Severe stomach pain has dozens of possible causes, ranging from trapped gas to conditions that need emergency surgery. What you should do depends on where the pain is, what it feels like, and whether you have other symptoms alongside it. The most important first step is figuring out whether you need emergency care or whether you can safely manage the pain at home while it resolves.
Signs You Need Emergency Care Now
Some types of severe abdominal pain signal a medical emergency. Call 911 or get to an emergency room if your pain comes with any of the following:
- Vomiting blood or having black, tarry, or bloody stool
- A swollen, rigid abdomen that’s tender to touch
- Chest pain, neck or shoulder pain, shortness of breath, or dizziness
- Blood in your urine
- High fever
- Persistent vomiting that won’t stop
- Pain related to an accident or injury
A ruptured organ, internal bleeding, or a blocked blood vessel in the abdomen can all cause severe pain that gets worse quickly. If the pain came on suddenly, feels like ripping or tearing, and you feel faint or lightheaded, treat it as an emergency. In adults over 60, a deep, constant pain in the belly or back combined with a throbbing feeling near the navel can signal a problem with the large artery in the abdomen, which is life-threatening if it ruptures.
Where It Hurts Tells You a Lot
Pain location is one of the most useful clues for narrowing down the cause. You don’t need to diagnose yourself, but knowing what each area is associated with can help you communicate with a doctor and understand the urgency.
Upper right side: Gallbladder problems are the most common culprit here. Gallstones cause pain in the mid-to-upper abdomen that often radiates to the back or under the right shoulder blade. This pain typically hits after eating a fatty meal and can last several hours.
Upper middle (just below the breastbone): This area is linked to the stomach, esophagus, and pancreas. Acid reflux, gastritis, and ulcers all concentrate pain here. Pancreas inflammation causes intense upper abdominal pain that bores straight through to the back and often comes with nausea.
Lower right side: This is the classic appendicitis zone. The pain often starts vague and central, near the belly button, then migrates to the lower right over several hours and gets sharper. If coughing makes the pain worse, or pressing on the left side of your abdomen triggers pain on the right, appendicitis is a strong possibility and you should get to an ER.
Lower left side: In adults over 40, diverticulitis is a common cause of severe lower-left pain, often accompanied by fever and changes in bowel habits.
Flank or side pain radiating downward: Kidney stones produce sharp pain in the lower back or side that radiates toward the lower abdomen and groin. It tends to come in intense waves and often brings nausea and an urgent need to urinate.
Causes Specific to Women
Women experiencing severe lower abdominal or pelvic pain have additional possibilities to consider. Three gynecological emergencies can cause sudden, intense pain: ectopic pregnancy (a pregnancy growing outside the uterus), ovarian torsion (when an ovary twists on itself, cutting off blood flow), and a ruptured ovarian cyst that bleeds internally.
If you’re of reproductive age and have severe one-sided pelvic pain, especially with vaginal bleeding, dizziness, or a missed period, get evaluated immediately. Ectopic pregnancy can cause dangerous internal bleeding, and ovarian torsion can permanently damage the ovary if not treated within hours.
Severe Pain in Children
Kids can’t always describe or locate their pain accurately, which makes evaluation trickier. Most childhood stomachaches are caused by constipation, gas, or viral infections, but a few serious conditions are unique to younger children.
In babies and toddlers under two, a condition called intussusception occurs when one section of the intestine telescopes into another. The classic signs are episodes of intense, colicky pain (the child may draw their knees up), vomiting, and a jelly-like red stool, though fewer than half of cases show all three symptoms together. Bilious vomiting (bright green or yellow) in an infant is another red flag that warrants immediate evaluation, as it can signal a twisted bowel.
What to Do at Home While You Assess
If you don’t have any of the emergency symptoms listed above, there are a few things you can do while you figure out your next step.
Stop eating solid food for a while. Stick to water and other clear liquids to stay hydrated. When you start eating again, go small and bland. Avoid alcohol, caffeine, spicy foods, and anything high in fat for at least a day or two, as these can all irritate an already-upset digestive system.
Lie in whatever position feels most comfortable. Some people find that lying on their side with knees pulled toward the chest eases cramping. Avoid taking laxatives or strong pain medications before you have a sense of what’s going on, because they can mask symptoms or make certain conditions worse. Over-the-counter antacids can help if the pain is clearly in the upper stomach and feels like burning, but they won’t do anything for pain coming from other organs.
Pay attention to what happens over the next few hours. Pain that steadily worsens, moves to a specific spot, or comes with new symptoms like fever or vomiting is a reason to seek medical care rather than waiting it out.
What Happens if You Go to the ER
If you do go to the emergency room for severe abdominal pain, expect a physical exam followed by blood and urine tests. Doctors will check markers of infection, inflammation, and organ function. If you’re a woman of childbearing age, a pregnancy test is standard.
Imaging comes next if the cause isn’t obvious. For pain in the upper right abdomen, an ultrasound is the go-to test because it’s fast and excellent at spotting gallstones. For lower abdominal pain, generalized pain, or suspected appendicitis, a CT scan with contrast dye is the most common choice. Pregnant patients are evaluated with ultrasound first, and MRI if more detail is needed, to avoid radiation exposure.
The timeline varies. Some diagnoses, like kidney stones or appendicitis, can be confirmed within an hour or two. Others require observation over several hours to see how the pain evolves. If appendicitis is confirmed, surgery typically happens the same day. Kidney stones, depending on size, may pass on their own with pain management, or may require a procedure to break them up. Gallbladder attacks often lead to planned surgery within days to weeks.
Common Causes That Feel Terrible but Aren’t Dangerous
It’s worth knowing that some of the most painful abdominal experiences aren’t emergencies. Severe gas pain and bloating can produce sharp, cramp-like pain that moves around the abdomen and can feel alarming. Gastroenteritis, the classic “stomach bug,” causes intense cramping, nausea, vomiting, and diarrhea that can last 24 to 72 hours. Food poisoning follows a similar pattern, often starting within hours of eating contaminated food. Menstrual cramps can also cause pain severe enough to be debilitating, centered in the lower abdomen and sometimes radiating to the back and thighs.
These conditions are miserable but self-limiting. The key difference between them and something more serious: they tend to come in waves rather than steadily worsening, they don’t produce a rigid or board-like abdomen, and they aren’t accompanied by the red-flag symptoms at the top of this article. If your pain is getting worse hour by hour rather than coming and going, that pattern alone is worth getting checked out.