Patient information · Gastroenterology
Abdominal pain
where it hurts narrows it down considerably
Abdominal pain covers everything from trapped wind to a surgical emergency. Location, timing and what makes it better or worse usually narrow it down quickly — and there is a short list of features that mean it needs assessing today rather than waiting to see.
Call 999 or go to an emergency department if pain is
- severe and sudden, or the worst you have experienced
- with a rigid, board-like abdomen, or pain on the slightest movement
- with vomiting blood, or black tarry stools
- with collapse, dizziness or a racing heart
- with a swollen, tender abdomen and not passing wind or stool
- in pregnancy, or with a positive pregnancy test
- with testicular pain in a boy or man — torsion is a four-hour emergency
Sudden severe abdominal or back pain in an older adult, particularly with collapse, may be a ruptured aortic aneurysm. Pain with a positive pregnancy test may be ectopic. Both are immediately life-threatening. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
What the location suggests
- Upper right — gallbladder, liver. Pain after fatty meals, radiating to the right shoulder blade.
- Upper middle — stomach, duodenum, pancreas. Burning suggests ulcer or reflux; boring through to the back suggests pancreas.
- Upper left — stomach, spleen, pancreas.
- Around the navel — small bowel; early appendicitis, before the pain shifts.
- Lower right — appendix, ovary, bowel. Pain moving from the navel to the lower right over hours is classic appendicitis.
- Lower left — diverticular disease, bowel, ovary.
- Loin to groin — kidney stone. Severe, colicky, and the person cannot keep still.
- Lower middle — bladder, uterus, prostate.
How you behave with the pain is diagnostic
People with peritonitis — inflammation of the abdominal lining, as in a perforation or advanced appendicitis — lie completely still, because any movement hurts. People with colic — a kidney stone or bowel obstruction — cannot keep still and roll about looking for a comfortable position. Clinicians notice this before anything else, and it is worth mentioning which describes you.
Features that need same-day assessment
- pain that is getting steadily worse over hours
- pain with fever, or with persistent vomiting
- pain that wakes you from sleep
- pain with unexplained weight loss or a change in bowel habit
- pain in someone over 50 with new symptoms, or who is immunosuppressed
- any pain in pregnancy
The common non-urgent causes
- Irritable bowel syndrome — cramping relieved by opening the bowels, with bloating and altered habit
- Constipation — very common and often overlooked
- Reflux and indigestion
- Period-related pain and endometriosis
- Muscular pain, and abdominal wall causes — pain that is worse when you tense the abdominal muscles is usually the wall, not the contents
- Urine infection, and lactose or other food intolerance
What investigation involves
- Examination, which does most of the work
- Urine test, and a pregnancy test in any woman of reproductive age
- Blood tests — full blood count, inflammatory markers, liver and kidney function, amylase, coeliac screening
- Stool tests — calprotectin and FIT where relevant
- Ultrasound — first-line for gallbladder, kidneys, liver and pelvis
- CT or endoscopy where indicated by the findings
Why come to us. Abdominal pain needs examining, and the useful tests are quick if they are available in the same building. We see you the same day, examine you properly, and take bloods, urine and stool tests in-house with results explained in the same visit, plus ultrasound performed on site. CT and endoscopy are arranged rapidly through our CQC-registered partners. If it is something needing emergency surgery, we will tell you straight away and get you there.
Examined, scanned and tested the same day
Ultrasound on site, bloods in-house. Seven days a week, 9am–7pm.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.