What Causes Abdominal Pain? Common Causes and Warning Signs

Created: 12.06.2024 · Last Updated: 17.08.2026 · Category: Gastroenterology · Prepared by the Academic Hospital Web and Editorial Board.

What Is Abdominal Pain?

Abdominal pain is pain or discomfort felt between the lower chest and the groin.

It can be mild and temporary or sudden, severe and persistent.

Abdominal pain does not always originate from the stomach or intestines. The gallbladder, liver, pancreas, kidneys, urinary tract, reproductive organs, blood vessels and even certain conditions outside the abdomen can cause abdominal symptoms.

What Causes Abdominal Pain?

Common causes include:

  • Gas and bloating
  • Indigestion
  • Constipation
  • Gastroenteritis
  • Gastritis or peptic ulcer disease
  • Irritable bowel syndrome
  • Gallstones or cholecystitis
  • Kidney or ureteric stones
  • Urinary tract infection
  • Appendicitis
  • Diverticulitis
  • Pancreatitis
  • Bowel obstruction
  • Inflammatory bowel disease

Less common but potentially serious causes include gastrointestinal perforation, mesenteric ischaemia, intra-abdominal bleeding and abdominal aortic aneurysm.

What Can the Location of Pain Suggest?

The location of pain can provide useful clues but cannot establish a diagnosis by itself.

  • Upper central abdomen: Gastritis, peptic ulcer disease, pancreatic or biliary disorders.
  • Right upper abdomen: Gallstones, cholecystitis or selected liver disorders.
  • Right lower abdomen: Appendicitis is an important possibility.
  • Left lower abdomen: Diverticulitis is an important consideration, particularly in adults.
  • Flank pain radiating towards the groin: Kidney or ureteric stones may be considered.

What Causes Right Lower Abdominal Pain?

Appendicitis is an important cause of right lower abdominal pain.

The pain can initially begin around the umbilicus and later migrate to the right lower abdomen. Loss of appetite, nausea, vomiting or fever may accompany the pain.

Kidney stones, bowel disease and gynaecological disorders can produce similar symptoms.

What Causes Right Upper Abdominal Pain?

Right upper abdominal pain is commonly associated with the gallbladder and biliary tract.

Gallstones or acute cholecystitis may cause pain that radiates towards the back or right shoulder and can be associated with nausea, vomiting or fever.

Ultrasonography is generally an important first imaging investigation when biliary disease is suspected.

What Causes Left Lower Abdominal Pain?

Constipation and several bowel disorders can cause left lower abdominal pain.

Diverticulitis is an important possibility, particularly in older adults, and may be associated with fever, tenderness and changes in bowel habits.

What Causes Abdominal Pain in Women?

Gynaecological causes should be considered in patients of reproductive age with lower abdominal or pelvic pain.

Possible causes include menstrual pain, ovarian cysts, ovarian torsion, pelvic inflammatory disease, endometriosis and ectopic pregnancy.

A pregnancy test is an important part of the assessment when pregnancy is possible.

Severe one-sided lower abdominal pain with possible pregnancy, vaginal bleeding, dizziness or fainting requires urgent assessment for ectopic pregnancy.

Which Abdominal Pain Is an Emergency?

Urgent assessment may be needed for:

  • Sudden severe abdominal pain
  • A rigid or markedly tender abdomen
  • Fainting, cold sweats or low blood pressure
  • Vomiting blood
  • Black tarry stools or significant rectal bleeding
  • Persistent vomiting
  • Abdominal distension with inability to pass stool or gas
  • High fever with worsening abdominal pain
  • Jaundice
  • Severe pain and bleeding when pregnancy is possible

How Is the Cause of Abdominal Pain Diagnosed?

Evaluation starts with the medical history and physical examination.

The clinician considers the onset, location, severity, radiation and progression of pain, as well as associated symptoms such as vomiting, fever, diarrhoea, constipation, urinary symptoms or bleeding.

Vital signs and the abdominal examination help identify patients who may require urgent investigation or treatment.

Which Blood and Urine Tests May Be Used?

Tests depend on the suspected cause and can include:

  • Complete blood count
  • C-reactive protein
  • Kidney function and electrolytes
  • Liver and biliary markers
  • Lipase
  • Urinalysis
  • Pregnancy testing when appropriate

When Are Ultrasound, CT and MRI Used?

Imaging is selected according to the location of pain and the suspected condition rather than pain severity alone.

Ultrasound is commonly used first for suspected biliary disease and many pelvic conditions.

CT is important for many causes of non-localised acute abdominal pain, bowel disease, obstruction, perforation and suspected appendicitis in adults.

MRI can be useful when avoiding ionising radiation is important, including selected pregnant patients when ultrasound is inconclusive.

Can Pain Relief Be Given for Acute Abdominal Pain?

Older teaching suggested that analgesia should be withheld until the diagnosis was established because pain relief might conceal examination findings.

Current evidence shows that appropriate analgesia improves comfort without meaningfully reducing the accuracy of the physical examination or diagnosis.

Severe abdominal pain should still be medically assessed. The concern is not that appropriate pain relief necessarily “hides” the diagnosis, but that relying on medication alone may delay assessment of a serious underlying condition.

When Should You Seek Medical Care?

Persistent, recurrent or progressively worsening abdominal pain deserves medical assessment.

Seek urgent assessment for:

  • Sudden and very severe abdominal pain
  • A rigid abdomen
  • Fainting or signs of circulatory instability
  • Vomiting blood or black stools
  • Persistent uncontrollable vomiting
  • Abdominal distension with inability to pass stool or gas
  • Severe pain with fever or jaundice
  • Severe pain, vaginal bleeding, dizziness or fainting when pregnancy is possible

Have Persistent Abdominal Pain Assessed

Persistent or recurrent abdominal pain, changes in bowel habits, nausea, vomiting or unexplained weight loss may require medical evaluation.

Frequently Asked Questions

What are the most common causes of abdominal pain?
Common causes include gas, indigestion, constipation, gastroenteritis, gastritis or peptic ulcer disease, gallstones, kidney stones, urinary tract infection, appendicitis and diverticulitis. Abdominal pain can also originate from organs outside the digestive system.
Does right lower abdominal pain always mean appendicitis?
Appendicitis is an important cause of right lower abdominal pain, but kidney stones, bowel disorders and gynaecological conditions can cause pain in the same area. Diagnosis requires clinical assessment and sometimes laboratory tests and imaging.
Does pain relief hide the diagnosis of acute abdominal pain?
Current evidence shows that appropriate analgesia for acute abdominal pain does not meaningfully reduce the accuracy of the physical examination or diagnosis. However, severe pain should not be managed with painkillers alone while delaying medical assessment.
Is ultrasound or CT used for abdominal pain?
The imaging method depends on the location of pain and the suspected condition. Ultrasound is often the first choice for right upper abdominal pain and suspected biliary disease. CT may be needed for non-localised acute pain and many bowel conditions.
Why is abdominal pain important when pregnancy is possible?
Pregnancy testing is important when pregnancy is possible. Severe one-sided abdominal pain with vaginal bleeding, dizziness or fainting may indicate an emergency such as ectopic pregnancy.
Which abdominal pain requires emergency care?
Sudden severe abdominal pain, a rigid abdomen, fainting, vomiting blood, black stools, uncontrollable vomiting, abdominal distension with inability to pass stool or gas, or severe pain and bleeding when pregnancy is possible may require urgent assessment.
Academic Hospital note: The cause of abdominal pain cannot be determined from pain severity or location alone. Medical history, physical examination, laboratory tests and appropriately selected imaging are interpreted together. Sudden severe pain, bleeding, fainting, a rigid abdomen or other warning signs require urgent assessment rather than a routine appointment. You can book an appointment.

References

  1. Academic Hospital. Causes of Abdominal Pain
  2. American Academy of Family Physicians. Acute Abdominal Pain in Adults: Evaluation and Diagnosis
  3. American College of Radiology. ACR Appropriateness Criteria: Right Upper Quadrant Pain
  4. American College of Radiology. ACR Appropriateness Criteria: Acute Nonlocalized Abdominal Pain