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Sharp Abdominal Pain: Causes & When to Go to the ER

Sharp abdominal pain could be common gas or need immediate medical attention.
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Last updated September 29, 2020

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Sharp abdominal pain symptoms

When abdominal pain is severe, it indicates an underlying problem. Severe abdominal pain is often referred to by the medical term acute abdomen. Severe abdominal pain, in some cases, requires emergency care. You know your body best, so if the pain becomes unbearable, seek care immediately. A few other symptoms you may be experiencing in addition to your severe abdominal pain are listed below.

Common accompanying symptoms of severe abdominal pain

Along with severe abdominal pain, you may experience:

Other characteristics of severe abdominal pain

Also, pay attention to the quality and location of the pain. Your pain may be localized and limited to one area of the abdomen. It may be intermittent, or colicky, which is a term that describes the pain that is sudden and feels like a severe muscle spasm. The pain can also feel like cramps or a tightening sensation in your stomach.

Sharp abdominal pain causes

Severe abdominal pain is associated with an underlying cause that may require emergency intervention. Seek medical attention as soon as possible if you experience symptoms.

Inflammatory causes

Inflammation of the organs or structures around the abdomen can result in severe abdominal pain.

  • Organ inflammation: Conditions that cause inflammation to the organs of the abdomen can result in sudden abdominal pain that persists and worsens over time. For example, appendicitis, inflammation of the appendix, results in abdominal pain that often starts around the belly button and travels to the lower right abdomen. The pain can be extremely severe and debilitating. Pancreatitis, inflammation of the pancreas, is usually associated with nausea and vomiting. The gall bladder, liver, and kidneys can also become inflamed.
  • Infection: Bacterial and viral infections that affect the abdomen can also result in severe abdominal pain. Gastroenteritis is the general medical term for an intestinal infection. The pain often results in vomiting, diarrhea, and nausea.

Obstructive causes

An obstruction somewhere in the abdomen can result in severe pain.

  • Intestinal: Many things can cause an obstruction in the intestines and lead to blockages of food or liquid. Fibrous bands of tissue, called adhesions, can often form in the abdomen after surgery or other inflammatory conditions. When these adhesions are not treated, they block blood flow (ischemia) resulting in severe abdominal pain symptoms. Hernias and diverticula (bulging pouches in the digestive tract) can also cause an obstruction. Sometimes your intestines can twist on themselves, causing an obstruction called intestinal volvulus.
  • Stones: Hardened materials of calcium, digestive fluid, and other substances can form and deposit in different organs of the abdomen. The kidney and gallbladder are particularly susceptible to stone formation. These stones not only create blockages but also irritate the surrounding organ, resulting in pain and discomfort that can be exacerbated with things like eating or moving.

Reproductive causes

Severe pain due to issues with the reproductive system may be felt in the abdomen.

  • Male: Testicular torsion can result in severe referred abdominal pain symptoms. Torsion occurs when the testicle rotates around the spermatic cord. Twisting can block blood flow to the scrotum, resulting in swelling that can appear as a lump. Torsion is extremely painful and extremely dangerous.
  • Female: Complications of pregnancy such as miscarriage or ectopic pregnancy can result in severe abdominal pain in addition to vaginal bleeding. In non-pregnant women, conditions such as ovarian torsion (when the ovary twists around its cord and limits blood flow) as well as ovarian cyst rupture can result in sharp, severe abdominal pain.

Traumatic causes

Direct trauma to the abdomen from a car accident, for example, can result in injury and or rupture of the organs. The spleen and liver are especially susceptible to rupture during traumatic situations and the resulting blood in the abdomen can irritate the lining of the stomach and further exacerbate pain.

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10 sharp abdominal pain conditions


Gallstones are small, round deposits found in the gallbladder, the organ where bile is stored. Gallstones can be subclassified a number of ways. Oftentimes, gallstones will be referred to as either cholesterol stones or pigment stones depending on the makeup of the gallstone.

Gallstones can also be class...

Gall bladder infection (cholecystitis)

Gallbladder infection, also called cholecystitis, means there is a bacterial infection of the gallbladder either with or without gallstones.

The gallbladder is a small organ that stores bile, which helps to digest fats. If something blocks the flow of bile out of the gallbladder – gallstones, damage to the bile ducts, or tumors in the gallbladder – the bile stagnates and bacteria multiplies in it, producing an infected gallbladder.

Risk factors include obesity, a high-fat diet, and a family history of gallstones.

Symptoms include fever; chills; right upper quadrant abdominal pain radiating to the right shoulder; and sometimes nausea and vomiting. A gallbladder infection is an acute (sudden) illness, while the symptoms of gallstones come on gradually.

Untreated cholecystitis can lead to rupture of the gallbladder, which can be life-threatening.

Diagnosis is made through physical examination, ultrasound or other imaging, and blood tests.

Treatment involves hospitalizing the patient for fasting with IV fluids, to rest the gallbladder; antibiotics; and pain medication. Surgery to remove the gallbladder is often done so that the condition cannot recur.

Rarity: Uncommon

Top Symptoms: abdominal pain (stomach ache), nausea, loss of appetite, diarrhea, constipation

Symptoms that always occur with gall bladder infection (cholecystitis): abdominal pain (stomach ache)

Symptoms that never occur with gall bladder infection (cholecystitis): pain in the upper left abdomen, pain in the lower left abdomen

Urgency: Hospital emergency room

Acute abdomen

Acute abdomen refers to sudden, severe abdominal pain that is considered a medical emergency, requiring immediate diagnosis and often urgent surgical intervention. People of both genders and all ages are at risk for acute abdomen because it can have such varied causes.

Symptoms include a predomin...

Stomach ulcer

A peptic ulcer is a sore in the lining of the stomach or the first part of your small intestine (the duodenum), which causes pain following meals or on an empty stomach.

Rarity: Uncommon

Top Symptoms: fatigue, nausea, loss of appetite, moderate abdominal pain, abdominal cramps (stomach cramps)

Symptoms that never occur with stomach ulcer: pain in the lower left abdomen

Urgency: Primary care doctor

Ovarian torsion

Ovarian torsion, also called adnexal torsion or tubo-ovarian torsion, is the twisting of the "stem," or supporting fleshy pedicle, of the ovary.

This condition can occur when a mass forms on the surface of the ovary and pulls it over. This is most often a complication of cystic ovaries.

It is most common in women under thirty or past menopause. It can occur during pregnancy.

Symptoms include severe, one-sided, lower abdominal pain with nausea and vomiting.

Diagnosis is made by ultrasound. The ovary will appear enlarged due to the torsion cutting off the circulation. There will be free pelvic fluid and a twisted pedicle.

Ovarian torsion is a medical emergency. The ovary can die due to loss of circulation, causing infection, abscess, or peritonitis. Surgery must be done to prevent tissue death and subsequent complications. In the majority of cases the affected ovary must be removed, which also removes the cyst or mass that caused the torsion.

Proper treatment of polycystic ovary syndrome (PCOS) can help prevent at least one cause of ovarian torsion.

Rarity: Rare

Top Symptoms: abdominal pain (stomach ache), nausea or vomiting, nausea, moderate abdominal pain, loss of appetite

Symptoms that never occur with ovarian torsion: diarrhea, pain below the ribs, mild abdominal pain

Urgency: Hospital emergency room

Ectopic pregnancy

Ectopic pregnancy is a fairly common condition (one to two percent of all pregnancies). An ectopic pregnancy is one that occurs outside the uterus, which is the normal site of fetal development.

The hallmark symptoms of an ectopic pregnancy include severe abdominal pain, vaginal bleed...

Ruptured ovarian cyst

It is normal for one of the two ovaries to create a small follicle each month. This follicle contains an egg cell that is released as part of the menstrual cycle.

In some cases, however, the egg cell fails to release. The follicle becomes overgrown and may eventually rupture, especially during sexual activity or strenuous exercise.

Symptoms of a ruptured ovarian cyst may be mild and only require over-the-counter pain relievers.

However, sudden severe pain on one side of the lower abdomen, especially with vaginal bleeding, may indicate internal bleeding and is a medical emergency. Take the patient to the emergency room or call 9-1-1.

Diagnosis is made through patient history, physical examination, and ultrasound, as well as blood tests and urine tests to rule out any other cause for the symptoms.

Treatment may involve hospitalization for IV fluids and pain medications. Surgery may be done to control the bleeding and remove any clots, blood, or fluid in the abdomen.

Rarity: Rare

Top Symptoms: stomach bloating, pelvis pain, lower abdominal pain, being severely ill, severe abdominal pain

Urgency: Hospital emergency room

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Acute pancreatitis

Acute pancreatitis is the inflammation of the pancreas, which creates and releases insulin and glucagon to keep the sugar levels in your blood stable. It also creates the enzymes that digest your food in the small intestine. When these enzymes accidentally get activated in the pancreas, they digest the pancreas itself, causing pain and inflammation.

Rarity: Rare

Top Symptoms: constant abdominal pain, nausea or vomiting, being severely ill, severe abdominal pain, fever

Symptoms that always occur with acute pancreatitis: constant abdominal pain

Urgency: Hospital emergency room

Abdominal aortic aneurism (aaa) rupture

The aorta is the major blood highway. Injuries to the aorta can cause life-threatening internal bleeding.

Rarity: Rare

Top Symptoms: being severely ill, nausea, severe abdominal pain, side pain, spontaneous back pain

Symptoms that always occur with abdominal aortic aneurism (aaa) rupture: being severely ill

Urgency: Emergency medical service

Kidney stone

A kidney stone is a stone made up of various possible materials that forms in the kidneys. Factors that increase the risk of forming kidney stones include high levels of calcium, uric acid, and oxalate in the urine, low levels of citrate in the urine, abnormal urine pH, low urine volume, certain urin...

Sharp abdominal pain treatments and relief

Many causes of acute abdomen require surgery. If you are stable when you arrive in the emergency room, your medical team will first do an abdominal X-ray or CT scan to get a better idea of what could be causing your severe abdominal pain symptoms.

When it is an emergency

If you arrive and are unstable (symptoms of fever, shortness of breath, low blood pressure, loss of consciousness) your care team may need to conduct urgent surgery in the case of obstruction, inflammation, or excessive bleeding. With this exploratory surgery (also called an exploratory laparotomy), your care team will be able to locate the severe abdominal pain cause and systematically find ways to stop it.

FAQs about sharp abdominal pain

Here are some frequently asked questions about severe abdominal pain.

When should I be concerned about a stomachache?

You should be concerned about a stomach ache if you are also experiencing dizziness, loss of consciousness, a rigid abdomen, or worsening pain with movement. Additionally, if you have blood in your stool or vomit, chest pain, or are potentially pregnant, you should seek emergency care.

Why do I have severe stomach pain during my period?

Severe stomach or abdominal pain during your period can be caused by endometriosis, a disorder in which uterine tissue migrates elsewhere. This tissue grows and sloughs off during your period. This can cause tenderness, pain during sex, and severe abdominal pain. Ectopic pregnancy, or a pregnancy in which the embryo is somewhere other than the uterus, can cause pain as well.

Why do certain foods cause severe stomach pain?

Certain foods can cause severe stomach pain by causing stomach cramps. If you have an ulcer, foods that require vigorous motion to digest or foods that contain acid can cause severe stomach pain. Additionally, foods that are hard may also cause cramps. High lactose or high fiber foods, as well as tough meats, can also cause severe abdominal pain.

Questions your doctor may ask about sharp abdominal pain

  • Have you experienced any nausea?
  • Any fever today or during the last week?
  • Have you lost your appetite recently?
  • How would you describe the nature of your abdominal pain?

Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.

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Dr. Rothschild has been a faculty member at Brigham and Women’s Hospital where he is an Associate Professor of Medicine at Harvard Medical School. He currently practices as a hospitalist at Newton Wellesley Hospital. In 1978, Dr. Rothschild received his MD at the Medical College of Wisconsin and trained in internal medicine followed by a fellowship in critical care medicine. He also received an MP...
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