Abdominal Pain: Symptom Irritable Bowel Syndrome IBS

Bloating Symptom Irritable Bowel Syndrome IBS

Everyone is familiar with abdominal pain: cramping, squeezing abdominal pain on the left or right side, sometimes accompanied by nausea, vomiting, diarrhea, or constipation. They often occur after eating. Usually they are not serious.

But sometimes abdominal pain has serious causes. Find out what signs may indicate harmless abdominal cramps and what signs may indicate you need to see a doctor.

A quick guide

  • Causes: Often harmless (e.g., too much food), but sometimes include conditions such as the stomach flu, gastritis, peptic ulcer, heartburn, reflux disease, appendicitis, diverticulitis, intestinal blockage, gallstones, hernia, heart attack, or pneumonia.

  • Treatment: Depending on the cause, either with home remedies (tea, hot water bottle, abdominal massage), medication, or sometimes surgery.

  • When to see a doctor? Very severe or increasing abdominal pain, hard distended abdominal wall, blood in stool, vomiting, high fever or fainting.

  • Diagnosis: Patient interview, palpation and listening to the abdomen, if necessary, additional tests depending on suspicion, such as blood test, ultrasound, gastroscopy, abdominal endoscopy, hydrogen breath test.

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Abdominal Pain: Types and Causes

Bloating Diseases Irritable bowel syndrome (IBS)

What causes abdominal pain?

The causes of abdominal pain are as varied as its symptoms. Depending on where the pain is felt (upper abdomen, lower abdomen, all of the abdomen), the cause can be narrowed down.

Even if the abdominal pain occurs in the typical location for a particular condition, it may radiate to other regions (as it progresses), migrate, or spread throughout the abdomen.

Increased risk of colon cancer

People with inflammatory bowel disease have an increased risk of colon cancer. Therefore, it is important for patients to be screened regularly for malignant changes in the bowel.

Pain in left upper abdomen

Pain on the left side of the upper abdomen often originates from one of the organs located there. These include the stomach and spleen (on the left side behind the stomach). Other organs, such as the heart or lungs, or parts of the intestines and pancreas (especially the pancreatic tail) can also cause left-sided upper abdominal pain.

The most common causes of left upper abdominal pain are

  • Gastritis: Common signs of a condition called gastritis include bloating, upper abdominal pain, loss of appetite, nausea, vomiting, heartburn, belching, and bad breath.

  • Peptic ulcer (ulcus ventriculi): Typical are sometimes severe upper abdominal pains on the left side, but also in the middle of the upper abdomen. The abdominal pain is usually most severe right after eating and subsides over time (until the next meal). It may also occur independently of eating.

  • Irritable stomach (functional dyspepsia): Digestive discomfort occurs as cramping abdominal pain independent of food. It is often accompanied by bloating, flatulence, and loss of appetite. Irritable stomach is also called functional dyspepsia.

  • Enlargement of the spleen (splenomegaly): A slightly enlarged spleen rarely causes symptoms. However, if it becomes larger, it can sometimes cause abdominal pain in the left upper abdomen. Find out what can cause splenomegaly here.

  • Rupture of the spleen (splenic rupture): The spleen usually ruptures as a result of a car accident, fall, or blow to the abdomen, or less commonly as part of an enlargement of the spleen. Patients may experience severe pain on the left side of the upper abdomen, especially when pressure is applied to the abdomen. Immediate medical attention is essential, for example after an accident!

  • Splenic infarction: When the blood supply to the spleen is cut off, the spleen tissue dies. Such an infarction usually causes sudden, extremely severe abdominal pain, felt most acutely in the left upper abdomen. The pain may radiate to the left shoulder and may be accompanied by nausea, vomiting, and fever.

  • In addition to gastritis, infections and other types of inflammation can cause pain when they affect organs in the left upper abdomen. For example, pneumonia, a gastrointestinal infection, or an inflamed pancreas (pancreatitis) can cause pain in the left upper abdomen. The same is true for a cancer that is located there (e.g., stomach cancer).

  • Pain in the left upper abdomen can also be caused by a heart condition. If you are also experiencing dizziness, shortness of breath, sweating, and/or other circulatory problems, call your doctor right away.

Pain in the right upper abdomen

Pain in the right upper abdomen is mainly caused by the organs located there. These are the liver and the gallbladder on the underside of the liver. In addition, parts of the intestines, such as the duodenum (the beginning of the small intestine) and the pancreas (especially the pancreatic head), run through here.

Typical causes of abdominal pain on the right side of the upper abdomen are

  • Duodenal ulcer (ulcus duodeni): This ulcer is characterized by sudden abdominal pain in the mid-upper abdomen at night, before breakfast, or a few hours after eating. This is also known as fasting pain. People usually feel the discomfort in the middle and/or right upper abdomen.

  • Gallstones: Depending on the location and size of the stones, varying degrees of abdominal pain may occur, usually on the right side of the upper abdomen and after a high-fat meal. In the worst case, biliary colic develops with sudden, very severe upper abdominal pain, sometimes radiating to the shoulder and back.

  • Inflammation of the bile ducts and gallbladder (cholangitis and cholecystitis): In addition to right-sided upper abdominal pain, fever, chills, and vomiting are typical of inflammation of the bile ducts. Abdominal pain often increases with inhalation because the diaphragm (which descends during inhalation) constricts the organs. This effect is particularly strong when, for example, a doctor presses on the right upper abdomen from the outside (Murphy's sign).

  • Liver disease: Liver damage often manifests as tenderness under the right rib cage or upper abdominal cramps. In hepatitis and cirrhosis, abdominal pain cannot always be localized. In addition to pain, depending on the severity of the liver disease, jaundice, loss of energy, fatigue, and loss of appetite may occur.

  • Cancer: Pain in the right upper quadrant can also be caused by cancer. It does not have to be liver or gallbladder cancer. Malignant growths in the liver are often metastases from other types of cancer, such as breast or colon cancer.

    Diseases of the pancreas, such as pancreatitis, can also cause pain in the right upper abdomen. The same is true for infections of the intestines, the left lower lung, and the pleura surrounding the lung (pleurisy).

Sometimes heart disease (such as a heart attack!) is also manifested by pain in the right upper abdomen. If you have other symptoms, such as shortness of breath or circulation problems, always call an emergency doctor.

Pain in the middle of the upper abdomen

A pressing, burning, or stabbing pain in the mid-upper abdomen is usually caused by diseases of the esophagus, stomach cardia, pancreas, lungs, or heart. Possible causes include

  • Heartburn, reflux disease: Burning, rising pain behind the breastbone, in the middle of the upper abdomen and possibly down to the throat, and intermittent acid regurgitation are the main symptoms. They usually occur after a large, fatty meal. If you lie down shortly after eating, for example on the sofa in the evening, the symptoms are often aggravated (the stomach acid can reflux more easily). Repeated contact with the aggressive stomach acid can inflame the lining of the esophagus, causing more pain.

  • Mucosal tears: An accident or vomiting can cause the lining to tear and hurt where the esophagus enters the stomach. Doctors call this Mallory-Weiss syndrome. Usually in the lower third, the wall of the esophagus can also tear completely, causing severe pain behind the breastbone and in the upper abdomen. This condition, called Boerhaave's syndrome, is life-threatening and requires immediate surgery.

  • Hiatal hernia: This is when parts of the body, such as the stomach, move through a gap in the chest. People often feel little or no discomfort. However, in addition to difficulty swallowing and heartburn, pain may occur in the middle of the upper abdomen.

  • Stomach diseases: Diseases of the stomach, such as gastritis or ulcers, can also cause pain, which patients tend to localize in the mid-abdomen.

    Pancreatitis (acute and chronic): Inflammation of the pancreas causes very severe, colicky abdominal pain, often belt-like around the upper abdomen. The pain may also be felt around the belly button. Usually other symptoms such as vomiting, loss of appetite, nausea, bloating, fever, or jaundice are also present.

  • Heart disease: Both "chest tightness" (angina pectoris) and heart attacks sometimes involve abdominal discomfort. Especially in women, heart attack symptoms can be atypical, such as severe abdominal pain. Other signs of heart problems include shortness of breath and breathlessness. In this case, call an emergency doctor immediately!

  • Spinal problems: Problems in the spine (such as thoracic vertebral block or vertebral fracture) sometimes cause discomfort that radiates to the abdomen and manifests as upper abdominal pain.

  • Abdominal aortic aneurysm: This is an abnormal bulging of the main artery (aorta) in the abdomen. It sometimes causes pain in the middle or throughout the abdomen. In addition, once it reaches a certain size, it often presses on nearby nerves, causing radiating pain in the upper abdomen and sometimes numbness in the legs. Caution: In some cases, an aneurysm may rupture suddenly, which can be life-threatening!

  • Cancer: Tumors sometimes cause pain or pressure in the upper abdomen. This is usually followed by other symptoms such as bloating, loss of appetite, weight loss, or fatigue.

Diseases that typically cause abdominal pain in the left, right, or middle of the upper abdomen can also cause discomfort in, radiate to, or spread to other areas of the abdomen.

Abdominal Pain in the Lower Abdomen

Abdominal pain below the belly button often originates from the intestines. But diseases of the urinary tract and gynecological problems can also cause lower abdominal pain.

  • Appendicitis: It usually starts with a dull abdominal pain around the navel, sometimes in the upper abdomen. As it progresses, the abdominal pain moves down to the right lower abdomen and then tends to be sharp. It gets worse with jumping, walking, sneezing and coughing, the abdominal wall is tense and very sensitive to pressure. This is often accompanied by fever, loss of appetite, nausea and vomiting.

  • Chronic inflammatory bowel disease: Ulcerative colitis manifests with bloody diarrhea plus cramping abdominal pain. In Crohn's disease, painful cramping occurs repeatedly, especially in the lower right abdomen, but also throughout the abdomen. This is accompanied by diarrhea, fever, and weight loss.

  • Urinary tract infection: A urinary tract infection is another possible cause of lower abdominal pain. Symptoms are often dull, but in the case of cystitis, they are more like cramping. In the case of ureteral colic, or the stones it causes, the pain comes in waves.

  • Renal colic: Both kidney stones and inflammation of the renal pelvis sometimes cause colicky pain in the lower abdomen, sometimes even in the upper abdomen. The pain radiates to the flanks and back. Sometimes the pain is so severe that it causes nausea and vomiting.

  • Hernia: This is most common in men, where the intestine herniates into the inguinal canal. The sign is a pulling pain in the groin with visible and/or palpable swelling in the groin area.

  • Diverticulitis: This condition is characterized by inflammation of the intestinal wall. Typical symptoms are dull pain, usually in the left lower abdomen. This is often accompanied by digestive problems such as constipation, diarrhea or bloating. If the pouches are not inflamed, the condition is called diverticulosis. It can also cause pain in the lower abdomen, although this is less common.

  • Gynecological problems: Lower abdominal pain in women often originates from the genital organs. In addition to the lower abdominal pain that sometimes accompanies menstruation, conditions such as inflammation of the fallopian tubes, endometriosis, and ectopic pregnancy are possible causes of lower abdominal pain.

  • Prostate inflammation: Inflammation of the prostate gland (prostatitis) often causes lower abdominal pain that may radiate to the back. Pain or pressure in the perineum and difficulty urinating may also occur.

  • Cancer with abdominal pain: Cancer often does not hurt until it is larger and has spread locally. In the lower abdomen and pelvis, cancer of the colon or rectum, bladder cancer, or gynecological tumors such as ovarian or uterine cancer can cause pain.

    Common types of abdominal pain and their causes

Abdominal Pain

Because of their location, diseases of the abdominal organs tend to be felt in certain regions. This provides important clues for causal research.

Pain throughout the abdomen

Often the abdominal pain is not localized - it spreads throughout the abdomen. Even simple constipation can cause unpleasant abdominal pain all over the abdomen. But there may be other factors and conditions that cause abdominal pain throughout the abdomen.


The mind and a fast, hectic lifestyle often take a toll on the stomach, causing gastrointestinal cramps and indigestion. When doctors cannot find a physical cause for chronic abdominal pain and other complaints, they call it a somatoform disorder, a psychosomatic illness.

Irritable bowel syndrome:

In irritable bowel syndrome, people sometimes experience diffuse abdominal pain that has no other clear cause (such as an infection). Other symptoms include bloating and irregular bowel movements.

Infection of the gastrointestinal tract (infectious gastroenteritis):

Diarrhea with cramping throughout the abdomen, vomiting, and nausea, sometimes accompanied by fever, general weakness, and tiredness are typical of gastrointestinal infections and mild food poisoning.

Food intolerances:

Food intolerances (such as lactose intolerance, fructose intolerance, or gluten intolerance/celiac disease) often present with abdominal cramping, bloating, and diarrhea that are difficult to localize.

Intestinal obstruction (ileus):

This acute emergency begins with colic and progresses to increasingly severe pain. There is also constipation and possibly vomiting (sometimes of stool!). The emergency physician must be called immediately!


Abdominal pain and fever are common symptoms of peritonitis. Possible causes include intestinal obstruction, rupture of a stomach ulcer or inflamed appendix, gallstones, and infected surgical scars. Again, call an emergency physician immediately!

Intestinal infarction (mesenteric infarction):

Resulting from an acute blockage of an intestinal artery, it begins with severe, stabbing abdominal pain, often accompanied by diarrhea and vomiting. The symptoms subside after a few hours, but this is deceptive. By this time, the part of the intestine that has been cut off from oxygen is severely damaged or even dead. In severe cases, circulatory failure and death are imminent! If you notice any signs of intestinal infarction, see a doctor immediately!


The collective term porphyria refers to a group of metabolic disorders in which the formation of the red blood pigment "heme" is disturbed. Instead, toxic intermediates are formed that damage the liver and other organs. Patients often suffer from episodes of severe cramping abdominal pain.


Abdominal pain is a side effect of many medications, including certain pain relievers, antibiotics, and laxatives. To find out if one of your medicines may be causing abdominal pain, read the package insert. Also, call your doctor if you develop discomfort after taking your medicine.

Abdominal pain (acute abdomen)

Several of the above causes of abdominal pain, when severe, can lead to "acute abdomen". In this condition, the abdomen is hard and distended. Sufferers complain of extreme abdominal pain and are unable to tolerate even light pressure on the abdomen.

Acute abdomen is always a medical emergency!

Possible causes of acute abdomen include intestinal infarction, intestinal obstruction, rupture of the fallopian tubes in ectopic pregnancy, peritonitis, and rupture of a gastrointestinal ulcer or inflamed appendix.

Abdominal pain in children

Children are usually not able to pinpoint the exact location of pain until they reach elementary school age. Toddlers, in particular, have difficulty localizing pain and may point to the stomach as the source of a sore throat or earache.

To be on the safe side, it is advisable to have your child's recurring abdominal pain evaluated by a doctor. It may be due to a medical condition that needs treatment or a food intolerance.

Sudden onset of severe abdominal cramps with accompanying symptoms such as fever, sweating, anxiety, vomiting, and diarrhea are warning signs of an acute illness. In this case, take your child to the doctor immediately!

Abdominal pain during pregnancy

Many women experience lower abdominal pain and cramps, especially at the beginning of pregnancy. This is because the growing fetus causes the uterus and surrounding tissues (called the maternal ligaments) to expand, which is usually felt as a strong pulling sensation


In addition, in advanced pregnancy, kicking the baby or lying on your back often causes abdominal discomfort. Many pregnant women also suffer from digestive problems such as constipation.

Often, a hot water bottle, digestive teas, and a comfortable position (such as lying on your left side) can help relieve abdominal pain.

  • In the following cases, however, a visit to the doctor is recommended:

  • If the pain does not go away

  • If the pain is worse than usual

  • If the pain is accompanied by other symptoms, such as fever, vomiting, nausea, or bleeding

Sometimes the cause of abdominal pain during pregnancy is relatively benign, such as a simple bladder infection or kidney stones. In other cases, it may be a sign of a serious complication, such as premature birth, miscarriage, or ectopic pregnancy.

SIBO IBS Expert Call Free

FREE: IBS & SIBO Expert Consultation

Your first step to a happier and healthier life.

Are you tired of feeling bloated, gassy and uncomfortable after every meal? Do you suffer from cramps, diarrhea or constipation?

Then talk to one of our Experts and let them guide you.