Abdominal pain: where it hurts, possible causes and what helps

• The abdomen is not the same as the stomach. Pain may come from the stomach or intestines, but also from the gallbladder, pancreas, urinary tract, reproductive organs or other structures within the abdomen.
• The location of the pain is an important clue. Pain in the upper middle abdomen, around the navel, under the right ribs or in the lower abdomen may have very different causes.
• The character of the pain also matters. Cramping, burning, sharp or dull pain, and whether it is constant or comes in waves, can help narrow down possible causes.
• Pain after eating does not necessarily mean a stomach problem. It is important to consider where the pain occurs, how long after a meal it begins and whether it is accompanied by bloating, diarrhoea, heartburn, nausea or other symptoms.
• What helps depends on the cause. Simple measures are often enough for mild, temporary digestive problems, while other causes should not be treated with self-care alone.
• Pain intensity alone does not show how serious the cause is. Sudden or very severe pain, a rigid and very tender abdomen, blood in vomit or stool, or difficulty breathing require prompt medical assessment.

The location of abdominal pain is one of the first clues that can help narrow down possible causes. For orientation, the abdomen can be divided into several regions, although the boundaries are not exact. Pain may also spread or be felt away from its actual source.

1. Pain in the upper middle abdomen

Pain below the breastbone and between the ribs is often associated with the stomach or duodenum, although it may also originate from other organs in the upper abdomen. If the main symptoms are burning pain, nausea, early fullness, heartburn or a clear relationship with meals, see our detailed guide to stomach pain and its possible causes.

2. Pain in the upper right abdomen

The upper right abdomen contains the liver, gallbladder and bile ducts, among other structures. Pain in this area may therefore be related to the gallbladder or bile ducts, particularly when it occurs after eating and spreads towards the back or right shoulder blade. Other causes are also possible.

3. Pain in the upper left abdomen

The upper left abdomen contains part of the stomach, spleen, pancreas and bowel. Location alone therefore cannot identify the cause. It is also important to note whether pain occurs after meals, radiates to the back, or is accompanied by nausea, bloating or changes in bowel movements.

4. Pain around the navel

Pain around the navel may be associated with the bowel and various digestive problems. In some conditions the location changes over time. Appendicitis is a well-known example: pain may begin around the navel and later move to the lower right abdomen.

5. Pain in the lower right abdomen

With new or worsening pain in the lower right abdomen, appendicitis is one important possibility. In women, pain in this area may also originate from the reproductive organs, while bowel and other causes are possible as well. Severe or rapidly worsening pain requires medical assessment.

6. Pain in the lower abdomen

Pain above the pubic bone or across the lower abdomen may arise from the bowel, urinary tract or reproductive organs. Relevant accompanying information includes urinary symptoms, bowel changes, the menstrual cycle, possible pregnancy, and unusual discharge or bleeding.

7. Pain in the lower left abdomen

Pain in the lower left abdomen may be associated with the large bowel, including constipation or diverticular disease. In women it may also originate from the reproductive organs. Age, duration, bowel changes, fever and other accompanying symptoms help distinguish between causes.

Important: location is only one part of the picture. The onset, duration, intensity and character of the pain, together with accompanying symptoms, are also important. Even relatively mild pain can require medical assessment in certain circumstances.

In addition to its location, it is important to consider what the pain feels like and how it changes over time. The character of the pain can help narrow down possible causes, but it cannot establish a diagnosis on its own.

1. Cramping pain

Cramps often come and go and may accompany bloating, diarrhoea or other bowel symptoms. Pain that occurs in pronounced waves may also be related to strong contractions of hollow organs, for example with gallstones or kidney stones.

2. Burning pain

A burning sensation in the upper abdomen may be associated with the stomach or oesophagus, particularly when it occurs with heartburn or in relation to meals. Burning pain is not specific to a single cause, so its location and accompanying symptoms also matter.

3. Sharp or stabbing pain

Sharp pain may be well localised, but its significance depends largely on how suddenly it began, whether it is worsening and what makes it worse. Sudden severe sharp pain requires more caution than a brief, mild stabbing sensation.

4. Dull or pressure-like pain

Dull pain or a feeling of pressure can be more difficult to pinpoint. It may occur with a variety of digestive and other problems, so duration, location and accompanying symptoms are particularly important.

5. Pain that comes in waves

Pain that intensifies, eases and then returns is often described as colicky. This pattern may occur with gallstones or kidney stones and can also be seen with some bowel problems.

6. Constant pain

Pain that does not ease and may gradually worsen needs a different assessment from brief cramps. It is particularly important when accompanied by fever, vomiting, a tender or rigid abdomen, or a general deterioration in how you feel.

Important: neither the type nor the intensity of pain alone shows how serious the cause is. Assessment should also take into account the location, onset, duration, changes over time and accompanying symptoms.

Abdominal pain can have many different causes. It is often related to temporary digestive problems, but pain may also originate from the stomach, bowel, gallbladder, urinary tract or reproductive organs. Assessment therefore depends on the combination of location, character and duration of the pain and any accompanying symptoms.

Indigestion, bloating and constipation

Common and usually less serious causes include bloating, excess gas, indigestion and constipation. Pain may be diffuse or cramp-like and is often accompanied by fullness, abdominal distension or changes in bowel movements.

Gastrointestinal infections and food poisoning

Viral or bacterial gastrointestinal infections and food poisoning can cause abdominal cramps and pain, often together with diarrhoea, nausea, vomiting or fever. Symptoms often begin relatively suddenly.

Stomach and duodenum

When pain is mainly in the upper middle abdomen, possible causes include conditions affecting the stomach or duodenum, such as inflammation of the stomach lining or an ulcer. Burning discomfort and symptoms related to meals may also occur with other upper gastrointestinal conditions.

This is a broad topic, so we cover it in more detail in our guide to stomach pain: possible causes and what may help.

The bowel

Conditions affecting the small or large bowel may also cause pain. These include irritable bowel syndrome, inflammatory bowel disease and diverticular disease. Duration of symptoms, changes in bowel habits, diarrhoea or constipation, blood in the stool, weight loss and other accompanying signs can help distinguish between possible causes.

Gallbladder and pancreas

Upper abdominal pain may also be related to gallstones, inflammation of the gallbladder or pancreatitis. Gallbladder pain is often more pronounced in the upper right abdomen and may radiate to the back or right shoulder blade. Pain from the pancreas may spread from the upper abdomen to the back.

Urinary tract and kidneys

Abdominal or flank pain may also originate from the urinary tract. A urinary tract infection may be accompanied by burning during urination and increased urinary frequency, while kidney stones can cause severe pain that comes in waves and may radiate towards the groin.

Reproductive organs and pregnancy

In women, possible causes also include menstrual cramps, endometriosis, ovarian cysts and pelvic inflammatory disease. Pregnancy should also be considered in lower abdominal pain. Sudden pain when pregnancy is possible requires particular caution because of the possibility of an ectopic pregnancy.

Appendicitis and other important causes

With appendicitis, pain may begin around the navel and then move to the lower right abdomen and become progressively worse. Abdominal pain may also be caused by bowel obstruction, a hernia and other conditions that can require prompt medical assessment.

The full list of possible causes is much longer, so abdominal pain should not be diagnosed from its location or a single accompanying symptom alone. A new, severe or worsening pain should always be considered in the context of the complete clinical picture.

If abdominal pain occurs during or after a meal, information about timing, the location of the pain and the type of food eaten can be useful. However, a connection with food does not necessarily mean that the problem originates in the stomach or that a food intolerance is responsible.

Upper abdominal pain or burning

Pain, burning, uncomfortable fullness, nausea or feeling full after only a small amount of food are among the typical symptoms of indigestion or dyspepsia. Similar symptoms may also occur with some conditions affecting the stomach and duodenum.

If the symptoms are mainly in the upper middle abdomen, see also our guide to stomach pain and its possible causes.

Cramps, bloating or diarrhoea after certain foods

If bloating, gas, cramps or diarrhoea repeatedly occur after particular foods, one possibility is difficulty digesting or absorbing certain food components. With lactose intolerance, for example, abdominal pain, bloating, gas and diarrhoea may develop within a few hours of consuming milk or other foods containing lactose.

Similar symptoms can also occur with other conditions, so recurring symptoms should not automatically be attributed to a single food intolerance or lead to unnecessary elimination of several food groups.

Upper right abdominal pain after a large meal

Pain in the upper right abdomen that develops after a large meal and may last for some time or radiate towards the back or right shoulder blade can be related to the gallbladder. Gallstone attacks often occur after heavy meals, although other conditions can cause similar pain.

The pattern matters more than a single meal

With an occasional mild episode, it may be enough to note what you ate and how long after the meal the pain appeared. If symptoms recur, it can be useful to record foods eaten, the timing and location of the pain, bowel movements and other symptoms. A repeated pattern is much more informative than conclusions based on one meal.

If pain after eating keeps returning, becomes more severe or is accompanied by vomiting, blood in the stool or vomit, fever, weight loss or other significant symptoms, medical assessment is appropriate.

There is no single measure that helps with every type of abdominal pain. The best approach depends on the cause. With mild, short-lived symptoms and no warning signs, a few simple measures can be tried while monitoring how the symptoms develop.

1. Drink enough fluids

With nausea, diarrhoea or vomiting, preventing dehydration is particularly important. Fluids are often easier to tolerate when taken frequently in small sips rather than in a large amount at once. If vomiting persists and you cannot keep fluids down, self-care is no longer an appropriate approach.

2. Temporarily reduce the burden on digestion

With digestive symptoms, smaller and simpler meals may be easier to tolerate. If a particular food clearly makes symptoms worse, it is reasonable to limit it temporarily. With upper abdominal symptoms, very fatty foods, alcohol, caffeine or fizzy drinks may aggravate symptoms in some people.

3. For bloating, eat more slowly and choose smaller meals

If gas and bloating are the main problems, eating more slowly, having smaller meals and limiting habits that cause you to swallow more air may help. It is also useful to notice whether particular foods or fizzy drinks repeatedly trigger symptoms.

4. For constipation, fluids, fibre and activity can help

If constipation is responsible, basic measures include adequate fluids, gradually increasing dietary fibre and regular physical activity. Fibre should be increased gradually because adding too much too quickly may worsen bloating in some people.

This does not apply to sudden severe pain, marked abdominal swelling, vomiting or an inability to pass stool or gas. In that situation, medical assessment should come first.

5. Look for a pattern

With recurring pain, it can be useful to record the location and type of pain, when it occurs, its relationship with meals, bowel movements and accompanying symptoms. This may reveal a recurring pattern and can also be useful when speaking with a doctor.

If the cause is unclear, simply suppressing the pain is not enough

Abdominal pain is a symptom, not a diagnosis. If it keeps returning, does not settle or becomes worse, identifying the cause is more important than repeatedly trying different forms of self-treatment.

Choosing medication for abdominal pain is not as straightforward as it may be for a headache or muscle pain. The most appropriate treatment depends mainly on the cause of the pain, so ordinary painkillers are not automatically the right choice for every abdominal pain.

Be cautious with ibuprofen, naproxen and aspirin

Non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, naproxen and aspirin, can cause or worsen digestive symptoms. Their side effects can include indigestion and stomach pain, and they may also increase the risk of stomach or intestinal ulcers and bleeding.

Particular caution is therefore needed with upper abdominal pain, a current or previous stomach or duodenal ulcer, gastrointestinal bleeding, and when taking certain other medicines. If you are unsure whether an NSAID is suitable for you, ask a pharmacist or doctor.

What about paracetamol?

Paracetamol does not carry the same risk of stomach ulcers as NSAIDs and may be a more suitable option for some types of pain. However, paracetamol does not treat the cause of abdominal pain and is not suitable for everyone. Follow the instructions, do not exceed the recommended dose, and take account of liver disease and other medicines that may already contain paracetamol.

Cramping pain may require a different approach

For some conditions characterised mainly by cramps, antispasmodic medicines may be used. The appropriate choice still depends on the cause and the individual’s health, so recurring or unexplained pain should not be treated solely on the basis of the symptom.

Pain relief does not prove that the cause is harmless

If a painkiller reduces the pain, this does not mean that the underlying cause is necessarily harmless. New, severe, sudden or worsening pain, particularly when accompanied by warning signs, requires medical assessment even if medication temporarily reduces the pain.

Most short-lived abdominal pain is not an emergency, but the same symptom can also occur with more serious conditions. Assessment therefore depends not only on the intensity of the pain but also on a sudden onset, rapid worsening and accompanying warning signs.

Seek urgent medical help

Prompt medical assessment is particularly important if you notice any of the following warning signs:

1. Sudden, very severe or rapidly worsening pain.
2. Blood in the stool, black tarry stools or vomiting blood.
3. Fever and vomiting, especially if you cannot keep fluids down.
4. A very tender, rigid or markedly swollen abdomen.
5. Fainting, marked weakness, difficulty breathing or chest pain.
6. Pregnancy or possible pregnancy together with abdominal pain, especially if there is also bleeding.

With these warning signs, it is not appropriate to wait and see whether the pain settles on its own or to try to manage the problem at home for an extended period.

Arrange a medical assessment for persistent or recurring pain

Medical advice is also appropriate when the pain is not severe but does not settle, keeps returning or gradually becomes worse. Assessment is particularly important if you also have:

• repeated vomiting or an inability to keep fluids down;
• fever together with abdominal pain;
• blood in the stool or persistent changes in bowel habits;
• unexplained weight loss or a prolonged loss of appetite;
• prolonged diarrhoea or constipation;
• burning or painful urination or marked changes in urination;
• pain that regularly wakes you from sleep or significantly interferes with daily activities.

Pain intensity alone is not a reliable measure of how serious the cause is. Some important conditions may initially cause relatively mild symptoms, while very unpleasant pain can sometimes have a less serious cause. The overall pattern of symptoms matters.

What have we learnt from many years of advising users?

Our practical experience has led to one particularly simple rule: there is little sense in continuing indefinitely simply because you have already started using a product.

When users themselves report a clear difference, our practical observations suggest that they usually notice it relatively quickly – often within a few days and generally within about a week. If there is no clear change after one pack, in our experience there is usually little reason to continue.

This is an observation based on many years of user feedback, not proof of effectiveness and not a prediction of how any individual will respond.

If you use it, follow the recommended dose

The recommended use is 2 capsules in the morning and 2 capsules in the evening. In conversations with users, we sometimes find that people start with a substantially smaller amount and then assess the experience very quickly.

In our practical experience, there is no important difference between taking the capsules with or without food. If taking them on an empty stomach does not suit you, taking them with a meal is a reasonable option.

When is Smrekovit not enough?

A food supplement is not a substitute for establishing the cause of unexplained pain or for prescribed treatment. Sudden or severe pain, warning signs, recurring symptoms without a clear cause or gradual worsening require medical assessment.

We also do not advise users to stop medicines prescribed by their doctor because they are using Smrekovit.

For more detail on practical use, dosage and how to assess the course of use, see our practical instructions for the stomach, bowel and digestive problems. Information about the composition and product itself is available on the Smrekovit Intus page.

Over more than three decades, we have received a large amount of feedback from Smrekovit users. Below are three summaries of genuine individual experiences relating to digestive problems and the internal use of Smrekovit.

These are individual experiences, so the same course or result cannot be expected for every user. Older accounts refer to Smrekovit capsules; the product is now called Smrekovit Intus.

Read more user experiences →