By Dr. Katie E. Golden, MD

Abdominal pain is a very common symptom. And most of us have the same (gut) instinct when it happens: to wait it out, and see how we feel a little later. ‘Did I eat something bad? Do I just need to poop? Maybe it will pass.’

But when your symptoms don’t go away, or they start to get worse, you may start to wonder if it could be something more serious than spoiled milk or constipation. The list of things that can cause abdominal pain is long, and it goes well beyond the stomach and digestive tract. Your abdomen is home to your liver, kidneys, spleen, important blood vessels, reproductive organs, to name a few. 

The good news is that abdominal pain is our bread and butter in the emergency room. Whether you want to find out what is going on, or simply need some relief from your symptoms, we’ll help you figure out if it’s time to peel yourself off the couch and get checked out.

What are common causes of abdominal pain in the ER?

Most of the time, episodes of abdominal pain are not caused by a medical emergency. But they can still feel like one. Below are just some of the causes of abdominal pain that we treat in the emergency room. As you can see, they span multiple different organs and systems in the body:

    • Gastritis. This is an inflammation of the stomach lining that leads to stomach pain, nausea, and sometimes vomiting. 
    • Gallstones. The gallbladder can be a pesky organ. And when it makes gallstones, people can experience pretty severe episodes of pain. Gallstones can also lead to a more serious infection of the gallbladder, called cholecystitis. 
    • Pancreatitis. Your pancreas sits right behind your stomach. And when it gets inflamed, it can cause unrelenting pain, nausea, and vomiting. 
    • Bowel Obstruction. This is when there is a blockage in your intestines that is not letting digestive contents through. It tends to cause extreme bloating, pain all over the abdomen, and vomiting. 
  • Enteritis and Colitis. This small and large intestine can get inflamed or infected for many different reasons, from food poisoning to inflammatory bowel diseases. These conditions tend to cause cramping, diarrhea, and even bloody bowel movements.
  • Appendicitis. The appendix is a small little segment of the intestine that has a tendency to get infected. When that happens, it causes pain  around the belly button or in the right lower part of the abdomen. It can also lead to loss of appetite, vomiting, and fever.
  • Diverticulitis. This is a relatively common condition, especially in older adults. It happens when small areas of the intestinal wall get inflamed or infected. It tends to cause pain in the left lower part of the abdomen. It can also cause fever, loss of appetite, and sometimes vomiting and diarrhea.
  • Kidney stones. These tiny little pebbles can cause some major pain. They often cause pain in the side/flank area, but sometimes that pain can also be felt in the lower abdomen. 
  • Urinary tract and pelvic infection. Infections of the bladder or reproductive organs (uterus, ovaries, testes, epididymis) can cause discomfort and pressure in the lower abdomen. 
  • Ovarian cysts. Ovarian cysts are common, and when they are large enough, they can cause a lot of pain in the lower abdomen. This is especially true if they rupture, or cause the ovary to twist on itself (a serious condition called ovarian torsion).
  • Problems with the aorta. The aorta is the largest blood vessel in the body. It carries blood from the heart to the rest of the body. Conditions like aneurysms (an enlargement of the aorta) or dissection (a tear in the vessel) are rare but life-threatening. Many people associate these conditions with chest pain, but they can also cause abdominal pain, too. 

These are just a few examples of conditions that we treat in the ER. Some of them are serious and life-threatening, others are not. But they all have one thing in common: they can be pretty painful. And commonly bring people in to see us.

When should I go to the ER for abdominal pain?

It’s never easy to decide when it’s time to leave the comfort of your own home to head to the ER. And it can be hard to peel yourself off the couch (or bathroom floor) when you are feeling sick. But if you are worried or alarm bells are going off in your head, it is always better to be safe than sorry when it comes to your health. 

And if you are experiencing any of the following symptoms, you should definitely get immediate medical care:

  • Pain that is progressively getting worse.
  • Pain that has you doubled over, and unable to stand upright.
  • Pain that gets worse hurts with any sort of movement, like walking or riding in a car.
  • Significant bloating and distention — especially if the skin over your abdomen feels tight because of it.
  • You cannot stop vomiting.
  • You feel lightheaded, dizzy, or like you are about to pass out.
  • You have a fever over 101, or shaking chills. 
  • You are unable to empty your bladder, or your urine appears dark brown.
  • You feel like you want to pass gas or a bowel movement, but you can’t.

What happens in the ER?

When someone is in the ER with abdominal pain, there are two main goals: to figure out the cause, and to get them feeling better. Every person’s care is a little different. But here is what you can expect if you go to the ER for abdominal pain:

  • IV placement. Most people with abdominal pain will get an intravenous (IV) placed in their arm. This allows staff to collect a blood sample, as well as give medicine and fluids.
  • Lab tests. Your clinician will likely test your blood counts, electrolytes, kidney and liver function. They may also ask you for a urine sample, to look for signs of infection.
  • Abdominal imaging. Based on your symptoms, physical exam, and lab tests, your clinician may recommend more testing. For many abdominal conditions, a CT scan is the best test to provide a detailed look at your internal organs. For others — like problems with the gallbladder or ovaries — an ultrasound is a better test.
  • Treatment.  Most people with abdominal pain receive IV medications to relieve both pain and nausea, as well as IV fluids if they are dehydrated. 
  • Nothing to eat or drink. Most of the time, your clinician will ask that you hold off on eating or drinking anything until they figure out what is going on. This is because certain conditions — like an appendicitis or gallbladder infection — require emergency surgery for treatment. So they want to keep your stomach as empty as possible in the event you need a last-minute procedure.

Many times, the abdominal pain workup in the emergency room does not reveal anything wrong. And after you feel better with time and some medicine, you can return home to rest and recover. And resume your place on the couch with some peace of mind.