Acute Severe Abdominal (Stomach) Pain

Severe abdominal (stomach) pain is a debilitating pain preventing someone to continue with his/her daily activities. Abdominal cramps (spasms) are painful contractions of the hollow abdominal organs or muscles in abdominal wall lasting from few seconds to several hours. The cause of the pain or cramp can be usually suspected from its location and accompanying symptoms. Severe abdominal pain often requires urgent hospitalization but not always.

Severe Abdominal Pain Requiring Immediate Hospitalization

A person with:

  • Severe stomach pain, forcing him/her to sit or lie down
  • Pain, lasting over 10 minutes
  • Restlessness or unusual calmness
  • Pale face and lips
  • Shallow breathing and weak heart beat
  • Fever, chills, nausea or vomiting..

..should be admited to hospital immediately to treat a possible life threatening disorder, like:

1. Acute Appendicitis

Sudden right lower abdominal pain, which usually starts near the navel and gradually moves few inches toward left and down, tenderness at this spot, nausea, vomiting and fever are main symptoms of acute appendicitis,which can affect a person of any age. Inflamed appendix has to be surgically removed as soon as possible to prevent its perforation and life threatening abdominal inflammation.

Diagnosis in typical cases can be made from history and physical examination; in non-typical cases a CT is the main investigation. Appendix is removed through an inch wide incision in the abdominal wall. Prognosis is excellent; death from appendicitis is rare.

2. Acute Poisoning

Severe upper middle abdominal pain and cramps, vomiting and altered consciousness are main symptoms of acute poisoning due to ingesting of corrosive liquids (e.g. petrol, acids), excessive amount of medications or illegal drugs, inhaling of poisonous gases like war gases or pesticides.

Inducing vomiting with fingers pushed into the throat or drinking a glass of salted water may be tried only in conscious person but not if corrosive substances like petrol or acids were ingested. Stomach pumping, injecting antidots, hemodialysis, and intravenous fluid infusion are some of possible treatments measures.

More about chemical poisoning.

3. Infections

In the western world, food poisoning by bacteria or parasites in a previously healthy person is rarely serious despite possible dramatic vomiting, abdominal cramps and diarrhea. Food poisoning often heals on its own in few days, and if not, a doctor may prescribe oral antibiotics.

Rotavirus infection causing stomach flu with fever, stomach cramps, vomiting and diarrhea is also usually not a serious disease in the western world, but it is still a major cause of children deaths in Africa, South Asia and South America. Therapy is with replacing lost fluids by oral rehydration solutions or intravenous infusion.

4. Injuries with Internal Abdominal Bleeding

A hit to the stomach (often in car accidents), shot and knife injuries may cause bleeding into abdominal cavity. Abdominal pain, paleness, thirst and feeling of coolness are main symptoms.

Therapy. An urgent surgery is required.

5. Perforation of the Stomach or Intestine

Perforation of the stomach is a complication of advanced stomach ulcer or cancer. Perforation of the small intestine is rare. Perforation of the colon may occur in advanced Crohn’sor ulcerative colitis, diverticulitis, Clostridium difficile infection, colorectal cancer and during colonoscopy or surgery.

Therapy is with an urgent surgery.

6. Dissection or Rupture of Abdominal Aorta

In persons after 50 with advanced atherosclerosis, layers in the wall of abdominal part of the aorta may be split what may cause a sudden severe abdominal pain. Therapy is with an urgent surgery; many patients die before treatment starts, though.

About Jan Modric (249 Articles)
Health writer
  • Jan Modric

    B,

    disabling severe pain with confirmed history of adhesions, vomiting, is enough of reasons to go to the hospital or ER. Adhesions can spread to any part of the abdomen, and yes, they can cause intestinal obstruction. Severe abdominal pain and bloating, relieved by vomiting speaks for intestinal obstruction. Adhesions can be found and treated by a laparoscopy.

  • lada

    Hi, I ma 40 years old female, and this is my long story . One year ago I started feel discomfort in left abdominal – middle part. At first I was thinking it is becasue of abs exercise I was doing, then i was thinking it is because I ate too much cherries. I also nioticed that stool become white for sevral days and then came back to normal, some days it is thin and some days not. The discomfort seemed to go Avay after I was eating apples, or any diary food. Then I took probiotic Culterelle – after which i kind of lost apetite and stomach became really flat. I had vistied 2 doctos – went through clonoscopy (polyp found and removed, diverticulosis found- doctor suggested – thta pain becasue of them – but the pain is not in the buttom of the stomach but in the middle), endoscopy – gustrit found, checked with gynecologist – everything ok – no cyst, made xray -everything in norm. I don’t know what to do anymore ? can you suggest something?

  • Jan Modric

    lada,

    white (bright white, sticky, foamy, floating?) stool speaks for fat malabsorption, which can be caused by a small intestinal disease (like celiac disease), bile duct obstruction with a gallstone, liver or pancreatic disease. White stool lasting for few days without much other problems could speak for a gallstone trapped in the bile duct and then released – just a thought. Gallstones can be only rarely detected by an X-ray, but a CT reveals them in most cases.

  • lada

    Thank you very much for quick responce, the white stool was only once(few days) and never come back again, but disturbance still exist in middle abdominal, i hought gallstones should cause pain in the back as well – but i never experienced that, can gallstones casue pain just in middle abdominal?
    i defenetly will ask for CT – surprised it was not suggested before

  • Jan Modric

    lada,

    gallstones in the bile duct can be present without pain, or cause pain in the right upper abdomen and sometimes additionally in the back. They do not cause pain in the left middle abdomen, but they can block bile flow into the intestine and thus cause fat malabsorption. Unabsorbed fat then travels from the small into large intestine where it is degraded by colonic bacteria which yield gas, which can distend the colon, what can be painful. Some fat is excreted unchanged with the stool, giving it white color. The only reason I proposed this hypothesis is the white stool you’ve mentioned. So, it is really important to say, was it bright white, sticky stool, or was it grey (colorless) stool, or was it translucent whitish mucus….No matter if the white stool was only for few days – it’s not normal. The only other possible cause of white stool would be barium enema or some supplements, like antacids.

    Before simply accepting the theory about gallstones, try to recall was it really a bright white stool or stool with white patches. And, did you take some tablets in a day or two before. A gastroenterologist might propose abdominal ultrasound as the first investigation – it can detect gallstones in the gallbladder and bile duct (CT is more accurate but also more expensive, so often an ultrasound is done first).

    Diverticles can cause some stool retention, resulting in gas built in the colon, which could cause pain on the whole left side of the abdomen…

  • lada

    thank you again, the stool was light grey a that time, no pills were taken before.
    the disturbance in the right side of abdominal only , any advise is appreciated

  • Jan Modric

    lada,

    stool is grey when there is no bile in it, again that means bile flow was blocked on its way from the liver to the duodenum. This can occur in an acute liver disease or blockage of the bile duct. Dark urine, from bilirubin entering the blood and excreting through kidneys, is a common accompanied symptom. You do not mention any severe symptoms at the time you had grey stool, and since it resolved in few days, this speaks for a bile duct blockage with a gallstone, which has been later released. I do not know, if this has something with your current symptoms, but it is possible you have gallstones.

    It would help to understand your condition, if you can say, if you feel any lump when you palpate the left abdomen, is this part distended or tender to touch? Do you have excessive gas and what exactly have you meant by thin stools? If you think cherries triggered the symptoms, you might have fructose malabsorption. In this case a low-fructose diet would help.

  • zombie

    i’ve had cat scan and indososcopy colonoscopy can’t find nothing. i have this severe pain in upper stomach. it feels like something chewing me up inside.when i wake up in the morning i’m fine as long as i’m lying down. as soon as i get up and move around i get that chewing pain. any idea’s what i should do next.had gallbladder and appendix removed25 years ago.

  • lada

    there is no lump in the abdominal , and no tender to touch, but there is kind of like small dent on the left side of abdomnal area, some days tere is exessive gas and some not at ; some days stool is thinner as regular (flowating) and some not

  • Jan Modric

    zombie,

    can you use some additional words to describe your pain? Is it constant pain, is it tender to touch, does it change as you move around, do you burp excessively or have distended abdomen?

  • Jan Modric

    lada,

    stool test for fat would reveal fat malabsorption and would speak for bile duct obstruction. Stool test for bacteria and parasites could be also done.

  • Willow

    I am mid 40s, and had a total Abdominal hysterectomy about 3 years ago. This past year, I started getting electrical pains.. feels like small electrical charges running through my skin… starting around my naval. They never last very long, just a few seconds, but they always make me catch my breath. At first, I had one, then a month would go by, and I would have another. Now, I can have a cluster of them in a day, and more the next, but then nothing for a few weeks. Crunches, walking, etc don’t seem to bring them on or make them happen more frequently. While they started around the naval, they have traveled all around the naval and can appear in new spots – in other words, the pain is not always in the same place. The doc seems to think it is just nerves healing from the surgery (several years later?) but I am beginning to think that although it appears to be under the skin, it may really be associated with gas or bowel issues… although constipation doesn’t seem to make it worse? Any ideas?

  • Jan Modric

    Willow,

    abdominal/pelvic adhesions may appear years after surgery. Adhesions are strands of tissue that connect bowel loops and adjacent organs or abdominal wall. Ultrasound may (only sometimes) reveal them, MRI shows them more often, and a doctor should see them during laparoscopy.

  • Elizabeth

    I am experiencing a constant dull ache in my upper abdomen accompanied by an occasional severe and excruciating ache in my lower abdomen. I only feel the excruciating ache when I am sitting down. If I stand up it gets better, if I lie down, it gets worse. If I eat something more substantial than a salad, the dull pain in my upper abdomen worsens for an hour after eating. I went to a traditional healer, and massaging my stomach worsens the pain hours later. Sometimes the pain in my upper and lower abdomen is so severe I vomit. The intestinal pain comes and goes, but my upper abdomen is always aching. The pain feels like someone is squeezing, twisting, and punching my stomach and intestines from the inside.

  • Jan Modric

    Elizabeth,

    this is very likely a gastrointestinal disorder. Peptic ulcer would cause upper middle abdominal pain during and after eating, aggravated by acidic foods and medicines, like aspirin or vitamin D. Gallstones could cause crampy pain in upper right abdomen (just below the rib cage) within an hour after the meal. Other disorders are possible – I recommend you to visit a gastroenterologist soon. Lower abdominal pain could be from gas or cramps due to constipation. If you have excessive gas, try to avoid foods high in soluble fiber and sugary foods. But if you are constipated, fiber may help you (try foods high in insoluble fiber).

  • lasonia

    my daughter is 15 for about 8 months now she started out with minor abdominal pain but as time went on each attack is more severe she has severe abdominal pain,nausea,vomiting,paleness and I have taken her to emergency room 4 times.They always tell me blood work is fine,ultrasound fine,xrays fine,ct scan fine,they said at 2 hospital visits she was impacted with stool they told me to feed her dulcolax until she was cleaned out second time they gave her an enima she still wasnt any better kept her appt. with gi doctor he said he thinks she might have what they call abdominal migrains but he said that that has nothing to with her being impacted with stool.I dont understand why she is impacted with stool when she goes to the bathroom and has any where from 1 to 3 bowel movements a day any help or sugesstions would be very grateful

  • Jan Modric

    lasonia,

    are her stools of normal consistence or are more soft or hard than usually? Any change from normal brown color of the stool? Where exactly is the pain located – upper or lower abdomen, left or right? Is the pain constant or crampy, and for how long does it last when it appears?

  • Bruce

    Two weeks ago , I woke in the middle of the night with aches like a bowel movement in my lower abdomen, I tried to have a bowel movement, only a small one and went back to bed and the pain subsided, the next morning I was urinating a very reddish colour this continued for two days till it cleared, I saw my doctor 4 days later and had a urine test , it came back as haveing no infection but a high red blood cell count, white blood cell count was normal, suspecting kidney stones I had a ultrasound this showed nothing .
    I have had 2 other occurences of this and again this afternoon the ache in my abdomen and tonight reddish urine, I am seeing my GP again this week , he has said something about a CT scan , but any idea’s or information would be appreciated, I might add that I am drinking at least 6 litres of water a day and the ache seemed stronger on my left hand side but seems now to cover my whole lower abdomen, I have had no injury that may explain it and on each occassion I feel like I want to make a bowel movement , my stools appear to be a normal color with no sign of bleeding, the blood is just in my urine.

  • Jan Modric

    Bruce,

    a process within the urinary bladder or prostate could press on the rectum, irritate it and thus cause a feeling of need to have a bowel movement. I recommend you to discuss with your GP to send you to an urologist **as soon as possible** – I believe it is this specialist who can decide about appropriate investigations, interprete them reliably and provide treatment.

  • Bruce

    Thankyou , GP has organised CT scan for tomorrow afternoon and a referral to a specialist after results of CT scan return

  • Diana Reynolds

    I had my gallbladder removed 17 years ago, now right below where the gallbladder were, I am in very severe sharp pain, it feel like someone stab and twist it, when I lay down on flat on my back, I have no problem, lay on side, it hurt, sit, walk, stand, cough or laugh it hurt also.What could it be? I can;t live with the pain anymore. I also have mild nausea and not feeling hungry at all. I also notice I shake. Otherwise I do not have any other symptoms I know of. Should I be concern?

  • Jan Modric

    Diana Reynolds,

    to mention only one possible cause – it could be a disorder of the bile duct. I recommend you to visit your doctor.

  • selena&mark

    my boyfriend is 18 years old, he has been havin severe stomach pain from the middle top of the stomach(side of rib there is a space between it,well like 2 inches downer)is whAT am talking about, anyways he has been having this pain for about 2 years now we’ve beento doctors,& hospitals,and they don’t know what it is.? any ideas?

  • Jan Modric

    selena&mark,

    pain arising from the area when ribs meat is probably from the stomach. I don’t know which tests and investigations he has already had, but upper endoscopy would reveal inflammation or ulcer, for example. If he has any other symptom, like abdominal distension (bloating) or excessive belching, he might have some food intolerance. There are more possibilities, but I would need more from his medical history (questionnaire).

  • trainerliz

    I am an extremely active (10 hours/week in the gym) generally healthy 38 year-old woman. For about 2 weeks I have been experiencing severe cramping at the lower end of my abdominals, below the bellybutton, just about in-line with my hip bones. The pressure is similar to what I felt when I was pregnant and increases as I walk. Before I noticed the cramping, I thought I injured my back and was in a tremendous amount of pain in my back. The back pain subsided after about a week and has been taken-over by this cramping. I have taken a pregnancy test which was negative, was examined for a hernia, and am having an ultrasound next week. Any thoughts about what I should be asking about or expecting?

  • Jan Modric

    trainerliz,

    are pains on both sides? The ultrasound can confirm/exclude intestinal hernia. I would wait for results before proceeding with other investigations. The back injury could possibly result in a bulging/herniated disc in your lower thoracic/upper lumbar spine and pinched nerves that innervate the lower part of the back and abdomen. I’m talking about pain, but you are talking about pressure and cramping – a hernia could cause these symptoms, and a (tender) lump would be likely felt in this case. Other possible causes include constipation (as a reaction to pain), or bloating from various reasons. It sounds, like a bowel issue to me, but a doctor can tell.

  • dethrow

    hello. i’m a 25 year old male, smoker. 5’9 150lbs. for the past several months i’ve had a reoccurring pain on the left side of my stomach. from where the ribs end to my hip bone. it’s a cramp type pain where i can’t do anything once it starts. it lasts for minutes sometimes, or even hours others. there is history in my family of colon cancer, which i have lost my grandmother and my aunt. my father and all of his living siblings have had their colons removed.

  • Jan Modric

    dethrow,

    I strongly recommend you to visit a gastroenterologist and ask about colonoscopy, since it’s possible you have a familiar (hereditary) type of adenomatosis with polyps in the colon.

  • inknots

    I’m 24, for some years now I experience what I call stomach attacks.

    Out of no where, even at my most calm moments BAM!! A deep gut cramp that sends me running. The waves of pain are so intense that I perspire, tremble and desperately look for something to squeeze the living hell out of to get my mind off this agony. More than once I’ve thought that, “This was it.” Trying to focus on my breathing is impossible and have felt close to passing out. In waves it hits me, usually the first part the bowel is somewhat solid and continues to liquidate. The pain starts moving lower and lower into my gut and feels like a brick laying near my uterus (just trying to describe how low). When each wave moves lower and intensifies, I know expulsion is near. However, when the diarrhea comes full on, that the attack is almost over.

    Does anyone else have this similar attack???

    I’ve used tri-cyclic anti-depressants to try and help to no avail. Donnatal recently, no relief! Not even as a mild sedative. Hell, the attack itself wipes me out, why do I need a sedative? Sigh, also Effexor (depression/anxiety), Prednisone & Plaquenil (for RA), Mirena for BC and I was on BP meds but figured I would control them the best I could through diet and exercise… I’m sure when in the midst of an attack though, that bad boy is through the ROOF!

    I have had colonoscopy, endoscopy, ct scans. The attacks are usually so severe i dont know when to go to the ER if it’s actually serious. I just come to expect them to pass after about an hour or two.

    I can’t express how debilitating the pain is and how much it has interfered with my life. I sometimes even fear eating, simply b/c i’m afraid it may have some sort of effect on my stomach.. there are no set patterns of food aggravations. Sure hope you can provide insight.

  • Jan Modric

    inknots,

    I don’t know if all possible disorders in your case were already excluded, but have you thought to experiment with your diet? Have you tried to exclude some type of foods to see if it helps? Was there any change in your life before your troubles started?

    Fructose malabsorption, irritable bowel syndrome, celiac disease and food allergies are fairly common causes of recurring constipation and diarrhea. There are specific diets for each disorder (low-fructose diet, low-FODMAP diet, gluten-free diet, or avoiding eventual foods that cause alergies ). I’m not sure if intestinal parasites could cause years of constant problems, but a stool test for parasites is available.

  • margaret

    hi, i am 18 years old,and this occurs during the middle of the night where i wake up to excruciating stomach pains, so i run to the bathroom. The pain lasts for 10 minutes and i can feel the blood rushing out of my face, and my hands and feet get cold b/c the pain is just horrendous! Then i would hear a very loud grumbling noise on the lower left of my stomach and as soon as i hear it, i would have a bowel movement!

    Can you please tell me why the pain is so painful!! THANK YOUUU

  • Jan Modric

    margaret,

    obviously the pain arises from your bowel, but there are several possible causes, including a bowel inflammation, food allergies, and so on. I recommend you to visit a gastroenterologist.

  • MT

    Last night I was feeling perfectly well and all of a sudden I felt a small stomach pain that began to increase. Once in a great while I’ll get stomach pains and when I do a bowel movement it goes aways instantley. So I went to the bathroom and just me trying to have a bowel movement increased the pain really bad. I eventually had a bowel movement but the pain did not go away. I tried to stand up to go back to bed but I was unable to stand straight due to the pain so I was slouching all the way to the bed when I suddendly felt weak, dizzy like if I was floating, thingling in my face and all the noise around me got really faint. It was somewhat of a relaxed feeling. Anyways I laid in bed twisting and turning until the pain went away. This morning I feel sore all over my lower abdomen and it radiates to my rectum. Any Suggestions? I do plan on making an appointment with a Dr soon.

    THANKS A BUNCH!

  • Jan Modric

    MT,

    how old are you, male or female? Did you have any bowel problems in the past? Bloating or excessive gas or constipation or diarrhea? Colorectal polyps or cancer rarely appear before 40. It sounds like something is preventing you to have a smooth bowel movement, but I would need to know more circumstances to say more. The fainting feeling was likely related to relaxation of the bowel muscles.

  • susan

    if the pain is making you dizzy for more than 24 hours you need to go to an er so they can do a ct scan and ultrasound. i didnt have that type of pain, however a friend of my moms had that exact pain and she had a cyst that ruptured in her colon and she went into shock. U should definitely get that checked out.

  • JojoBay

    What could cause acute stomach pain in my left abdomen just under the bottom of my rib? I am a 55 yr old female with Addison’s disease. The pain only comes at night and is so severe that it wakes me up. It lasts for an hour or two, occasionally results in vomiting and once made me feel extremely faint. Any suggestions would be greatly appreciated.

  • Jan Modric

    JojoBay,

    what was said to be a cause of Addison disease in your case? Where exactly do you feel the pain (in inches from the middle line)? Is it a constant or cramping pain, is it related to meals, is it tender to touch? Have you changed your treatment regime? Do you feel completely ok between the pain attacks? Would you say you are constipated, bloated?

  • Allison

    Pain by belly button. Taking meds for brontitius. Could this be related

  • Jan Modric

    Allison,

    where exactly is the pain, is it a constant pain or triggered by cough? Is it tender to touch? Was the pain there before starting with medications? Would you say you are constipated or have excessive gas? Pain could be caused by persistent coughing or constipation, for example, but I can’t exclude other causes.

  • Jonatan

    hello, im 23 and since i moved from one country to another my stomach has been acting up, in several cases now when i wake up i feel a tremendous pain in my stomach i cant really pin-point the exact location because the pain is too great, than i rush to the bathroom and a few seconds later i start sweating but i feel verry cold and my face and lips are pale and i feel disoriented, a few minuted later i start feeling better. in the last few months the pain has happened several times i went to a doctor and she gave me medication but its not working, please can anyone help me.

  • Jan Modric

    Jonatan,

    in bowel symptoms after moving the place intestinal parasites may be suspected. Diagnosis can be confirmed by a stool test. Sweating and disorientation is probably caused by excitation of nerves and temporary drop of the blood pressure related to the excreting the stool, or/and by dehydration, so be sure to drink enough water.

    Another possible cause could be irritable bowel syndrome (IBS) triggered by stress and/or food. In IBS, symptoms usually occur shortly after meals, and are relieved by bowel movements. I can’t exclude other causes, but you can discuss about above two possibilities with a doctor.

  • ineedsandnsun

    I am a 41 year old married male and I have been thin most of my life. My wife and I currently do not have health insurance and our funds are very limited. I have been experiencing abdominal issues for the past 5+ years that seem to be getting worse. Every time I have gone to a professional they have never been able to help me. The last time (12 months ago) I ran up $3500 in bills and was told I was experiencing a panic attack. The doctor wanted to put me on Prozac which I refused and I haven’t been to anyone since. My eating habits would probably be considered poor because we eat out a lot but not much has changed in the past 10 years. I am hoping to get some guidance as to what I should do next etc…

    Here is a brief rundown of my past issues:

    – In 2006 after suffering stomach pains and losing considerable weight I went to an ER and they ran a bunch of tests. Things like a chest xray, an ultrasound, a lower GI and finally a colonoscopy. Nothing was ever found and the gastroenterologist suggested it was IBS.

    – About 1 year later I started experiencing very severe stomach pains and foul smelling stools usually around 3am. After going to the bathroom the pain usually subsided within an hour or so. Even today I occasionaly have this issue and I believe it is at least partially related to diet.

    – In September of 2009 after staying up all night working on a project, I experienced the worst case of stomach pain that I had ever felt. That pain then spread and caused me to start feeling like I was having a heart attack so I called 911. Paramedics took me to the hospital and I went through some of the same tests as before; a chest xray, an ultrasound, blood work etc… None of the tests showed anything and as mentioned before I was diagnosed as having a panic attack. I don’t doubt that I had a panic attack but I feel like something else was the underlying cause not just stress.

    This brings me to my current status. Within the past 2 months my stomach has become very bloated which makes me look fat. It is definitely not fat as I lead a very active lifestyle. Just recently I also started experiencing stomach spasms or possibly contractions along with a lot of stomach “growling”. When I have pains, they are either around the belly button area or the upper left side of my stomach area. Also, ever since the panic attack episode, I have had severe lightheaded feelings after sex.

    Any suggestions or guidance you can provide would be very appreciated.

    Thanks in advance,
    Marc

  • Dr. Chris

    Hi Ineedsandandsun

    Much of what you describe could be attributed to irritable bowel syndrome (IBS) if no other abnormality can be found upon conducting various gastrointestinal investigations. Stress, like working through the night on a project, can trigger acute attacks which are characterized by changes in bowel movement (diarrhea or constipation), bloating and gastrointestinal cramps.

    The theory is that with IBS the gastrointestinal motility is altered and this is exacerbated by certain foods (often varies from person to person), cigarette smoking, alcohol consumptions and stress, including anxiety and extremes of emotion. You have not mentioned undergoing an upper GI endoscopy and this may be advisable to exclude acid reflux, gastritis peptic ulcers and even gallstones or cholecystitis (inflamed gallbladder).

    All of these conditions could explain your symptoms and may be co-existing with irritable bowel syndrome. Of course an ECG should also be done. See a gastroenterologist who can consider other investigations as well. Remember that during an ER visit, the priority is to exclude acute conditions that may have dire consequences. You should then follow up immediately afterwards with your doctor/specialist.