When stomach pain strikes, it’s hard to think about anything else.
It can also be a mystery. Was it something you ate? Is it the signal of a disease? Does it warrant medical attention?
Stomach pain is extremely common in the human experience because so many things are happening in the abdominal area, says Dr. Christine Lee, a gastroenterologist at the Cleveland Clinic in Ohio.
“There are a lot of organs going in there. So you’ve got your liver, gallbladder, pancreas, stomach, small bowel, colon, kidneys, adrenal glands, bladder, ovaries,” Lee tells TODAY.com.
“That’s a lot of organs packed into a small space, so the potential of something going awry or just going slower or faster to cause some discomfort — the chance of that happening is very high.”
To figure out what’s causing the pain, doctors first try to pinpoint its location. Think of your abdominal space as divided into four quadrants — right upper, left upper, right lower and left lower. Knowing where the pain is coming from can help narrow down the possible causes, Lee says.
For the most accurate location, she asks patients to point to their abdominal pain while they’re standing or lying flat on their back because sitting shifts everything inside the abdominal space.
But even when people are in the correct position, their perception of where the pain is coming from can depend on how they’re wired and their unique anatomy, Lee points out. Pain can also radiate to other parts of the body.
Don’t ignore persistent discomfort because whenever you have pain, your body is trying to tell you something’s going on, she adds.
For pain in the middle of the stomach, just above the belly button, Lee says the possible causes include:
Acid reflux:
Also known as gastroesophageal reflux, it happens when the contents of your stomach flow back towards your throat. It’s common for everyone once in a while, but about 20% of Americans have a more severe and longer-lasting version of this condition called gastroesophageal reflux disease, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
Treatment: Avoiding acidic foods such as citrus fruits and tomatoes may help, as can cutting down on alcohol, chocolate, high-fat and spicy foods. Eating certain foods, including bananas and brown rice, can help ease the discomfort. Over-the-counter antacids and other medications to lower the amount of acid the stomach produces can relieve symptoms. If over-the-counter medications aren’t helping, prescription drugs may be needed.
Gastritis:
This is inflammation of the lining of the stomach, which can be caused by medicines such as aspirin or ibuprofen, heavy alcohol drinking or a bacterial infection, according to the National Library of Medicine.
Treatment: It depends on the cause. Stopping the use of the medicines or taking an antibiotic may help. Antacids may also provide relief.
Peptic ulcer disease:
A peptic ulcer is an open sore in the lining of the stomach or the first part of the small intestine, according to the American College of Gastroenterology. It’s caused by a bacterium or pain relievers known as NSAIDs, including aspirin and ibuprofen, the group noted. Eating food can sometimes relieve the pain, but it can also sometimes make it worse. Ulcers can bleed and cause anemia.
Treatment: Acid-blocking drugs. Patients whose ulcers were caused by NSAIDs may need to switch other pain relievers. If a bacterial infection was the cause, antibiotics are part of the treatment.
Pancreatitis:
This is inflammation of the pancreas, a gland that helps the body break down food and regulate blood sugar. Common causes include gallstones, heavy alcohol use, certain medications and genetic disorders of the pancreas, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
Lee described this condition as “extremely painful.” Besides stomach pain, patients may experience nausea and vomiting, fever, a rapid pulse and weight loss.
Treatment: A hospital stay may be required, along with pain medicine and antibiotics. If gallstones caused the pancreatitis, surgery to remove the gallbladder may be necessary.
Appendicitis:
This happens when the appendix, a small pouch attached to the large intestine, becomes inflamed — usually because it’s blocked by feces, a foreign object, a tumor or even a parasite, according to the National Library of Medicine.
When appendicitis is in its early stages, people have a hard time explaining where the pain is, Lee says.
“They’ll say, ‘My stomach hurts.’ And if you ask them to point with one finger where, they generally struggle and have no idea. They’ll have an open hand. They’re kind of rubbing their entire belly,” she notes.
“It isn’t until the appendicitis progresses and when it’s full blown that they will then point towards the right lower quadrant area.”
Treatment: The appendix is usually surgically removed because it can cause a serious infection if it bursts. Treatment with antibiotics at home is safe for some appendicitis cases, a 2022 study found.
Irritable bowel syndrome (IBS):
It involves acollection of symptoms — including cramping, abdominal pain, bloating, diarrhea and constipation — that last for at least three months, according to the Office of Women’s Health. Up to 20% of U.S. adults have IBS, with patients more likely to be women and adults under 50, it adds. The cause is unknown.
The pain can be felt in any part of the abdominal space, Lee says. “Generally, the hallmark for irritable bowel is it’s more than one location, so it will be multiple spots and sometimes it will be in different spots,” she adds.
Treatment: There is no cure, but lifestyle changes can ease symptoms. They include eating more high-fiber foods such as whole grains, fruits and vegetables; drinking six to eight glasses of water a day; and avoiding large meals.
Gallstones:
These hard deposits that form in the gallbladder typically cause pain only when they slip out of the organ and get stuck, causing pressure to build up, Lee says.
In general, the pain is felt in the right upper quadrant area of the abdomen, but some people point towards the middle region, she adds. The pain, may be constant or cramping, and will be felt for at least 30 minutes, according to the National Library of Medicine.
Treatment: Surgery is usually needed when people have symptoms. Medications can dissolve gallstones, but they can take years to work.
Lactose intolerance:
This condition happens when a person can’t digest the sugar lactose, which is found in milk and other dairy products. About 15% of white adults and 85% of Black adults in the U.S. are lactose intolerant, according to the American College of Gastroenterology.
Patients may feel pain anywhere in the abdominal area, Lee says.
Treatment: Avoid lactose-containing foods and drinks. If you do still consume them, take a supplement that contains lactase, the enzyme that breaks down lactose, to ease symptoms.
Crohn’s disease:
This is an inflammatory bowel disease that causes chronic inflammation of the gastrointestinal tract, according to the Crohn’s & Colitis Foundation. The cause is unknown.
Crohn’s can literally be anywhere in the intestinal tract, from the esophagus to the rectum, Lee says.
Treatment: There is no cure, but medications can reduce the inflammation and dietary modifications — such as eating soft, bland foods and avoiding spicy or high-fiber foods — may help ease symptoms.
Celiac disease:
This is an autoimmune disorder where eating gluten — a protein found in wheat, rye and barley — leads to damage in the small intestine, according to the Celiac Disease Foundation. It estimates only 30% of people with the condition are properly diagnosed.
Because the small bowel is long, wrapped around and packed into the abdominal space, the pain can be felt anywhere, though people will typically rub their upper abdomen, Lee says.
Treatment: A gluten-free diet.
When to seek help for stomach pain:
Everyone will experience abdominal pain at some point in their life — what happens next depends on the severity of the pain and how long it lasts, Lee notes. She advises these options:
Call 911 only if you also have chest pain, shortness of breath, lightheadedness or dizziness to the point where you think you’re going to pass out, low blood pressure or an erratic heart rate.
Go to urgent care if the stomach pain is intense and constant, but your vital signs are stable. (If the intense pain goes away in seconds and doesn’t return, you may not require immediate medical attention and have more time to schedule a less urgent visit.)
Make an appointment with your doctor in the next few days or a week if the stomach pain persists and is annoying, but you can go to work and function as normal. Don't ignore it — get it checked out.