9 most common cause(s)
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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:
- Fever
- Nausea
- Vomiting
- Tenderness when you touch the stomach
- Diarrhea that can be bloody
- Cramping
- Abdominal distension
- Bloating
- Abdominal rigidity
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.
10 sharp abdominal pain conditions
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 or gastric ulcer is an open sore that forms when inflammation occurs in the stomach lining.
This stomach inflammation is caused by the bacteria Helicobacter pylori (H. pylori) and by prolonged use of pain relievers such as ibuprofen or aspirin. Chronic inflammation allows acid to damage the stomach lining and an ulcer may form.
Smoking, drinking alcohol, stress, and spicy foods may aggravate ulcers, but do not cause them.
Symptoms include burning pain in the stomach; heartburn; nausea; and bloating.
The pain may be worse between meals or at night. Antacids will only work for a short time. There may be dark red blood in the vomit or stools.
Left untreated, ulcers may bleed and cause anemia. They may perforate the stomach and cause peritonitis (serious infection of the abdominal cavity.)
Diagnosis is made through physical examination and by testing breath and stool for H. pylori. Endoscopy is sometimes used.
Treatment involves a course of antibiotics to kill the bacteria, and medication to block excess acid and heal the 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
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
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
Kidney stone
A kidney stone, also called renal lithiasis or nephrolithiasis, is a solid deposit that forms inside the kidney. Stones may form if the urine becomes too concentrated for any reason, allowing the minerals in it to crystallize.
There are several possible causes:
- Not drinking enough water.
- Family or personal history of kidney stones.
- Diets high in protein, salt, or sugar.
- Obesity.
- Digestive diseases and conditions, including gastric bypass surgery.
- Urinary tract infection.
- Metabolic conditions and/or hereditary disorders.
Symptoms include severe pain in the side, back, and abdomen; pain on urination; urine that is pink, red, brown, and/or foul-smelling; nausea and vomiting; and sometimes fever and chills.
Diagnosis is made through blood test, urine test, and imaging.
For smaller stones, the patient may only need to drink extra water and take over-the-counter pain relievers. Medication may be given to help pass the stone. Larger stones may require the patient to be hospitalized for surgical procedures.
Prevention involves drinking more water and restricting certain foods, including animal protein, calcium, and salt. Sometimes prescription medications will be used.
Gallstones
Gallstones are small, pebble-like, mineral deposits that can form inside the gallbladder. They may cause no symptoms unless they become lodged in a duct leading out of the gallbladder.
Gallstones are thought to be caused by high cholesterol, which can form into crystals in the gallbladder; by cirrhosis, or scarring, of the liver; or by incomplete emptying of the gallbladder.
Most susceptible are women over age 40. Other risk factors are obesity, lack of exercise, poor diet, and rapid weight loss as with gastric bypass surgery.
Symptoms include sudden sharp pain in the center or upper right abdomen, in the right shoulder, and in the upper back. There may also be nausea and vomiting, yellowing of skin and eyes, and fever and chills.
It's important to see a medical provider for these symptoms. Gallstones can lead to pain, infection, and further complications.
Diagnosis is made through physical examination, CT scan, blood tests, and sometimes specialized scans to examine the gallbladder system.
Treatment usually involves surgery to remove the stones and sometimes the gallbladder itself.
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
Ectopic pregnancy
Ectopic pregnancy, or tubal pregnancy, means that a fertilized egg has not implanted in the uterus as it should. Instead, it has attached elsewhere – usually inside one of the fallopian tubes.
The condition is caused by scarring and damage to the fallopian tube from pelvic inflammatory disease or injury; by hormonal imbalance; or possibly by abnormal development of the fertilized egg. Other risk factors include smoking, use of an IUD, and use of fertility drugs.
Early symptoms include light vaginal bleeding, pelvic discomfort, and sometimes referred shoulder pain. Later symptoms include sudden severe pain on one side of the lower abdomen, vaginal bleeding, shoulder pain, and fainting.
The fallopian tube cannot accommodate a growing pregnancy. Eventually it will rupture, causing uncontrolled bleeding within the abdomen. If ectopic pregnancy is suspected, take the patient to the emergency room or call 9-1-1.
Diagnosis is made through pelvic examination, blood tests, and ultrasound.
Treatment almost always requires surgery, though in some cases medications can be used.
Prevention involves avoiding pelvic inflammatory disease by always practicing safe sex.
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.
You should go to the ER. There, diagnosis is made by physical examination, imaging, and blood tests. Treatment typically involves intravenous (IV) fluids and medicines to control the pain.
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 large artery that leaves the heart and travels down the center of the body. If there is a weakened spot –an aneurysm – in the wall of the aorta where it runs through the abdomen, the condition is called an abdominal aortic aneurysm.
Most susceptible are men over age 65. Other risk factors include family history; high blood pressure; using any form of tobacco; hardening of the arteries; infection; and trauma, such as a car accident.
Symptoms include a deep, painful pulsating sensation in the abdomen near the navel, and back pain.
If there is also sudden pain, sweating, and nausea, it may indicate that the layers of the aorta have begun to come apart (dissection) or torn through (rupture.) This is a life-threatening medical emergency. Take the patient to the emergency room or call 9-1-1.
Diagnosis is made through abdominal ultrasound. If there is no dissection or rupture, surgery will be planned so that repair of the aneurysm will not have to be done as an emergency.
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
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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References
- Patterson JW, Dominique E. Acute Abdomen. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2018. NCBI Link.
- Phillips MM. Abdominal Pain. U.S. National Library of Medicine: MedlinePlus. Updated December 3, 2018. MedlinePlus Link.
- Patient Education: Chronic Abdominal Pain in Children and Adolescents (Beyond the Basics). UpToDate. UpToDate Link.
- Abdominal Pain - Unexplained. Cedars-Sinai. Cedars-Sinai Link.
- Macaluso CR, McNamara RM. Evaluation and Management of Acute Abdominal Pain in the Emergency Department. International Journal of General Medicine. 2012;5:789-797. NCBI Link.