Stomach Knot Pain (Knots in the Abdomen) Causes

It is not uncommon to describe anxiety or other strong emotions like fears as “the stomach was tied up in knots” or “had knots in the stomach”. This is just a common way to describe the strange sensation that we experience in the abdominal area during times of heightened emotion. It is usually temporary and not treated a medical condition on its own. However, there are times when this sensation may be a symptom of an underlying abdominal or stomach disorder.

What are stomach knots?

Stomach knots are a type of uneasy sensation or dull ache in the stomach or abdominal region usually associated with anxiety and nervousness. It is also sometimes described as “butterflies in the stomach”. However, discomfort and pain may also at times be described as stomach knots. In some cases the abdomen is referred to as the stomach which may then refer to abdominal regions where the stomach is not located.

When a stomach knot feeling is not in any way linked to anxiety, nervousness or any other mental health condition, then other medical conditions need to be considered. Most of the time this is related to the stomach or surrounding upper gastrointestinal (gut) conditions. However, at other times this uneasy feeling may not be due to any digestive condition and may not even arise from the abdomen.

Always consult with a medical professional as the stomach knot sensation may require further investigation and subsequent medical treatment.

Causes of Stomach Knots

A stomach knot is a symptom that may arise with a host of different conditions. It may also be accompanied by other symptoms like heartburn, nausea, vomiting and bloating. Identifying the cause of stomach knots can be difficult at times. It could be considered collectively with any other symptoms that are present in order to identify the cause. Medical investigations like an upper gastrointestinal endoscopy or MRI may be necessary.

Emotions and Mental Disorders

The first consideration should be mental health causes ranging from strong emotions to anxiety disorders and depression. It is often attributed to changes in blood flow as a result of the body’s fight-or-flight response. This is mediated by hormones like adrenalin. However, this “butterflies fluttering in the stomach” may also be due to nervous system activity in the area. Eating disorders may also present with stomach knots.

Upset Stomach

An upset stomach usually refers to indigestion. Although it is very common and often arises with overeating and other dietary triggers, an upset stomach may sometimes be due to more serious conditions. Acute cases may be easily relieved by antacids and similar drugs but repeated bouts of indigestion or a persistent sensation needs to be investigated to exclude some of the other conditions discussed below.

Stomach Diseases

A number of different stomach diseases could present with a symptom such as stomach knots. Often this is discomfort or a dull ache that is mistaken for the stomach knot sensation. Gastritis is one of the more common conditions for this type of sensation as a result of stomach inflammation. Stomach ulcers is another possible cause. Less often it may occur with conditions where the stomach emptying is delayed.


Peptic ulcers are another possible cause of stomach knots but most of the time there is some degree of pain in these conditions. These open sores that form in the wall of the stomach or duodenum (small intestine) may be due to many of the same reasons as gastritis. It is more common in the duodenum and sometimes may be associated with ulcers as high up as the esophagus (food pipe).

Acid Problems

The backward flow of stomach acid into the stomach is probably one of the more common acid problems in the upper gut. This is known as gastroesopheageal reflux disease (GERD) or simply as acid reflux. Zollinger-Ellison syndrome is where there is an overproduction of gastric acid. It is not as frequently a seen condition like acid reflux but may cause persistent irritation that may initially feel like a knot in the stomach.

Gallbladder and Pancreas

The gallbladder and pancreas are important digestive organs that lie close to the stomach and duodenum (small intestine). Gallstones are a common gallbladder problem whereby stones become obstructed in the bile ducts. Pancreatitis is often associated with excessive alcohol intake. Both these conditions typically present with pain but in mild cases or the early stages there may be discomfort and sensations described as stomach knots.

Hunger and Overeating

Most of us know the feeling of hunger and can therefore clearly identify it. However, sometimes this feeling can be mistaken for other symptoms. It may present as a knot in the stomach for some people. Similarly overeating cause indigestion and bloating. This as well may be described as stomach knots. In both these cases the sensation will subside, either with eating as is the case of hunger or with simple remedies to hasten stomach emptying after overeating.

Alcohol and Medication

Certain substances may irritate the stomach lining and alter the secretions within it. This can give rise to various sensations, including discomfort and aches, burning or pain. It is more likely to arise with ingested substances. Alcohol can be harsh for the stomach lining. Other substances include medication that may irritate the stomach lining. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) as well as certain types of antibiotics are among the more common drugs to trigger symptoms like stomach knots.

Diarrheal Illnesses

Gastroenteritis is a common condition often affecting long portions of the gut. In most cases it arises with an infection from viruses or bacteria, or with exposure to the toxins that these microbes secrete. Typically there is nausea, vomiting in some cases, diarrhea and abdominal cramps. The microbes or its toxins may be spread directly from person to person, in contaminated food or water as well as through inanimate objects (fomites).

Other Causes

The following causes may also be responsible for stomach knot pains:

  • Abdominal wall injury and strain
  • Heart attack
  • Kidney problems
  • Liver diseases
  • Bowel disorders

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