Stomach pain: causes, when to worry and help by video

Almost everyone gets belly pain now and then, and most of the time it is not serious. How the pain feels gives clues to the cause:

• All over the belly: more typical of a stomach virus, indigestion or gas.
• In one spot: may come from a specific organ, such as the appendix or the gallbladder.
• Cramp-like: usually not serious and often followed by diarrhea.
• Colicky, coming in waves: often starts and ends suddenly and is severe, as with kidney stones or gallstones.

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The table on this page sums up the most common causes. The less serious ones are gas and indigestion, a stomach bug or food poisoning, constipation, irritable bowel syndrome, gastritis and reflux. More serious causes include appendicitis, a bowel blockage, pancreatitis, kidney stones and a pregnancy outside the womb (ectopic pregnancy).

More clues: if the pain comes with feeling sick to your stomach, read nausea. If you are traveling and have cramps with diarrhea, it may be traveler’s diarrhea. If it started 3 to 6 hours after eating reef fish such as barracuda or grouper, think of ciguatera. And cramping in the lower belly during your period is usually period cramps.

Dengue is present in Puerto Rico. If you have had a fever in the last few days and now your belly hurts or is tender to the touch, that is a warning sign of severe dengue, especially if you vomit 3 or more times in 24 hours or bleed from the nose or gums. It often appears as the fever goes down. Go to the ER right away and read the dengue warning signs.

In children, belly pain usually comes from a virus, constipation or gas. If there is diarrhea or vomiting, see diarrhea and vomiting in children. The doctor evaluates your child by video with you on camera; patients under 21 need a parent or legal guardian on camera with ID.

For safety, go to the ER if your child has severe pain in the lower right belly, green or bloody vomit, cannot keep fluids down, is peeing very little, is very listless or hard to wake, or is a boy with sudden pain or swelling in a testicle.

Severe pain that starts and stops suddenly in the side of the back or the belly, and moves down toward the groin, may be a kidney stone. It can come with blood in the urine, nausea and vomiting. Stones are confirmed with imaging done in person: if the doctor suspects one, she refers you to where to go. Go to the ER if the pain is not controlled, or if it comes with fever and chills or vomiting. See also blood in urine.

For mild pain without warning signs:

• Sip water or other clear fluids.
• Avoid solid food for the first few hours.
• If you vomited, wait about 6 hours, then eat small amounts of mild food such as rice or applesauce.
• If the pain comes after meals, an antacid may help.
• Do not take pain medicine without checking first.
• Get checked if the pain lasts more than a week, does not improve within 24 to 48 hours or gets worse, or comes with fever, diarrhea that does not go away, or unexplained weight loss.

For your safety, do not wait for a video visit: call 911 or go to the ER if you have any of these signs. See when to go to the ER.

• Sudden, severe pain, or a hard, rigid belly that is tender to the touch
• Pain that starts around the belly button and moves to the lower right belly
• You cannot pass stool, especially if you are also vomiting
• Vomiting blood, or red or black blood in the stool
• Belly pain and you are or could be pregnant
• Pain that started after an injury to the belly
• Pain in the chest, neck or shoulders, or trouble breathing