Abdominal pain

Almost everyone has belly pain at some point. Most of the time it comes from something simple, like gas, a stomach bug or constipation, and it goes away on its own. Pain that lasts for weeks, keeps returning, or comes with other changes deserves a visit. Dr. Pimienta sees adults from across Los Angeles County for abdominal pain, and the first step is always a careful conversation about what you feel.

What can the location of belly pain mean?

Where the pain sits is a useful clue, though not a diagnosis. Organs overlap, and pain can spread or move. This table shows common digestive causes by area, in plain terms.

Pain in the lower belly can also come from the bladder, kidneys, or, in women, the uterus and ovaries. Pain in the lower right side that starts near the belly button and moves there can be appendicitis, which needs emergency care.

What are common digestive causes of abdominal pain?

Reflux and gastritis

Burning or gnawing pain high in the belly, often with heartburn, nausea or early fullness. Learn more about acid reflux and GERD.

Peptic ulcers

Sores in the lining of the stomach or the first part of the small intestine. The two most common causes are an infection called H. pylori (Helicobacter pylori) and regular use of pain relievers such as ibuprofen, naproxen or aspirin (NSAIDs). Ulcer pain is often a burning ache that may improve or worsen with meals. Ulcers can bleed, which can show up as black stools.

Gallstones

Hard deposits in the gallbladder can block its outlet and cause steady, strong pain in the upper right or middle belly, often after a fatty meal, lasting from 30 minutes to several hours. Pain with fever or yellow skin needs urgent care.

IBS and constipation

Cramping that is linked to bowel movements, often eased by passing stool or gas, is common with irritable bowel syndrome and constipation. Bloating often comes with it.

Diverticulitis

Small pouches in the wall of the colon (diverticula) are common with age. When one becomes inflamed, it usually causes steady pain in the lower left belly, sometimes with fever, nausea or a change in bowel habits.

Inflammatory bowel disease

Crohn's disease and ulcerative colitis cause inflammation of the bowel. Pain often comes with diarrhea, blood in the stool, tiredness or weight loss. See inflammatory bowel disease.

When should I see a GI doctor for belly pain?

Make an appointment if your pain:

• Has lasted more than a few weeks, or keeps coming back
• Wakes you up at night
• Comes with weight loss you cannot explain, or loss of appetite
• Comes with a lasting change in your bowel habits
• Comes with trouble swallowing, vomiting or feeling full after a few bites
• Is new and you are over 50, or you have a family history of colon cancer or IBD

Severe or sudden pain is different. Use the emergency guidance at the top of this page.

How does Dr. Pimienta find the cause?

Most of the answer comes from your story and the exam. Dr. Pimienta will ask where the pain is, when it started, how long it lasts, what makes it better or worse, how it relates to meals and bowel movements, and which medicines you take, including over-the-counter pain relievers. He then examines your belly. From there, he chooses only the tests that fit your symptoms:

• Blood tests, such as a blood count and liver and pancreas tests.
• Stool tests, for example to look for infection, inflammation or H. pylori.
• Imaging, such as an ultrasound of the gallbladder and liver, or a CT scan.
• Other tests that may be arranged, such as a breath test for H. pylori or for certain food sugars.
• Upper endoscopy (EGD) to look for ulcers, inflammation and other causes of upper belly pain, with biopsies if needed.
• Colonoscopy when lower belly pain comes with bleeding, a change in bowel habits, or other warning signs.

How is abdominal pain treated?

Treatment depends on the cause, which is why finding it matters. Some examples:

• Acid-reducing medicines for reflux, gastritis and ulcers, and antibiotics when H. pylori is found
• Stopping or changing medicines that irritate the stomach, with your doctor's help
• Diet changes, fiber and targeted medicines for IBS and constipation
• Referral to a surgeon when gallstones cause repeated attacks
• Medicines that calm inflammation for IBD

Your plan depends on your health. You and Dr. Pimienta decide together what fits you, and follow-up visits make sure the plan is working.

Keep a symptom diary

A simple log for one to two weeks before your visit can make the diagnosis faster. Write down:

1. When and where

   The time of day, where the pain is, and how strong it is on a scale of 0 to 10.

2. What you ate and drank

   Meals, snacks and drinks, and how long before the pain started.

3. Your bowel movements

   How often, and whether stools are hard, loose, black or bloody.

4. What helped

   Medicines you took, passing gas or stool, rest, or anything else that changed the pain.

Questions patients ask

References

1. MedlinePlus, US National Library of Medicine. Abdominal pain.
2. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Peptic Ulcers (Stomach and Duodenal Ulcers).
3. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Gallstones.
4. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Diverticular Disease.