ER immediately if you have symptoms of a perforated or ruptured organ. It is always an emergency regardless of what caused it, and emergency surgery is required.
7. Acute bowel obstruction
- Sudden abdominal pain that intensifies and can come and go
- Inability to pass gas
- Visible bulge in the abdomen
An acute bowel obstruction can be caused by several conditions. Two of the most common are a strangulated hernia and a twisted bowel (called volvulus).
A hernia occurs when an organ or piece of tissue pokes out of a weak spot in the muscles that surround your abdominal cavity. A strangulated hernia is a hernia that cuts off blood supply to the intestines.
A volvulus occurs when the bowel becomes twisted, cutting off the blood supply to the bowel may be cut off. A volvulus is more common in elderly people and those who have a history of abdominal surgery or abdominal cancer.
A strangulated hernia and a volvulus are both medical emergencies. Strangulated hernias require surgery.
Surgery may also be necessary if you have a volvulus. Some people with volvulus may be able to be treated with a less invasive procedure called a sigmoidoscopy, where your doctor inserts a flexible tube into your anus and uses it to unravel the volvulus.
8. Acute mesenteric ischemia
- Very sudden and very severe abdominal pain
- Sudden need to have a bowel movement
- Dizziness or lightheadedness
Acute mesenteric ischemia is caused by a sudden blockage in the blood vessels that supply your intestines with blood. This leads to death of intestinal tissue. Acute mesenteric ischemia is a medical emergency that requires surgery.
Some causes of ischemia (interruption in blood flow to the bowels) are less severe because the blood vessels are narrowed but not completely blocked. They still require urgent care to prevent them from becoming more serious.
These include chronic mesenteric ischemia (severe pain after eating) and colonic ischemia (pain is more gradual over days, may have bloody bowel movements). Treatment may include IV fluids, pain medication, blood thinners, and antibiotics.
9. Heart attack
A heart attack occurs when blood flow to the heart becomes blocked. Chest pain is a classic symptom of a heart attack, but the condition may cause severe abdominal pain as well. The pain may travel from the abdomen toward the chest or from the chest to the abdomen.
Go to the ER if you think you’re having a heart attack. Treatments used to clear the blockage and restore blood flow may include inserting a stent (a mesh tube that keeps the blocked artery open), undergoing bypass surgery, and a range of medications such as blood thinners, statins to lower cholesterol, and ACE inhibitors to help heart muscle recover.
Other possible causes
A number of other conditions can cause acute abdominal pain:
- Peptic ulcer disease
- Hepatitis (inflammation of liver)
- Spontaneous bacterial peritonitis (infection and inflammation of the abdominal space in people with cirrhosis)
- Abdominal abscess (collection of infection and inflammation in the abdomen)
- Colitis (infection/inflammation of colon)
- Inflammatory bowel disease
- Kidney stones
- Kidney infection
- Abdominal tumors
- Obstetrical and gynecological conditions (pregnancy complications, miscarriage, pelvic inflammatory disease, fibroids, etc.)
Children and acute abdominal pain
Infants and children are at risk of conditions that cause acute abdominal pain and require emergency medical attention. It’s important to pay attention to symptoms, especially if they cannot speak for themselves. Other symptoms in children can include extreme crying without any relief or ability to soothe, a rigid belly, being unable to pass gas or stool, or a change in skin color or condition.
Causes of acute abdominal pain in children include:
- Intestinal malrotation
- Necrotizing enterocolitis
When to call the doctor
If you have mild abdominal pain, make an appointment to see your doctor, as this type of pain may not be a sign of an emergency.
Because the abdomen contains so many organs and structures, a number of conditions may cause similar severe abdominal pain. So it is important to get evaluated at a medical center right away to distinguish between the conditions and get you treated. —Dr. Choi
Should I go to the ER for acute abdominal pain?
Go to the ER if you have severe abdominal pain and any of these symptoms:
- Constipation or inability to pass gas
- Bloody stool or dark, sticky stool
- Rigid abdomen
- Loss of consciousness
- Skin changes (redness, rashes, yellowish or gray skin)
- Chest pain
- Shortness of breath
- A traumatic injury
- Vaginal discharge or bleeding or recent changes in menstruation
- In infants and children, extreme crying without any relief or ability to soothe, a rigid belly, being unable to pass gas or stool, or a change in skin color or condition
Treatment for acute abdominal pain may include:
- Pain medications
- Procedures such as a sigmoidoscopy
Dr. Choi is a board-certified Internist and current Pulmonary and Critical Care fellow at Brigham and Women’s Hospital. She completed her residency at Columbia University NewYork-Presbyterian Hospital, received her MD with a scholarly concentration in Health Services and Policy Research from Stanford School of Medicine, and received her BS from MIT. Her academic interests include clinical epidemiology, health policy, and medical writing.