Stomach pain: When should you see your doctor?

When is a stomachache just a stomachache? And when is it cause to call your doctor?

“Abdominal—or stomach—pain can occur for a multitude of reasons,” says Christine Stallkamp, MD, FAAFP, director of urgent care for Main Line Health. “The most common causes are indigestion, viral infection, constipation and menstrual cramps. These conditions are not considered serious and often resolve on their own. But sometimes, stomach pain can indicate a more serious concern.”

Dr. Stallkamp says it’s important to be thoughtful about the possible causes of stomach pain.

“If you wake up with a stomachache, and the night before you had a heavy meal of steak, red wine and chocolate, chances are your pain is directly related, especially if you have a history of acid reflux,” says Dr. Stallkamp. “You need to be conscious of your lifestyle. In another example, women may regularly experience menstrual cramps, and can even have pain in the lower abdomen midway through their cycle due to ovulation. You need to be in tune with your body. Most of us have some sense of when something feels normal and when it doesn’t feel quite right.”

Common causes of stomach pain

• Indigestion – Certain foods and beverages, including spicy foods, minty foods, caffeine and alcohol, can lead to stomach pain, heartburn and gas. Many people suffer from chronic heartburn—or acid reflux—while others might just be bothered episodically. Even eating too much at once or eating right before bedtime can cause reflux.
• Viral gastrointestinal infection – More commonly known as the stomach flu, symptoms include vomiting and diarrhea, and sometimes fever. Stomach flu comes on suddenly, and tends to travel quickly through schools and households.
• Constipation – This is typically described as a change in your bowel pattern with less frequent bowel movements.
• Menstrual cramps – Cramps are usually predictable based on a woman’s monthly cycle.
• Stress – People carry stress in different areas of their bodies, some in the form of headaches, while others feel pain in the neck, shoulders or back. Some of us carry stress in our stomachs. A stressful day can trigger a flare up, especially in people with irritable bowel syndrome (IBS).

When to call your doctor

• History of heart problems – Men and women with a history of heart disease, as well as older individuals, should contact their doctor if they are experiencing abdominal pain, especially if the pain occurs higher up in the stomach. This may be a sign of a heart attack, particularly in women, and should quickly be evaluated by a doctor. If there is any concern of a heart attack, call 911 immediately.
• History of diabetes, high blood pressure or high cholesterol – If you have a history of chronic conditions, do not hesitate to call your doctor.
• Acute pain – Acute pain or pain that comes on suddenly might signal a more serious condition, such as a gallbladder attack or appendicitis. Both of these organs are located on your right side.

Appendicitis usually starts around the belly and moves down to the lower right abdomen. Other conditions include kidney stones, which cause intermittent pain beginning in the back; diverticulitis, which typically includes pain in the lower left abdomen; pancreatitis—inflammation that causes pain in the upper abdomen; and many others. If your pain continues to worsen, the area is tender to the touch, or it hurts to move around, you should be evaluated by a physician.

When to visit the emergency department

Stomach pain is one of the most common symptoms people report during emergency room visits.

“It can turn out to be nothing,” says Dr. Stallkamp, “but it can also signify a more serious condition. Listen to your body.”

If you’re experiencing symptoms like the ones below, visit the emergency room:

• Chest pain, pressure or shortness of breath.
• Severe, unrelenting stomach pain that continues to worsen.
• Stomach pain that radiates to your back.
• Abdominal areas that feel hard or tender to the touch.
• High fever.
• Vomiting or coughing up blood.
• Bloody stools (bright red blood or dark black stools).
• Signs of extreme dehydration – The stomach flu can lead to dehydration, sometimes severe.
• Signs of dehydration include decreased urine output or urine that appears dark in color, indicating that you are losing more liquid then you are talking in.
• Feeling woozy upon standing up and a rapid heart rate are also telltale signs of dehydration. If you are unable to keep fluids down for at least ten minutes, you may need to visit the ED to receive intravenous fluids.

With children, identifying the cause of stomach pain can be more of a challenge.

“It might be because they just don’t want to take their math test,” say Dr. Stallkamp. “Sometimes, a stomachache accompanied by a fever can indicate strep throat. When kids have stomach pain, look for decreased appetite or a low activity level. These are signs your child should be seen by a physician. When in doubt, call your family doctor or pediatrician.”

When contacting any physician about stomach pain—yours or your child’s—take note of exactly where in the abdomen the pain is located, how long it has been present, whether it feels dull or sharp, if it’s constant or intermittent, and how often it comes and goes. This information can help your physician determine potential causes and recommend the most appropriate course of action to ensure you and your loved ones are receiving the best care possible.