Welcome to our guide, Understanding New and Severe Abdominal Pain.

New and severe abdominal pain always needs to be closely evaluated by a doctor. It is frequently a sign of serious illness. This guide was not designed to substitute for office-based care.

If you are having new and severe abdominal pain, this pain may be frightening to you because of its mystery -- the abdomen contains many important organs that could be the source of your pain. It may seem like a daunting task for a doctor to diagnose the source of your symptom; in fact, there are more than a hundred medical conditions that commonly result in abdominal pain.

Despite the long list of possible causes for abdominal pain, your doctor will be likely be able to narrow down the possibilities to a short list after initial evaluation. Your experience may be less frightening to you if you understand the way that doctors begin to make sense of your symptom, and the reasons for ordering certain tests.

The purpose of this guide is to help you to understand a common way that doctors think through abdominal pain. This guide may also enable you to provide a more helpful medical history during your doctor's evaluation.

This guide was intended for people with new abdominal pain -- pain that has been present for less than two weeks. If your pain has been present for longer or is recurring from previous episodes, please visit our Guide for Recurring Abdominal Pain.

Click here to begin.

In this guide, we will start by identifying where you feel the pain most strongly. The middle third refers to an up-and-down stripe from the bottom center of your ribs, down through your navel (belly button) and ending above your pelvic bone. The sides of the abdomen refer to the outer one-third on each side of the middle third.

When your body was first forming as an embryo, a part of your development included the "migration" or rearrangement of several of your body organs. The nerves that connected to your organs did not re-wire as the organs rearranged. For this reason, some organs cause pain in a location different from where they are now located.

A specific location of pain in your abdomen is a very valuable clue, but it does not always lay blame on the organs that are located in its vicinity.

Please select the location where your pain is felt most strongly:

In the middle third of my abdomen

On one side or the other

All over my abdomen

When pain is present throughout the whole abdomen, it is usually arising from one of these sources:

1) A problem within the intestinal tract

2) A mineral abnormality, hormone abnormality, or abnormality of blood acidity that can affect the comfort of your intestinal tract

3) A problem involving the inside lining of your abdominal wall (called the "peritoneum") and any fluid that may exist between this lining and the abdominal organs.

If your pain is arising from the third source of diffuse abdominal pain we have listed -- your "peritoneum" -- then this can be a true emergency. Our first questions will help to identify if your problem is likely to involve your peritoneum or the fluid that may collect underneath it.

The peritoneum is a structure that is very sensitive to friction. If the peritoneum is inflamed, it is painful for people to have even minimal movement of their abdomen.

Do you have sharply increased pain if your abdomen is lightly jiggled? For example, do you have pain if someone bumps into the furniture on which you are sitting or lying or sharply increased pain when you cough or sneeze?

Yes, I have pain from minimal movements.

No, I do not have this symptom.

Good, this makes it less likely that you have an irritated peritoneum.

There are several causes of an enlarged abdominal girth or belt size. If your abdomen has expanded in its size during your episode of severe pain, this would bring several concerning problems to mind. The most common reason for abdominal bloating (enlargement) is gas.

Do you have enlargement of your abdominal size that you can not explain by fat?

Yes, this describes my situation.

No, this does not describe my situation.

A fever would make our suspicion high that you have an infection that is affecting your intestines.

Do you have a fever?

Yes, I have a fever.

No, I do not have a fever.

Diffuse abdominal pain can be the result of a chemical or metabolic change in the body. One such change is an increase in the acidity of the blood. A dangerous complication of type 1 diabetes may present with this symptom. This complication is called diabetic ketoacidosis. It is an uncommon complication in people who have type 2 diabetes.

Do you have type 1 diabetes?

Yes, I do have type 1 diabetes.

No, I do not have type 1 diabetes.

If you have vomiting associated with your pain, this suggests that the stomach or intestines have been strongly disturbed.

Are you vomiting?

Yes, I am vomiting.

No, I am not vomiting.

How old are you?

I am 50 or older.

I am under 50.

Your answers have been reassuring, and they make it probable that your pain is not from a dangerous condition. Severe or persistent abdominal pain should still evaluated by a doctor.

Common causes of diffuse abdominal pain that might explain your symptoms include a viral infection (gastroenteritis), gas, constipation, an irritable colon, or inflammatory bowel disease (Crohn's disease or ulcerative colitis).

Due to your age, you are at risk for several serious medical problems that could explain widespread abdominal pain. You urgently need to discuss your symptoms with your doctor.

The arteries that feed your bowel are susceptible to narrowing in any person who has atherosclerosis (cholesterol-associated artery damage). Sometimes, a blockage in an artery to the bowel will create diffuse abdominal pain. Impaired circulation to your intestine is called "intestinal angina" or "ischemic intestine."

Many adults form "diverticuli" as they age, which are hollow tubular bulges that branch from the colon lining like small pockets. These pockets can accumulate bacteria and can cause pain or brisk bleeding.

Your pain could also be explained by a more mundane medical problem. Common causes of diffuse abdominal pain that might explain your symptoms include a viral infection (gastroenteritis), gas, constipation, an irritable colon, or a metabolic abnormality such as high calcium.

Vomiting can arise from a variety of abdominal problems. One of the most common is food poisoning. Food poisoning can result when foods remains at room temperature or a warm temperature for several hours. While food is at warm temperatures, trace amounts of bacteria on the surface of the food can multiply or the bacteria can generate large amounts of an irritating chemical (a "toxin"). Egg-containing products, meats, seafood and rice are all very vulnerable to food poisoning.

When you consume food containing a bacterial toxin, you usually develop abdominal cramps, vomiting, diarrhea, or a combination of these symptoms within hours of eating. When food poisoning is caused by bacterial growth in the colon, rather than by a toxin, symptoms can take several days to appear. Sometimes, several people who have shared a meal become sick at the same time from food poisoning. At other times, only one person at the table may become ill.

Before you developed your pain and vomiting, did you eat food that may have been improperly prepared or stored?

Yes, I am suspicious about a food that I ate.

No, food poisoning does not seem likely.

Your vomiting and abdominal pain may be caused by a viral infection (gastroenteritis), but they could be a sign of something more serious. A common, dangerous condition that can cause these symptoms is bowel obstruction. Bowel obstruction should be strongly considered during your doctor's evaluation if you have not had a recent bowel movement or if you have a history of abdominal or pelvic surgery. Surgery can be result in thread-like or band-like scars in the abdomen that can ensnare a loop of bowel and block the passage of bowel contents.

Symptoms from food poisoning or viral gastroenteritis should improve after the first day. If your symptoms are severe or if they do not quickly improve, see your doctor for an urgent evaluation.

Food poisoning is a good explanation for your symptoms.

If your symptoms began within a few hours of your suspicious meal, the food was probably contaminated with a toxin. Fortunately, food poisoning symptoms go away on their own without treatment if they are caused by a toxin. Vomiting and abdominal cramps usually last less than a full day, but diarrhea and changes in your appetite and digestion may linger for up to one week.

If your symptoms took several days to develop after your suspicious food exposure, you may have a bacterial infection in your intestine. Your doctor might request that you provide a stool sample, so you can be checked for an infection with salmonella, shigella, campylobacter, or an aggressive strain of e. coli. Infections with these bacteria types require antibiotic treatment.

If you develop diarrhea, you may become significantly dehydrated as a result of food poisoning. Treatment with intravenous (IV) fluids might be necessary. If you notice dizziness or feel that you are losing fluid faster than you can keep up with by drinking, you should contact your doctor urgently. Your doctor's care is especially important if you are elderly or have heart disease or diabetes.

Your vomiting and abdominal pain may also be caused by a viral infection (gastroenteritis). Symptoms from food poisoning or viral gastroenteritis should improve after the first day. There are also more serious possible explanations for your symptoms. A common, dangerous condition that can cause these symptoms is bowel obstruction. Bowel obstruction should be strongly considered during your doctor's evaluation if you have not had a recent bowel movement or if you have a history of abdominal or pelvic surgery. Surgery can be result in thread-like or band-like scars in the abdomen that can ensnare a loop of bowel and block the passage of bowel contents.

If your symptoms are severe or if they do not quickly improve, see your doctor for an urgent evaluation.

You should seek a doctor's evaluation urgently because it is possible that you have the diabetic complication, "ketoacidosis." Ketoacidosis can be life-threatening if it is not treated quickly.

At this point, we are suspicious about an infection that is affecting your intestines.

If your fever is coming from an infection within your intestine, then the infection is also likely to result in diarrhea.

Are you having a new symptom of diarrhea?

Yes, I have diarrhea.

No, I do not have diarrhea.

The most common cause of fever and abdominal pain is viral gastroenteritis, an infection that causes symptoms only for several days in most people. You need to consider other explanations. If your fever and pain are persistent, or if your pain is severe, you should be urgently evaluated by a doctor.

Several serious infections can cause a symptom of diffuse abdominal pain if they spread inflammation into the small amount of fluid that moistens the outside of your abdominal organs. Dangerous infections that can cause diffuse abdominal pain include appendicitis, diverticulitis, or infected ascites (fluid that accumulates beneath the peritoneum in people who have cirrhosis of the liver). A fever and diffuse abdominal pain may also be a sign of life-threatening abdominal contamination due to a hole (perforation) in the stomach or intestines. Usually, a perforation is a complication of a peptic ulcer (open sore in the wall of the stomach or duodenum).

Fortunately most of the infections that result in diffuse abdominal pain, fever, and diarrhea are viral infections that cause symptoms only for several days. However, some infections that cause diarrhea require antibiotics to clear and could worsen without treatment.

You should be evaluated by a doctor immediately if your symptoms are severe, if you feel dizzy upon standing due to your loss of fluid from your diarrhea, or if you see blood in your diarrhea. You should also seek immediate medical care if you were treated with antibiotics within the past several months, since the bacteria clostridium difficile can proliferate in the intestine following antibiotic treatment and can cause a severe infection.

Please consider visiting our Diarrhea Health Decision Guide if your diarrhea symptom is prominent.

Your pain and expanding waistline could be a sign of a serious medical illness, particularly if you have nausea or vomiting along with your other symptoms! Seek a medical evaluation immediately!

Increasing abdominal girth (belt size) can result from fat, from an enlarged liver or spleen, from gas in the intestines, from distended intestines (due to a bowel obstruction) or from pregnancy. Less commonly, the abdomen can expand due to a tumor, or due to fluid accumulation around your abdominal organs and beneath the peritoneum (abdominal wall lining). Fluid that accumulates in this area is called "ascites," and it can be a complication of cirrhosis of the liver or certain other illnesses.

Because your pain is accompanied by expansion of your abdomen, the most likely explanations for your pain would be gas, bowel obstruction, constipation with or without a total blockage from stool (fecal impaction), or (if you have cirrhosis of the liver) ascites or infected ascites.

You have reported that you have pain with even minimal motion of the abdomen. This is concerning because it suggests you may have an inflamed abdominal lining, a condition known as "peritonitis."

Seek emergency care immediately!

Peritonitis can be the result of a severe abdominal infection such as appendicitis or diverticulitis. It may also be a sign of life-threatening abdominal contamination due to a hole (perforation) in the stomach or intestines. Usually, a perforation is a complication of a peptic ulcer (a sore in the wall of the stomach or duodenum).

If you have cirrhosis of the liver, you may accumulate fluid called "ascites" beneath the peritoneum. Ascites can result in severe abdominal pain if it becomes infected.

On which side of your abdomen is the pain?

The pain is on my right side.

The pain is on my left side.

We can divide the left side of the abdomen into three regions.

Where is your pain the most intense?

Soft upper belly area beneath your ribs

Muscular area at the side of your abdomen (your flank)

Your lower abdomen

Some causes of abdominal pain are more common in people who are older than 50, and some are more common in people younger than this age.

How old are you?

I am over 50 years old.

I am under 50 years old.

If your pain is arising from inflammation within your large intestine (colon), then we would expect to see some changes in your stool.

Have you noticed a change in your stools so that they now contain mucus or blood?

Yes, I have noticed a change in my stools.

No, I have not noticed a change in my stools.

It is reassuring that you have not noticed these stool changes.

Pain in this area can arise from the reproductive organs, so it is important to know whether you are a man or a woman.

Are you a man or a woman?

I am a man.

I am a woman.

One common cause of pain in this area is a hernia. A hernia is a bulge of intestine that protrudes through a gap in the muscles and other tissues that line the abdominal wall. If you have a hernia, you may have noticed that your symptoms feel strongest when you cough, strain, or sneeze.

Have you noticed a bulge in your groin, or have you noticed a sharp increase in your pain when you cough, strain, or sneeze?

Yes, I have a bulge or I have these pain triggers.

No, I have not noticed these symptoms.

A fever would make our suspicion high that you have an infection involving a part of your colon.

Do you have a fever?

Yes, I have a fever.

No, I do not have a fever.

Thank you for answering our questions.

The problems that are most likely to explain your discomfort are constipation, gas, or an irritable bowel.

Because of your young age, one problem that is not as likely to be the cause of your pain is diverticulitis. This diagnosis still needs to be considered, particularly if you are approaching the age of fifty or if you have a history of constipation. Many adults form "diverticuli" as they age, which are hollow tubular bulges that branch from the colon lining like small pockets. These pockets can accumulate bacteria and can cause symptoms much like appendicitis. Between episodes of infection, diverticuli can be asymptomatic, or they may cause pain or brisk bleeding. Without infection, these tubular bulges give you a diagnosis of "diverticulosis." With infection, you have "diverticulitis."

If a large part of your colon is involved, you are likely to have diarrhea along with your other symptoms.

Are you having diarrhea?

Yes, I have diarrhea.

No, I do not have diarrhea.

When diarrhea is not a prominent symptom, fever and pain in the lower abdomen can be signs of a serious infection. You should have your symptoms evaluated by a doctor right away.

You are younger than 50, but if you are approaching this age (particularly if you have a history of constipation) you may have the infection, "diverticulitis." Many adults form "diverticuli" as they age, which are hollow tubular bulges that branch from the colon lining like small pockets. These pockets can accumulate bacteria and can cause symptoms much like appendicitis, but on the left side. Between episodes of infection, diverticuli can be asymptomatic, or they may cause pain or brisk bleeding.

It is also possible for a pocket of infection (abscess) to form near to the rectum if bacteria contaminate the surrounding tissue. This can cause pain in the left lower abdomen and fever. This diagnosis is called a "perirectal abscess" or "perianal abscess."

Your symptoms are most consistent with "colitis," an infection or inflammation of the colon.

One common cause of colitis is an infection that can develop following antibiotic treatment. Infections from contaminated food, such as salmonella, shigella, or campylobacter can cause similar symptoms.

It is also possible for an autoimmune condition to result in colitis. Autoimmune problems that cause colitis include Crohn's disease and ulcerative colitis.

You may find more helpful information by visiting our Diarrhea Health Decision Guide.

There are several conditions that could explain your pain, but your history is particularly suggestive for a hernia. A hernia in the lower abdomen near to the groin is called an "inguinal hernia."

If your menses are not regular, this would suggest that your pain is arising from an interruption of normal ovulation or from pregnancy.

Are you having a delay or change in your menstrual bleeding?

Yes, my menstrual bleeding has changed.

No, my menstrual bleeding has not changed.

An infection in the pelvic organs could cause pain in this area. If you have had sex without a condom with someone who could carry a sexually transmitted disease, this is a serious concern.

Are you having a new discharge from your vagina, or have you had sex without a condom with a high-risk partner?

Yes, one or both applies to me.

No, this does not apply to me.

A fever would make our suspicion high that you have an infection. You do not have a high risk for a pelvic infection, so a fever would suggest an infection that involves a part of your colon.

Do you have a fever?

Yes, I have a fever.

No, I do not have a fever.

If a large part of your colon is involved, you are likely to have diarrhea along with your other symptoms.

Are you having diarrhea?

Yes, I have diarrhea.

No, I don't have diarrhea.

When diarrhea is not a prominent symptom, fever and pain in the lower abdomen can be signs of a serious infection. You should have your symptoms evaluated by a doctor right away.

Although you do not have specific symptoms that link your fever and pain to your uterus, tubes, or ovaries, a pelvic infection must be considered. An abscess near to the colon could also explain your symptoms.

You are younger than 50, but if you are approaching this age (particularly if you have a history of constipation) you may have the infection, "diverticulitis." Many adults form "diverticuli" as they age, which are hollow tubular bulges that branch from the colon lining like small pockets. These pockets can accumulate bacteria and can cause symptoms much like appendicitis, but on the left side. Between episodes of infection, diverticuli can be asymptomatic, or they may cause pain or brisk bleeding.

Your symptoms are most consistent with "colitis," an infection or inflammation of the colon.

One common cause of colitis is an infection that can develop following antibiotic treatment. Infections from contaminated food, such as salmonella, shigella, or campylobacter can cause similar symptoms.

It is also possible for an autoimmune condition to result in colitis. Autoimmune problems that cause colitis include Crohn's disease and ulcerative colitis.

You may find more helpful information by visiting our Diarrhea Health Decision Guide.

Ovulation (the release of an egg from your ovary) is a normal event that can cause pain on either side of the lower abdomen. If your menstrual cycles are timed to occur every 28 days, as is the case with most women, ovulation should occur about 14 days after the first day of bleeding from each of your periods.

Is your pain occurring roughly two weeks from the date that your last period began?

Yes, this describes my situation.

No, this does not describe my symptoms.

It is common for women to experience lower abdominal pain during their menstrual period.

Is your pain occurring just before your menses or during the first several days of your menses?

Yes, this describes my situation.

No, this does not describe my situation.

Thank you for answering our questions.

The problems that are most likely to explain your discomfort are constipation, gas, or an irritable bowel.

Because of your young age, one problem that is not as likely to be the cause of your pain is diverticulosis. This diagnosis still needs to be considered, particularly if you are approaching the age of fifty or if you have a history of constipation. Many adults form "diverticuli" as they age, which are hollow tubular bulges that branch from the colon lining like small pockets. These pockets can accumulate bacteria and can cause symptoms much like appendicitis. Between episodes of infection, diverticuli can be asymptomatic, or they may cause pain or brisk bleeding. Without infection, these tubular bulges give you a diagnosis of "diverticulosis." With infection, you have "diverticulitis."

It is very likely that your pain is caused by normal menstruation. The symptom of pain with menstruation is named "dysmenorrhea." Usually, nonsteroidal anti-inflammatory pain medicines such as ibuprofen are very helpful.

Another problem that can cause pain before or during menses is "endometriosis." Endometriosis occurs when endometrial tissue (tissue that is normally found lining the inside of the uterus) is present in the pelvis or abdomen outside of the uterus. Endometrial tissue can ooze blood at the time of your menses, wherever this tissue is located.

Since this is such a common symptom and since your timing is right, you are probably experiencing pain from normal ovulation. This pain is called by the medical name "mittelschmerz."

Since you are having pain and a delay in your menses, it is possible that you have the dangerous problem of an ectopic pregnancy (tubal pregnancy)! You must be tested for pregnancy immediately, and you should be evaluated by a doctor!

If you are not pregnant, it is also possible that your pain is coming from an ovarian cyst. Because a cyst in the ovary can create a shift in your hormone levels, it may affect the timing of your menses.

Your symptoms are very suggestive for inflammation or irritation within the colon. Your doctor may suspect that an infection is the source of this inflammation (such as salmonella, shigella, or antibiotic-associated diarrhea, which is an infection with Clostridium difficile bacteria) or your doctor may suspect an autoimmune source of inflammation. In the autoimmune conditions "Crohn's disease" and "ulcerative colitis," your immune system attacks your own bowel, causing inflammation.

If you have mucus but no blood in your stools, it is also possible that you are experiencing an "irritable bowel."

A fever would make our suspicion high that you have an infection involving your large intestine (colon).

Do you have a fever?

Yes, I have a fever.

No, I don't have a fever.

A fever would be concerning for an infection in your chest or spleen.

Are you having a fever?

Yes, I have a fever.

No, I do not have a fever.

The upper abdomen is a common location for the skin rash of "shingles" (varicella zoster infection).

Do you have a red or blistering rash in the area of your pain?

Yes, I also have a rash.

No, I do not have a rash.

It is reassuring that you do not have a fever or a rash. Several problems can result in strong pain in the left upper abdomen. Without a fever or a rash, the most likely explanations are gas, a problem in or around the lung, indigestion, irritation or an ulcer within the stomach, an injury within the spleen, or inflammation in the pancreas (pancreatitis).

Since the chest is adjacent to the diaphragm, pain from an infection in the chest may be felt within the upper abdomen. Symptoms that are typical for a chest infection would cause us to suspect pneumonia or another lung infection.

Are you experiencing a new productive cough?

Yes, I recently developed a cough.

No, I do not have a cough.

Your abdominal pain may be from a serious infection, and you should be evaluated by your doctor today.

When you have pain in the upper abdomen with fever, some of the most concerning possible explanations are pneumonia, fluid surrounding the lung (pleural effusion), pancreatitis, or an abscess in the spleen or nearby in the abdomen.

Several viral infections can cause enlargement of your spleen, and this can result in abdominal pain in the left upper abdomen. The most common infection that causes the spleen to enlarge is the viral infection mononucleosis, and this infection usually also causes an extremely sore throat.

The upper abdomen is a common location for the skin rash of "shingles" (varicella zoster infection, also called herpes zoster). This infection can cause pain and a low-grade fever.

A common viral infection in the stomach ("gastroenteritis") can also cause pain in this area.

Your abdominal pain may be from a serious infection, and you should be evaluated by your doctor today.

Your symptoms may be caused by an infection in the lung (pneumonia). Alternatively, you may have an infection surrounding the lung. When fluid or infection collects around the lung, the fluid is called a "pleural effusion."

We can divide the right side of the abdomen into three regions.

Where is your pain the most intense?

Soft upper belly area beneath your ribs

Muscular area at the side of your abdomen (your flank)

Your lower abdomen

One dangerous diagnosis that must be considered when you have pain in the right lower abdomen is appendicitis.

We would like you to consider a special pattern of pain that appendicitis can cause. If you have an infected appendix, you are likely to first feel pain symptoms near your navel. Later on, it is typical for the pain to relocate to the right lower abdomen. Fever is common but may not occur in the early stages of the infection.

Did your pain begin in the center of your abdomen, moving to your right lower abdomen sometime later?

Yes, this describes my pain.

No, this does not describe my pain.

A fever would also be concerning, since it would suggest you might have an infection in your abdomen or pelvis.

Do you have a fever?

Yes, I have a fever.

No, I do not have a fever.

Your symptoms are suggestive for appendicitis!

Appendicitis is not the only thing that can cause pain in this area. Pelvic organs can cause symptoms in the lower abdomen, so it is important to know your gender to consider other diagnoses that could explain your pain and fever.

Are you a man or a woman?

I am a man.

I am a woman.

Since you are a man, appendicitis is the most likely cause of pain in the right lower abdomen along with fever. Seek an urgent evaluation by your doctor.

Appendicitis is the most dangerous cause of a fever and right-sided lower abdominal pain, but other causes may be considered.

Inflammatory bowel disease (such as "Crohn's disease") can cause inflammation in an area of bowel that is close to the appendix, and it can also result in a fever.

An abscess can occur anywhere in the abdomen. An abscess could also explain your symptoms.

Your symptoms could also come from "colitis," an infection or inflammation of the colon.

One common cause of colitis is an infection that can develop following antibiotic treatment. Infections from contaminated food, such as salmonella, shigella, or campylobacter can cause similar symptoms.

Your symptoms are suggestive for a serious infection! Seek an urgent evaluation by your doctor.

You may have appendicitis.

You may have an infection in your uterus and fallopian tubes, called "pelvic inflammatory disease." If you have had sex without a condom with someone who could carry a sexually transmitted disease, this is a serious concern. This type of infection can threaten your fertility if it is not treated promptly.

Infection is the most dangerous cause of a fever and right-sided lower abdominal pain, but other causes may be considered. Inflammatory bowel disease (such as "Crohn's disease") can cause inflammation in an area of bowel that is close to the appendix, and it can also result in a fever.

An abscess can occur anywhere in the abdomen. An abscess could also explain your symptoms.

Your symptoms could also come from "colitis," an infection or inflammation of the colon.

One common cause of colitis is an infection that can develop following antibiotic treatment. Infections from contaminated food, such as salmonella, shigella, or campylobacter can cause similar symptoms.

If your pain is arising from inflammation within your large intestine (colon), then we would expect to see some changes in your stool.

Have you noticed a change in your stools so that they now contain mucus or blood?

Yes, this describes my symptoms.

No, this does not describe my symptoms.

It is reassuring that you have not noticed these stool changes.

Pain in this area can arise from the reproductive organs, so it is important to know whether you are a man or a woman.

Are you a man or a woman?

I am a man.

I am a woman.

One common cause of pain in this area is a hernia. A hernia is a bulge of intestine that protrudes through a gap in the muscles and other tissues that line the abdominal wall. If you have a hernia, you may have noticed that your symptoms feel strongest when you cough, strain, or sneeze.

Have you noticed a bulge in your groin, or have you noticed a sharp increase in your pain when you cough, strain, or sneeze?

Yes, I have a bulge or I have these pain triggers.

No, I have not noticed these symptoms.

Thank you for answering our questions.

The problems that are most likely to explain your discomfort are constipation, gas, or an irritable bowel. Since there are serious medical conditions that can cause pain in the right lower abdomen, including appendicitis, you should be evaluated by a doctor.

There are several conditions that could explain your pain, but your history is particularly suggestive for a hernia. Hernias that cause pain in the lower abdomen protrude through a ligament named the inguinal ligament. For this reason, they are called "inguinal hernias."

If your menses are not regular, this would suggest that your pain is arising from an interruption of normal ovulation or from pregnancy.

Are you having a delay or change in your menstrual bleeding?

Yes, I am experiencing a change in my menstrual bleeding.

No, I have had no change in my menstrual bleeding.

This does not apply, I am past menopause.

Thank you for answering our questions.

The problems that are most likely to explain your discomfort are constipation, gas, or an irritable bowel. Appendicitis is also a possibility. Because severe abdominal pain can come from a serious medical problem such as an infection, you should be examined by your doctor.

An infection in the pelvic organs could cause pain in this area. If you have had sex without a condom with someone who could carry a sexually transmitted disease, this is a serious concern.

Are you having a new discharge from your vagina, or have you had sex without a condom with a high-risk partner?

Yes, one or both applies to me.

No, this does not apply to me.

Ovulation (the release of an egg from your ovary) is a normal event that can cause pain on either side of the lower abdomen. If your menstrual cycles are timed to occur every 28 days, as is the case with most women, ovulation should occur about 14 days after the first day of bleeding from each period.

Is your pain occurring roughly two weeks from the date that your last period began?

Yes, this describes my situation.

No, this does not describe my symptoms.

It is common for women to experience lower abdominal pain during their menstrual period.

Is your pain occurring just before your menses or during the first several days of your menses?

Yes, this describes my pain.

No, this does not describe my pain.

Thank you for answering our questions.

The problems that are most likely to explain your discomfort are constipation, gas, an irritable bowel, or a problem involving one of your ovaries, such as an ovarian cyst. Since there are serious medical conditions that can cause pain in the right lower abdomen, including appendicitis, you should be evaluated by a doctor.

It is very likely that your pain is caused by normal menstruation. The symptom of pain with menstruation is named "dysmenorrhea." Usually, nonsteroidal anti-inflammatory pain medicines such as ibuprofen are very helpful.

Another problem that can cause pain before or during menses is "endometriosis." Endometriosis occurs when endometrial tissue (tissue that is normally found lining the inside of the uterus) is present in the pelvis or abdomen outside of the uterus. Endometrial tissue can ooze blood at the time of your menses, wherever this tissue is located.

It is also possible that your pain is coming from an ovarian cyst. Cysts can cause pain if they swell, if they rupture, or if they become infected.

If your pain is severe, if it persists for longer than a day, or if you develop fever or nausea along with your pain, then you should be evaluated by a doctor to make sure it is not from a more serious problem, such as appendicitis.

Since this is such a common symptom and since your timing is right, you are probably experiencing pain from normal ovulation. This pain is called by the medical name "mittelschmerz."

If your pain is severe, if it persists for longer than a day, or if you develop fever or nausea along with your pain, then you should be evaluated by a doctor to make sure it is not from a more serious problem, such as appendicitis.

Since you are having pain and a delay in your menses, it is possible that you have the dangerous problem of an ectopic pregnancy (tubal pregnancy)! You must be evaluated by a doctor and be tested for pregnancy immediately!

If you are not pregnant, it is also possible that your pain is coming from an ovarian cyst. Because a cyst in the ovary can create a shift in your hormone levels, it may affect the timing of your menses.

Your symptoms are very suggestive for inflammation or irritation within the colon. Your doctor may consider infections as a source of this inflammation (such as salmonella, shigella, or antibiotic-associated diarrhea, which is an infection with Clostridium difficile bacteria) or your doctor may suspect an autoimmune source of inflammation. In the autoimmune condition "Crohn's disease," your immune system attacks your own bowel, causing inflammation.

If you have mucus but no blood in your stools, it is also possible that you are experiencing an "irritable bowel."

Your symptoms are suggestive for appendicitis! Seek an urgent evaluation by your doctor.

Pain in the flank can come from the kidneys or ureters. If your pain is coming from one of these structures, your urine may provide a hint. Blood in the urine can change the urine color.

Do you have a pink or brown color to your urine?

Yes, this is true for me.

No, this is not true for me.

Infection in the urine can cause symptoms with urination.

Do you have pain with urination or an unusually frequent or urgent need to urinate?

Yes, this describes my symptoms.

No, this is not true for me.

The flank is a common location for the skin rash of "shingles" (Varicella zoster infection).

Do you have a red or blistering rash in the area of your pain?

Yes, I also have a rash.

No, I do not have a rash.

It is common for pain from the vertebrae in your spine to extend around your flank. This phenomenon is called "referred pain," since the structure causing the pain is not located in the immediate vicinity of the most obvious discomfort. The spine problem that most typically causes pain in the flank is a vertebral fracture. We should know if you are at high risk for a vertebral fracture.

Have you had recent trauma to your back, do you have thin bones (osteoporosis), or are you a woman who is older than 65?

Yes, this describes me.

No, this does not describe my situation.

Thank you for answering our questions.

It will not be possible to identify the most likely cause of your pain without a doctor's evaluation. Several explanations are possible. The most common conditions that result in pain in your flank are a kidney infection or kidney stone, a muscle strain, and a vertebral (spine) fracture caused by osteoporosis.

Your symptoms are concerning since you have suggested you may be at risk for a vertebral spine fracture. You should discuss your symptoms with your doctor so that an x-ray can be obtained.

Your urinary symptoms suggest a kidney infection. A kidney infection requires antibiotic treatment, so you should be evaluated by a doctor right away!

Your urine may contain blood, a sign that you might have a kidney infection or a kidney stone. A kidney infection requires antibiotic treatment, so you should be evaluated by a doctor right away!

The largest and most important structure underneath your right ribs is the liver. The liver has many jobs, and one of them is to clear the yellow pigment "bilirubin" out of your system. If the liver's function or liver's drainage system is not normal, you may accumulate this colorful pigment in your body and skin.

Is your skin or are your eyes becoming abnormally yellow?

Yes, my skin or eyes are yellow.

No, my skin or eyes are not yellow.

A fever would be concerning for an infection in your chest, liver, bile ducts or gallbladder.

Are you having a fever?

Yes, I have a fever.

No, I do not have a fever.

The upper abdomen is a common location for the skin rash of "shingles" (Varicella zoster infection).

Do you have a red or blistering rash in the area of your pain?

Yes, I also have a rash.

No, I do not have a rash.

It is reassuring that you do not have a fever. Several problems can result in strong pain in the right upper abdomen. Without a fever or a rash, the most likely problems are indigestion, peptic ulcer, gallstones, hepatitis, or pancreatitis.

Your pain may be caused by viral infection with the varicella zoster virus (herpes zoster, "shingles").

Since the chest is adjacent to the diaphragm, pain from an infection in the chest may be felt within the upper abdomen. Symptoms that are typical for a chest infection would cause us to suspect pneumonia or another lung infection.

Are you experiencing a new productive cough?

Yes, I recently developed a cough.

No, I do not have a cough.

There are several dangerous infections that may be causing your pain. Two possibilities include an infection of the liver ("hepatitis") and an infection of the gallbladder ("cholecystitis"). You should be evaluated by a doctor immediately.

The upper abdomen is also a common location for the painful skin rash of "shingles" (Varicella zoster infection). This infection can sometimes cause a low-grade fever.

Your symptoms may be caused by an infection in the lung ("pneumonia"). Alternatively, you may have an infection surrounding the lung. When fluid or infection collects around the lung, the fluid is called a "pleural effusion."

Your symptoms are suggestive for an infection or other problem in your liver that is putting you in significant danger! Seek urgent care today!

Important infections in the liver include hepatitis (infection or inflammation of the liver) and cholangitis (infection in the bile ducts that drain the liver).

The nerves that detect pain within your entire intestine (stomach, small and large intestine, and rectum) were originally "wired" to the midline of your abdomen. As your intestines lengthened and twisted, they spread out across a much larger area. Nonetheless, all areas of your intestine retain nerve connections to your midline, and pain from every area of your intestine can be felt in your midline. You may also feel pain in your midline from a solid organ that is centrally located. To further narrow down the various body organs that may be the source of your pain, please continue.

Going from the top of your abdomen to its bottom, please select the place you feel your pain the most strongly:

Upper abdomen (your stomach area)

Middle abdomen (in the vicinity of your navel)

Lower abdomen (above your pubic bone)

Pain low in the abdomen can arise from the bladder, the colon, the rectum, or pelvic organs. If your pain is coming from your bladder, you almost certainly would have other symptoms that are suggestive for bladder irritation.

Do you have pain with urination, a pink or brown color to your urine, or an unusually frequent or urgent need to urinate?

Yes, I have one or more of these symptoms.

No, I do not.

Since the pelvic organs can be the cause of pain in this location (particularly for women), your gender is relevant.

Are you a man or a woman?

I am a man.

I am a woman.

An infection in the pelvic organs could cause pain in this area. If you have had sex without a condom with someone who could carry a sexually transmitted disease, this is a serious concern.

Are you having a new discharge from your vagina, or have you had sex without a condom with a high-risk partner?

Yes, one or both applies to me.

No, this does not apply to me.

You do not have a high risk for a pelvic infection, so a fever would suggest an infection that involves a part of your colon.

If you have a fever, it would make an infection that involves a part of your colon a likely possibility.

Do you have a fever?

Yes, I have a fever.

No, I do not have a fever.

It is common for women to experience lower abdominal pain during their menstrual period.

Is your pain occurring just before your menses or during the first several days of your menses?

Yes

No

The problems that are most likely to explain your discomfort are constipation, gas, or an irritable bowel.

It is very likely that your pain is caused by normal menstruation. The symptom of pain with menstruation is named "dysmenorrhea." Usually, nonsteroidal anti-inflammatory pain medicines such as ibuprofen are very helpful.

Another problem that can cause pain before or during menses is "endometriosis." Endometriosis occurs when endometrial tissue (tissue that is normally found lining the inside of the uterus) is present in the pelvis or abdomen outside of the uterus. Endometrial tissue can ooze blood at the time of your menses, wherever this tissue is located.

You may have an infection in your uterus and fallopian tubes, called "pelvic inflammatory disease." This type of infection can threaten your fertility if it is not treated promptly. You should seek an urgent evaluation.

A fever would make our suspicion high that you have an infection involving a part of your colon.

Do you have a fever?

Yes, I have a fever.

No, I do not have a fever.

Your lower abdominal pain is less likely to be caused by an infection since you do not have a fever. However, it is still possible that you have "diverticulitis."

If your pain is not from diverticular disease (with or without infection), then it might be caused by constipation, gas, or an irritable bowel.

If a large part of your colon is involved, you are likely to have diarrhea along with your other symptoms.

Are you having diarrhea?

Yes, I have diarrhea.

No, I do not have diarrhea.

When diarrhea is not a prominent symptom, fever and pain in the lower abdomen can be signs of the serious infection, "diverticulitis." You should have your symptoms evaluated by a doctor right away.

Changes in the colon that occur with age (particularly if you have a history of constipation) can predispose you to infection. Many adults form "diverticuli" as they age, which are hollow tubular bulges that branch from the colon lining. These pockets can accumulate bacteria and can cause symptoms much like appendicitis. Between episodes of infection, diverticuli can be asymptomatic, or they may cause pain or brisk bleeding.

Your symptoms are most consistent with "colitis," an infection or inflammation of the colon.

One common cause of colitis is an infection that can develop following antibiotic treatment. Infections from contaminated food, such as salmonella, shigella, or campylobacter can cause similar symptoms.

It is also possible for an autoimmune condition to result in colitis. Autoimmune problems that cause colitis include Crohn's disease and ulcerative colitis.

You may find more helpful information by visiting our Diarrhea Decision Guide.

Your symptoms make it probable that your abdominal pain is arising from a bladder infection or other problem in your urinary tract. A urine test can confirm that you have a bladder infection.

The area close to your navel is called the periumbilical region. Pain felt in this location can come from any part of your small intestine, even if it is from an area of intestine (such as your appendix) that is not centrally located. Pain in this location can also come from structures that are centrally located, such as your largest artery (the aorta) or your pancreas.

A fever would make our suspicion high that you have an infection involving part or all of your small intestine.

Do you have a fever?

Yes, I have a fever.

No, I do not have a fever.

It is reassuring that you do not have a fever, although it does not eliminate the possibility that you have an infection as the cause of your pain.

Our suspicion that your symptoms are coming from part or all of the small intestine will be stronger if you are having nausea or vomiting. Nausea and vomiting are common symptoms that can result from small bowel irritation.

Are you having nausea or vomiting?

Yes, I have these symptoms.

No, I am not nauseated or vomiting.

The vast majority of problems that result in periumbilical pain are associated with the digestive tract. One important condition is not, and that is an expansion (aneurysm) of the large artery in the abdomen, your aorta. This artery can become deformed and can cause symptoms if it is affected by atherosclerosis (artery disease). Disease of the aorta should be considered if you are high risk for atherosclerosis:

Do you have a history of heart disease, stroke, aortic aneurysm, or other artery disease

or

Are you over 50 years old

or

Do you have high blood pressure, high cholesterol, or a smoking history?

Yes, I have one of these risks.

No, I am at low risk for artery disease.

Fortunately, you do not report some of the symptoms that are most worrisome when they occur with periumbilical abdominal pain. It is very likely that your symptoms are arising from irritation of your small bowel. Many problems that can result in your symptom are non-threatening and self-limited. However, it is possible that you are having the first symptoms of a more serious illness. Please watch your symptoms closely and consult your doctor right away if you develop a fever, pain in the right side of your abdomen, or vomiting.

Since you are at increased risk for problems in the aorta, please answer the following question:

Do you have pain that may be described as "throbbing" in nature?

Yes, I have throbbing pain.

No, I do not have throbbing pain.

Fortunately, you do not report some of the symptoms that are most worrisome when they occur with periumbilical abdominal pain. It is very likely that your symptoms are arising from irritation of your small bowel. Many problems that can result in your symptom are non-threatening and self-limited. However, it is possible that you are having the first symptoms of a more serious illness. Please watch your symptoms closely and consult your doctor right away if you develop a fever, pain in the right side of your abdomen, or vomiting.

It is uncommon for an aortic aneurysm to cause symptoms unless it is expanding its size rapidly or developing another irregularity. Proceed with immediate medical evaluation to consider the diagnosis of aortic aneurysm, particularly if a digestive source of your symptoms cannot be confirmed.

Nausea or vomiting and pain in the periumbilical area are both symptoms that commonly occur during the early stages of appendicitis or during a bowel obstruction. You should have your symptoms evaluated by a doctor today.

If you have an infected appendix, you are likely to first feel pain symptoms near to your navel. Later on, it is typical for the pain to relocate to the right lower abdomen. Fever is common but may not occur in the early stages of the infection.

If you also have a feeling of bloating or fullness, it is possible that your symptoms are the result of a bowel obstruction. This is particularly likely if you have ever had abdominal surgery in your past, since scarring that is left after surgery can predispose you to developing a blocked intestine.

A very common illness that can result in your symptoms of periumbilical pain and vomiting or nausea is the viral infection, gastroenteritis. Diarrhea or a recent exposure to someone else with the illness would suggest this diagnosis.

Finally, pancreatitis or hernias can cause you to experience the pain in this area. Nausea or vomiting can accompany these illnesses.

Fever and pain in the periumbilical area are both symptoms that occur during the early stages of appendicitis. You should have your symptoms evaluated by a doctor right away.

If you have an infected appendix, you are likely to first feel pain symptoms near your navel. Later on, it is typical for the pain to relocate to the right lower abdomen. Fever is common but may not occur in the early stages of the infection.

A more common and less serious infection that can cause pain in the periumbilical area is the viral infection, "gastroenteritis." Diarrhea or a recent exposure to someone else with the illness would suggest this diagnosis.

Pancreatitis usually causes pain higher than the navel, but it is possible to experience the pain in the navel area in some cases. Fever can accompany this illness.

This area of the abdomen is called the "epigastric" area because it is where your stomach is located. In this area, you can feel pain that arises from one of the following organs:

• heart

• esophagus

• stomach

• duodenum (part of your small intestine)

• pancreas

• aorta.

In order to narrow down our list, it will be helpful to know the character of your pain. If your pain feels like a burn or feels like it is gnawing, then it is probably from one of the organs on this list that is exposed to digestive acid.

What does your pain feel like?

My pain is burning or gnawing.

My pain is aching, sharp, crampy, heavy, squeezing, or dull.

Your pain is much less likely to be caused by an acid-related problem, since it is not burning or gnawing in its character. This removes several common diagnoses from our list.

Some specific illnesses that cause pain in the upper abdomen are associated with a fever. Have you had a fever?

Yes, I have had a fever.

No, I have not had a fever.

Next, the depth of your pain may be helpful information. Structures that are located close to the back of your abdomen commonly cause pain that you feel all the way to your back.

How deep is your abdominal pain?

My pain goes all the way to my back.

My pain isn't deep enough to be felt in my back.

Two structures that can cause upper abdominal pain are located within your chest, and these organs usually cause chest pain as well. These organs are your heart and your esophagus.

Does your abdominal pain extend upward into your chest?

Yes, my pain extends into my chest.

No, I do not have any chest pain.

Occasionally, a change in your position can change pain in the upper abdomen significantly. If your pain is sensitive to your positions, this can come from a collection of fluid (which may aggravate your pain as it shifts) or it may come from an organ that is sensitive to the weight of other surrounding structures. The most important position change for you to consider is the transition between sitting up (bent forward) and lying down flat.

Does your pain feel better when you are sitting up (bent forward) and worse when you are lying flat?

Yes, my pain is more tolerable when I am sitting up.

My pain does not change with my position.

You have not identified very specific features of your upper abdominal pain that can help to narrow the list of possible sources. Your doctor will probably begin by considering the most common problems that result in abdominal pain in this area and will select tests that can provide more information.

You have identified that you are sensitive to a change in your position. This may lead your doctor to consider one or more of the diagnoses below:

The esophagus can occasionally cause pain that is heavy or aching, even though its usual symptom is heartburn (burning pain). Acid reflux should be considered as a possible diagnosis since your symptoms are worse when you lie flat. Acid can enter the esophagus more easily in this position.

Pancreatitis is less painful when you sit up or sit forward. When it is inflamed, your pancreas is very sensitive to the weight of surrounding structures. Your pancreas is located in the back of your abdomen. When you lean forward, you take the weight of overlying structures such as your stomach and intestines off of your pancreas.

Irritation of a protective sack that surrounds your heart (called the pericardium) can result in fluid accumulation around the heart. Pericarditis is least painful when you lean forward.

Several other problems -- an ulcer in the stomach or duodenum or gallstone disease -- can also be more painful when you lie down at night. For these conditions the increase in pain is not related to your position at all; rather, it is related to timing. The time that you lie down in the evening is two or three hours after the evening meal for most people. At this stage in your digestion, there is a large amount of digestive acid in your stomach and duodenum but not very much mucus. Acid can therefore become very irritating to any open sore (ulcer) located along the wall of these structures. Gallstones are most symptomatic at night because the gallbladder squeezes most forcefully several hours after a large meal.

Because you have chest pain with it, it is most likely that your abdominal pain is coming from your heart or your esophagus.

Your pain may be a symptom of a heart attack! If you think you could be having a heart attack, you should chew an aspirin tablet if one is available and seek emergency care immediately!

Common symptoms that accompany the pain of a heart attack include nausea, shortness of breath, sweating, and arm or neck symptoms.

If you are not having symptoms from heart disease, it is likely you are experiencing heartburn from gastroesophageal reflux disease, or GERD.

Two structures in your upper abdomen's midline are quite close to your back. They can give you abdominal pain and back pain all at once. They are the pancreas and, less commonly, the aorta (your largest artery). Because of your pain in the back, your doctor will consider inflammation in the pancreas (pancreatitis) as one possible diagnosis and may choose to evaluate you with an imaging test that can view the pancreas well, such as a computed tomography scan (CT scan).

When a fever accompanies upper abdominal pain, it is more often than not the result of a non-threatening, self-limited viral infection (gastroenteritis).

Other illnesses (some serious) will need to be considered. Fever and new abdominal pain together make it important for you to have a medical evaluation.

You have identified that your pain is burning or gnawing in its nature. This probably means that it is coming from your esophagus, your stomach, or your duodenum (all structures that are exposed to stomach acid), or from your gallbladder. These organs each cause symptoms at predictable times during your digestion process. Sometimes, a relationship to your meal time can help your doctor to guess at the cause of your pain.

Your pain may be affected by eating. Please make a selection below:

I feel better right after I eat.

I feel worse right after I eat.

I can't eat or I don't notice a change with food.

It is difficult to separate out which of the abdominal structures is most likely to be the cause of your pain, although it was very helpful that you were able to locate the center of your pain as precisely as you did. The most common diagnoses that will be considered include those that affect your esophagus, your stomach, your duodenum, and your gallbladder.

Your burning or gnawing pain is worsened when you eat food. Although you generate a lot of acid during your meals, it is also a time that the stomach coats itself very generously with protective mucus. The stomach tends to feel less acid-associated pain right after eating, because of the large amount of soothing mucus that it creates. The mucus can also protect the first few inches of your small intestine, the duodenum. Acid, but not much mucus, tends to reflux up into the esophagus most vigorously when the stomach is full. Since you have pain right after you eat, it is likely that your pain is coming from the esophagus. It can also come from a stomach that is sensitive to stretching. It is less likely to come from acid irritation in the stomach.

Another common condition that can be more painful after eating is gallstone disease. It can cause pain where you are having symptoms. Gallstones are usually diagnosed by an ultrasound test.

Your burning or gnawing pain is improved when you eat food. Although you generate a lot of acid during your meals, it is also a time that the stomach coats itself very generously with protective mucus. The stomach tends to feel less acid-associated pain right after eating, because of the large amount of soothing mucus that it creates. The mucus can also protect the first few inches of your small intestine, the duodenum. It is likely that your pain is coming from a problem in the stomach or duodenum, such as an ulcer (peptic ulcer) or inflammation (gastritis). These problems commonly cause delayed pain several hours after a meal (when the mucus thins), even though they feel better immediately after a meal.