Stomach ache
Almost everyone gets a bad stomach at some point, and the reason is usually an everyday one: something that did not agree with you, a bowel that is not quite…
On this page
- How to describe the pain so the consultation gets straight to the point
- When to call an ambulance
- Pain low down on the right that keeps building
- Pain in the pit of the stomach and under the right rib
- Pain in the flank that travels to the groin
- When the trouble is in the bowel
- What not to do while the cause is unclear
- Online consultation
Medicines commonly prescribed for Stomach ache
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: CAPSULE, 20 mgActive substance: omeprazoleManufacturer: Laboratorios Cinfa S.A.Prescription not requiredDosage form: TABLET, 1000 mgActive substance: paracetamolManufacturer: Galenicum Health S.L.U.Prescription requiredDosage form: CAPSULE, 500 mg paracetamolActive substance: paracetamolManufacturer: Upsa S.A.S.Prescription not required
Almost everyone gets a bad stomach at some point, and the reason is usually an everyday one: something that did not agree with you, a bowel that is not quite keeping up, trapped wind, a tense week. That kind of pain clears up on its own within a day or two. But the abdomen is exactly the place where a sensation that feels much the same can mean either too much dinner or a situation counted in hours. So it helps to sort out tummy pain not by disease names but by three questions: where it hurts, how it hurts, and what comes with it. Below, first the things that cannot wait, then the common causes, in the order people usually arrive at this subject.
How to describe the pain so the consultation gets straight to the point
Half the diagnosis comes from the account, not the examination. Before you see a doctor, answer a few questions for yourself:
- where it hurts. Upper abdomen, the pit of the stomach, under the right or left rib, around the navel, lower right or lower left, the flank running back into the loin. If the pain has moved, say from where to where — that matters more than where it sits now;
- how it hurts. Constant and building, gripping in waves that let go, burning, dull and pressing, sharp as a blow;
- when it started. Whether you can name the hour and the minute, or whether it has been coming and going for weeks and months;
- what changes it. Food, an empty stomach, fatty meals, milk, opening your bowels, passing wind, passing urine, movement, coughing, position;
- what goes with it. Fever, shivering, feeling sick and vomiting, what your stools look like and whether there is blood in them, the colour of your urine, a late period, weight you have not tried to lose.
Note separately which medicines you take regularly and what you have already taken for the pain: a painkiller changes the picture, and the doctor needs to know they are examining an abdomen that has already been smoothed over.
When to call an ambulance
Some combinations are not for a routine appointment and not for waiting until morning. Call an ambulance if:
- the pain came on suddenly and severely, like a blow, and you can name the minute it started;
- your abdomen is rigid, hard as a board, it hurts even to touch, and every movement or cough jars it;
- the pain comes with fainting, sudden pallor, cold sweat and a fast weak pulse;
- there is blood in your stools, or they have turned black and tarry, or you are vomiting blood or something that looks like ground coffee;
- the pain is in a pregnant woman, or in anyone whose period is late — an ectopic pregnancy can start this way, and it does not wait;
- the pain comes with being unable to pass urine even though the bladder feels full;
- the pain goes together with a high fever and shaking chills;
- the pain is in an older person and is clearly worse than anything the examination shows: the abdomen is soft, the picture looks calm, and the person is very unwell. That is how a loss of blood flow in the bowel's own vessels behaves;
- the pain spreads through to the back or between the shoulder blades in someone with high blood pressure — that combination means the aorta gets checked.
Do not drive yourself, and do not put someone pale and weak into your own car. Across Europe the single number 112 works, and many countries also have their own local emergency medical number. Take your list of medicines with you.
Pain low down on the right that keeps building
This is the script worth knowing by heart. Appendicitis rarely starts on the right: more often the pain turns up around the navel or in the pit of the stomach, feels vague, and a few hours later shifts down and to the right and stays there. From then on it does not ease, it builds; loss of appetite, nausea and a slight fever join it; and walking, turning over in bed, coughing and straightening up all hurt more.
With that picture there is nothing to wait for: appendicitis does not settle by itself, it is cured by an operation done in good time. In a child it moves considerably faster than in an adult and is described far less well in words — a child may simply lie with their legs drawn up, refuse food and not let anyone near the tummy. In pregnancy and in older people the pain often sits somewhere other than expected, and without fever, so their threshold for getting seen is lower. If that lower right pain in a woman comes alongside a late period or unusual discharge, it needs sorting the same day: the cause may not be the appendix at all.
Pain in the pit of the stomach and under the right rib
The upper abdomen belongs to the stomach and the gallbladder, and they hurt differently.
With gastritis and reflux the pain burns or gnaws, sits in the pit of the stomach and is tied to eating: some people get it on an empty stomach and lose it with food, others the other way round. It often disturbs the night and comes with an acid taste, belching and burning behind the breastbone. It is fed by painkillers from the anti-inflammatory group, by alcohol, by smoking and by eating in a hurry, and not infrequently the bacterium Helicobacter pylori is behind it — that is looked for and treated with a course of medicines, not with a diet.
With gallstones the picture is different. The pain arrives as an attack half an hour to an hour after something fatty, fried or simply too much, settles under the right rib, spreads to the right shoulder blade or right shoulder, lasts from half an hour to several hours and comes with nausea. Between attacks the person feels normal. If an attack picks up a fever with chills, yellowing of the skin and the whites of the eyes, dark urine and pale stools, that is no longer a stone shifting — it is a complication, and it needs seeing to straight away.
Pain in the flank that travels to the groin
Renal colic is recognised by how the person behaves. The pain starts in the flank or the loin, comes down in waves towards the groin and the genitals, is very severe and offers no position that helps: nobody with it lies still, they pace about. Alongside it there is usually nausea, sometimes vomiting, a frequent urge to pass urine, and the urine may turn pink or red. That is a stone that has moved into the ureter.
Colic needs a doctor in any case, both to confirm the cause and to stop the pain. It becomes an immediate matter if a high fever with chills joins in, or if urine stops coming altogether: that means infection has been added to the stone, or the drainage is completely blocked. Pain in much the same place but dull and constant, with frequent painful passing of urine, points more towards a urine infection, and that does not clear by waiting either.
When the trouble is in the bowel
This is the commonest group of causes and the most harmless, as long as you know where its limits are.
- Constipation. Pressing pain low down that eases after the toilet, hard stools, a feeling of not having finished. It is dealt with by fluids, fibre, movement and, if needed, gentle products from the pharmacy;
- irritable bowel syndrome. Pain and cramps over months, tied to opening the bowels and easier afterwards, going along with bloating and an alternation of diarrhoea and constipation. It does not wake you at night, does not take weight off you and does not put blood in your stools;
- lactose intolerance. Bloating, rumbling, cramps and loose stools an hour or two after milk, while fermented products and hard cheeses go down better;
- infections and food poisoning. Griping pain with watery stools, nausea and vomiting, often in several people who ate the same thing. What matters here is drinking, not fasting; the worrying additions are a high fever, blood in the stools and signs of dehydration.
The limit is worth holding on to. If an adult's bowel habit changes and does not come back to the old pattern over several weeks, if blood appears, if weight goes without any effort, if the pain lifts you out of bed at night, it has stopped resembling an irritable bowel and needs investigating.
What not to do while the cause is unclear
With severe unexplained tummy pain, three familiar household moves make things worse:
- do not warm the abdomen. A hot water bottle or a hot bath widens the vessels and drives inflammation on; in appendicitis and other processes with pus, heat speeds up the very thing that is feared most;
- do not take laxatives and do not give an enema until it is clear why the bowel is not moving. If the way through is closed, a laxative raises the pressure inside a loop with no exit;
- do not smother the pain with painkillers before the examination if an operation is in question. It is precisely from how the pain changes over the first hours that a doctor works out what is happening; a smoothed-over picture leads away from the diagnosis. If you have already taken something, simply say what and when.
The same section: do not put yourself on antibiotics, and if an operation looks likely, do not eat or drink before you are examined, apart from a few sips of water if your mouth is very dry. And do not put off getting seen because the pain has let go for a while: when a hollow organ perforates there is a deceptive quiet hour, after which things get considerably worse.
Online consultation
An online doctor can sort your pain out by the very features that are hard to judge alone: where exactly it sits, where it spreads, how it relates to food, to opening your bowels and to passing urine, and whether any of your symptoms belong to the group that needs an ambulance rather than an appointment. They can say which tests and which scan are worth doing first so you do not pay for the wrong thing, explain what you can take now and what is better not taken before the examination, and help you place your case: among those settled by food and habits, or among those that need an abdomen felt by a pair of hands today.
This material is for information only and does not replace medical advice.
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