Where Is Your Abdominal Pain?

When a person has abdominal pain, the exact location of the discomfort can often reveal the source of problem.

When abdominal pain hits, it’s often difficult for people to name what’s causing it. Could it be food poisoning? Appendicitis? Gallstones? The complexity of the digestive system and a wide range of potential problems can make getting to the root of the issue seem impossible.

“But that same complexity can help doctors and patients figure out what’s wrong,” says gastroenterologist James L. Buxbaum, MD, executive director of the USC Digestive Health Institute, part of Keck Medicine of USC. “Every part of the abdomen houses different organs, and each organ can have its own set of problems.”

Familiarizing yourself with the digestive tract can help you identify what the cause of your abdominal pain might be.

The journey down

People who are middle-aged or older, pregnant people and people of all ages with a hiatal hernia are all prone to acid reflux, or gastroesophageal reflux disease (GERD), a condition where acid from the stomach regularly backs up into the esophagus. This creates a burning sensation in the chest or upper abdomen, often called heartburn.

“There are a lot of great dietary strategies to manage GERD,” Dr. Buxbaum says. “Changing your sleeping position is also helpful. Medications to reduce acid are now widely available over the counter.”

First stop: the stomach and pancreas

The stomach and pancreas are both located in the upper left portion of the abdomen.

People often attribute stomach pain to ulcers, Dr. Buxbaum says. However, “Ulcers are not as common as you think.”

Also contrary to popular belief, ulcers not caused by stress or anxiety. The most common cause of an ulcer is a medication class known as nonsteroidal anti-inflammatory drugs (NSAID), such as ibuprofen or naproxen. There’s also a bacteria known as H. pylori, which affects people in many parts of the world but is rare in the United States.

For ulcers caused by H. pylori, antibiotics are the gold standard treatment method. Ulcers can also be treated with acid blockers to give the stomach time to heal.

Another cause of pain in the upper abdomen is pancreatitis. Pancreatitis is a painful inflammation of the pancreas with a wide range of possible causes, and it’s felt in the upper center of the abdomen. People describe the pain as sharp and severe, sometimes traveling to the back. It’s often accompanied by nausea, vomiting and sometimes fever.

Unfortunately, there are currently no drugs to treat pancreatitis, but “Keck Medicine is actually doing a lot of research to change that,” Dr. Buxbaum says.

Next stop: the small bowel

“The most common issue I see is sprue, also known as celiac disease, which is an autoimmune response to gluten,” Dr. Buxbaum says.

Patients often experience sharp pain throughout their abdomen, along with cramping, nausea, diarrhea, vomiting and signs of malnutrition, since the damaged small bowel causes malabsorption of nutrients. Once a person is diagnosed with celiac disease, either through an antibody blood test or a small bowel biopsy, they can recover by cutting gluten out of their diet.

Next stop: the lower bowel and colon

In the lower right portion of the abdomen are the lower bowel and colon, where one of the most common issues is something called motility disturbance.

“Sometimes there isn’t anything structurally wrong, but the gut just doesn’t squeeze right,” Dr. Buxbaum says. “This is often due to something called the gut-brain connection.”

Because of the way the gut and the brain communicate with each other, it’s not uncommon for stress or difficult emotions to trigger irritable bowel syndrome, which usually shows up as either severe diarrhea or constipation, plus aching and bloating. Usually, the best course of action for these patients is to find a center that specializes in gut-brain connection disorders, like the USC Digestive Health Institute.

Further down the colon, diverticulitis can occur in older people as well as people with a genetic predisposition. Diverticula are pouches that develop along the inner walls of the colon that sometimes become inflamed or even infected. This can cause sharp pain in the lower abdomen that feels very similar to appendicitis.

“Diverticulitis can be treated with antibiotics,” Dr. Buxbaum says. “In the worst cases, colorectal surgeons can intervene.”

The most serious condition that causes abdominal pain is also in this area: colon cancer.

“The American population has a very high rate of colon cancer,” Dr. Buxbaum says. “So, we do recommend population screening with colonoscopies to look for polyps, which are the leading cause of colon cancer.”

Fortunately, if a colorectal surgeon finds any polyps during a colonoscopy, they can remove them as part of the procedure.

When to see a doctor for abdominal pain

Anyone experiencing severe abdominal pain should get to a doctor or emergency room right away, especially if there’s a risk of ulcer or appendicitis, or if they see blood in their stool.

“Duration also matters,” Dr. Buxbaum says. “If pain is persistent and really bothering you, you should definitely get it checked out.”

He adds, “Even if doctors can’t find a definitive cause, a good gastroenterologist will keep working with you until they find what you need in order to feel better.”

Topics