Abdomen Pain When Pressed – Causes of Abdominal Point Tenderness

What is abdominal point tenderness?

Ther term abdominal point tenderness simply means that there is pain in a certain part of the abdomen when pressure is applied to it. In contrast, the term abdominal pain means that pain may be present irrespective of whether there is pressure applied to it or not. Tenderness can accompany pain. However, the pressure on the abdomen like with pressing (palpation) during a physical examination will intensify this pain.

Why is there pain with pressing?

The abdomen should not be tender to touch. Pressing on the abdomen only elicits pain when an organs or tissues are inflamed. This inflammation may be due to a host of causes, such as injury, infection or immne-mediated reactions like allergies and autoimmune diseases. Inflammation is a mechanism to protect against tissue damage. Therefore tenderness  of the abdomen is an indication of some underlying tissue damage in the abdominal cavity or abdominal wall.

Abdominal Organs Located at Tenderness

The abdomen can be divided into four quadrants – the right upper quadrant (RUQ), the left upper quadrant (LUQ), the right lower quadrant (RLQ) and the left lower quadrant (LLQ). Tenderness when pressing on these quadrants is usually indicative of a problem with an organ in the specific quadrant.

  • RUQ: Liver, gallbladder, pancreas, small intestine and large intestine (transverse colon).
  • LUQ: Stomach, small intestine, large intestine (transverse colon), pancreas and spleen.
  • RLQ: Large intestine (appendix and ascending colon) and small intestine.
  • LLQ: Large intestine (descending and sigmoid colon) and small intestine.

The small and large intestines occupy most of the abdominal cavity. It extends across all of the abdominal quadrants but most of it lies in the lower quadrants.

abdominal organs

The peritoneum lines the abdominal organs. It provides support to the organs within the abdomen and also allows for blood/lymphatic vessels and nerves to pass through.

Causes of Abdominal Pain When Pressing

The following conditions tend to present with abdominal point tenderness. It may also be the cause of abdominal pain. The location of the pain as well as accompanying signs and symptoms can help with identifying the possible cause. At times it can be difficult to isolate the problem to one specific quadrant as organs may overlap and pain can radiate to neighboring quadrants.

Some of the possible causes of abdominal pain when pressing on it (abdominal tenderness) has been discussed below. However, it should be investigated immediately by a medical professional. Remember that some of the serious and even life threatening conditions may appear with mild to moderate symptoms whereas less serious conditions can present with severe symptoms. Medical attention is therefore necessary.

Right and Left Upper Abdominal Tenderness

  • Liver pain:
    – Most of the liver lies in the right upper quadrant and extends into the left upper quadrant.
    – Hepatitis is inflammation of the liver and is often caused by a viral infection.
    – Hepatocellular carcinoma (liver cancer) is another possible cause of RUQ pain and tenderness.
  • Gallbladder pain:
    – The gallbladder is located under the liver and lies around the upper middle region of the abdomen.
    – Gallbladder inflammation may occur with conditions like gallstones and infections.
    – Bile duct stones and infections may also cause pain and tenderness in this region.
    – Gallbladder and bile duct cancer can also be responsible for pain and tenderness.
  • Pancreas pain:
    – The pancreas is located in the upper middle region of the abdomen and tapers into the left upper quadrant.
    – Pancreatitis is inflammation of the pancreas that is often caused by mechanical and chemical injury.
    – Pancreatic cancer is another possible cause of pancreas pain and upper middle abdominal tenderness.
  • Stomach pain:
    – The stomach is located in the upper left quadrant of the abdomen extending towards the midline.
    – Gastritis and stomach ulcers are common causes of stomach pain.
    – Hiatal hernia is where a portion of the stomach becomes trapped in the chest cavity.
    – Stomach cancer is also a possible cause of left upper abdominal pain and tenderness.
  • Duodenal pain:
    – The duodenum is located in the upper middle region of the abdomen next to the stomach and pancreas.
    – Duodenal inflammation is a common problem and arises for many of the same reasons as gastritis.
    – Duodenal ulcers are common and may be another cause of abdominal pain and tenderness.

Read more on upper abdominal pain.

upper abdominal pain

Right and Left Lower Abdominal Tenderness

  • Appendix pain:
    – The appendix is located around the middle of the right lower quadrant (RLQ) of the abdomen, which is known as McBurney’s point.
    – Appendicitis is inflammation of the appendix with pain and tenderness between the umbilicus (belly button) and upper edge of the pelvis.
    – Perforated appendix may arise as a complication of appendicitis and can be life threatening.
  • Colon pain:
    – The colon runs across the abdomen as well as as along the sides.
    – Colitis is inflammation of the colon which occurs for many reasons, like an infection.
    – Colon cancer is a common cancer and may also involved the rectum.
    – Diverticulitis is inflammation of the small outpouchings of the colon.
    – Toxic megacolon is a complication of infectious colitis or inflammatory bowel disease (IBD) which can be life threatening.
  • Small intestine pain:
    – The small intestine is coiled in the abdomen and occupies most of the abdominal cavity.
    – Obstruction in the small intestine can cause arise with adhesions, inflammatory bowel disease, hernias, cancer and twisting of the small intestine (volvulus).
    – Enteritis is inflammation of the small intestine and is most commonly caused by an infection.
  • Urinary tract pain:
    – The bladder is located in the middle of the pelvic cavity which most of the time is mistaken for the lower abdomen. Ureters run from either side of the bladder, up the flanks to the kidneys in the upper abdomen.
    – Urinary tract infections (UTIs) are common and may present with pain in the genitalia (urethra ~ uretheritis), lower mid abdomen (bladder ~ cystitis), along the flanks (ureter ~ ureteritis) and upper flanks or back (kidneys ~ pyelonephritis).
    – Urinary stones may form in the kidney and pass down to the bladder or it may form within the urinar bladder.
  • Reproductive pain:
    – The reproductive organs lie in the pelvis and may extend into the lower abdomen.
    – Prostatitis is inflammation of the prostate gland which sits just under the bladder.
    – Pelvic inflammatory disease (PID) is infection of the female reproductive organs, like the uterus and fallopian tubes.
    – Endometriosis is where the inner uterine tissue implants outside the uterus and irritates surrounding tissue.
    – Ovarian cysts where abnormal cysts arise in the ovaries.
    – Torsion of the ovaries where the fallopian tubes twist.
    – Ectopic pregnancy is where a fertilized egg cell is trapped within the fallopian tubes.
    – Cancer may arise in any of the reproductive organs and give rise to pain and tenderness.

Read more on lower abdominal pain.

Tenderness Anywhere on the Abdomen

There are several structures of the abdomen that may extend across the entire abdominal cavity or at least across multiple quadrants.

  • Peritonitis is inflammation of the peritoneum that lines the abdominal cavity and its organs. There is usually severe abdominal pain with tenderness.
  • Hernias are outpuchings from the abdominal wall and sometimes a portion of the bowel can get trapped within it (strangulated hernia). A hernia itself may not always be painful or tender.
  • Trauma to the abdominal wall can occur for a number of reasons, such as a blow to the abdomen, and the area may be tender for days or even weeks.
  • Abdominal muscle strain is a common cause of abdominal pain and tenderness. These muscles may be strained not only be trauma but also by overuse and other forms of stress.


  1. Point tenderness – abdomen. NIH.gov

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