Unexplained Abdominal Pain

Pain in the abdomen can be a symptom of a number of different conditions, and in some cases, it can be difficult to diagnose the cause. Of course, conditions affecting any of the structures within the abdomen or abdominal wall can cause abdominal pain, but pain originating in the chest, back, or pelvis can also be perceived as abdominal pain.

When abdominal pain is severe or when it's accompanied by fever, diarrhea, persistent constipation, blood in the stools, persistent nausea or vomiting, vomiting blood, severe tenderness of the belly, jaundice (yellowing of the eyes and skin), or swelling of the abdomen, it's important to seek immediate medical attention.

Some common causes of abdominal pain include:

  • Injury to the abdomen or chest wall from blunt trauma or muscles strains.
  • Scars in the abdominal wall
  • Peptic ulcers
  • Gastritis (irritation of the lining of the stomach)
  • Non-ulcer dyspepsia (discomfort after eating not due to ulcers)
  • Functional abdominal pain
  • Cancers of the upper abdomen, including liver, bile duct, gallbladder, pancreatic, stomach, or lymphoma
  • Esophagitis (inflammation of the esophagus)
  • Pancreatitis (inflammation of the pancreas)
  • Cholecystitis (inflammation of the gallbladder)
  • Gallstones
  • Problems with the bile duct valve
  • Hepatitis (infection of the liver)
  • Colitis (infection of the colon)
  • Irritable bowel syndrome
  • Crohn's disease
  • Diverticulitis (inflammation of the pouches that form in the colon)
  • Bowel obstruction due to adhesions (scars that form after surgery or inflammation), tumor, inflammation, or colon cancer
  • Appendicitis
  • Hernias
  • Kidney stones
  • Urinary tract infections
  • Tumors of the kidneys or bladder
  • Pelvic pain relating to muscular structures in the pelvis, which can be seen in men and women
  • Pelvic problems in women, such as ovarian cysts or cancer, fallopian tube infection, ectopic pregnancy, uterine fibroids, malignant tumors in the uterus or cervix, endometriosis, or menstrual cramps
  • Nerve irritation
  • Shingles
  • Pneumonia
  • Pleurisy (irritation of the lining around the lungs)
  • Pulmonary embolism (blood clots to the lungs)
  • Costochondritis (inflammation of the rib cartilages)
  • Heart attack
  • Vascular problems, such as blocked arteries or veins or swelling of the main artery in the belly

Providers will use the patient's history and a physical examination to narrow down the possible causes of abdominal pain. They may ask about the characteristics of the pain, its location, and its relation to eating or to having a bowel movement. They may also consider the pattern of pain, its duration, and its association with other symptoms. During the physical examination, providers may look for areas of tenderness, the presence or absence of bowel sounds or abdominal swelling, palpable masses, organ enlargement, and evidence of blood in the stools.

If the history and physical examination are inconclusive, providers may order different diagnostic tests. Frequently used tests include blood tests, x-ray and imaging tests, urine and stool samples, and endoscopy.

Treatment for abdominal pain depends on the cause. Occasionally, however, no clear cause can be found. In these situations, the pain itself may be treated with medications that reduce pain, called analgesics. However, some pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and narcotics, can cause other abdominal symptoms and conditions, and even worse pain.