Abdominal pain, discomfort anywhere between the chest and groin, is one of the most common symptoms people experience. It can range from the mild cramping of gas or indigestion to the severe, sudden pain of appendicitis or kidney stones. Location, character (sharp, dull, cramping), duration, and associated symptoms all help healthcare providers narrow down the cause. This guide covers the most common causes organized by their typical presentation.

1. Gas and Bloating

What it is: Accumulation of gas in the digestive tract, causing cramping, distension, and discomfort.

Why it happens: Gas is produced naturally by digestion and bacterial fermentation of food in the colon. Swallowed air, high-fiber foods, carbonated beverages, and food intolerances can increase gas production or sensitivity.

Common symptoms: Cramping or sharp pains that come and go; bloating; belching or passing gas; discomfort that often improves after passing gas or having a bowel movement.

Risk factors: High-fiber diet, carbonated drinks, eating quickly, certain foods (beans, cruciferous vegetables, dairy in lactose-intolerant individuals).

When to seek evaluation: Gas pain is generally benign. If bloating and cramping are persistent or accompanied by changes in bowel habits, blood in the stool, or weight loss, evaluation is warranted.

2. Irritable Bowel Syndrome (IBS)

What it is: A functional gastrointestinal disorder causing chronic abdominal pain and changes in bowel habits without an identifiable structural abnormality.

Why it happens: The exact cause is not fully understood, but IBS involves abnormal gut-brain interaction, heightened intestinal sensitivity, and altered gut motility. Triggers include stress, certain foods, hormonal changes, and gut infections.

Common symptoms: Recurrent abdominal cramping or pain, often relieved by having a bowel movement; alternating diarrhea and constipation, or predominantly one; bloating; mucus in the stool; symptoms often flare with stress.

Risk factors: Female sex, age under 50, history of GI infections, anxiety or depression, family history of IBS.

When to seek evaluation: IBS is diagnosed clinically after ruling out other conditions. A provider should evaluate persistent abdominal symptoms to exclude inflammatory bowel disease, celiac disease, or colorectal cancer.

3. Gastroesophageal Reflux Disease (GERD) and Indigestion

What it is: Upper abdominal discomfort caused by acid reflux or difficulty digesting food.

Why it happens: Stomach acid escaping back into the esophagus causes burning and upper abdominal pain. Indigestion (dyspepsia) may involve pain or discomfort in the upper abdomen related to meals, often without true reflux.

Common symptoms: Burning or aching in the upper abdomen or chest; worse after meals, when lying down, or bending over; sour taste in the mouth; belching.

Risk factors: Obesity, pregnancy, spicy or fatty foods, alcohol, smoking, eating large meals.

When to seek evaluation: Upper abdominal pain that is severe or persistent, or comes with difficulty swallowing or unintentional weight loss, should be evaluated promptly. Vomiting blood is an emergency, so call 911 or go to the emergency room.

4. Appendicitis

What it is: Inflammation of the appendix, a small finger-shaped pouch attached to the large intestine in the lower right abdomen, which can become life-threatening if the appendix ruptures.

Why it happens: Usually caused by a blockage (from stool, foreign body, or infection) leading to bacterial overgrowth and inflammation within the appendix.

Common symptoms: Pain that typically begins around the navel and migrates to the lower right abdomen over 12-24 hours; pain worsens with movement; nausea, vomiting, low-grade fever; loss of appetite.

Risk factors: Most common in ages 10-30, but can affect any age.

When to seek evaluation: Suspected appendicitis is a surgical emergency. Call 911 or go to the emergency room immediately for progressively worsening lower right abdominal pain, especially with fever and nausea.

5. Kidney Stones

What it is: Hard mineral deposits that form in the kidneys and can cause intense pain as they move through the urinary tract.

Why it happens: Concentrated urine allows minerals (most commonly calcium oxalate) to crystallize and grow. Small stones may pass on their own; larger stones can obstruct the ureter, causing severe pain.

Common symptoms: Severe, cramping pain in the flank (side, between the ribs and hip), often radiating to the lower abdomen or groin; pain may come in waves; nausea; blood in urine; painful urination.

Risk factors: Family or personal history of kidney stones, chronic dehydration, high-sodium or high-oxalate diet, obesity, certain metabolic conditions.

When to seek evaluation: Severe flank pain should be evaluated. Call 911 or go to the emergency room immediately if kidney-stone pain comes with fever and chills, inability to urinate, or persistent vomiting, a stone blocking the flow of urine can cause a serious infection (sepsis) that needs emergency treatment.

6. Gallstones and Gallbladder Disease

What it is: Solid particles (gallstones) that form in the gallbladder and can cause episodes of upper right abdominal pain, particularly after fatty meals.

Why it happens: Gallstones form when bile contains too much cholesterol or bilirubin, or when the gallbladder doesn't empty properly. They may be silent or cause biliary colic, pain when a stone temporarily obstructs the bile duct.

Common symptoms: Steady, severe pain in the upper right or center abdomen lasting 20 minutes to hours; pain may radiate to the right shoulder or back; nausea; triggered by fatty meals.

Risk factors: Female sex, pregnancy, age over 40, obesity, rapid weight loss, high-cholesterol diet, diabetes.

When to seek evaluation: Recurring right upper quadrant pain after meals warrants an ultrasound to look for gallstones. Fever with belly pain, or yellowing of the skin or eyes (jaundice), can signal a gallbladder or bile-duct infection, go to the emergency room, as these can become life-threatening quickly.

7. Peptic Ulcers

What it is: Sores that develop on the inner lining of the stomach, small intestine, or esophagus.

Why it happens: Most commonly caused by infection with Helicobacter pylori bacteria or long-term use of NSAIDs (ibuprofen, aspirin). These damage the protective mucous lining of the stomach or duodenum.

Common symptoms: Burning or gnawing pain in the upper abdomen, often occurring between meals or at night; may be temporarily relieved by eating or antacids; nausea; bloating.

Risk factors: H. pylori infection, regular NSAID use, smoking, alcohol, stress.

When to seek evaluation: Peptic ulcers are diagnosable and treatable. Call 911 or go to the emergency room immediately for sudden severe abdominal pain, vomiting blood, or black tarry stools, which can indicate a bleeding or perforated ulcer.

8. Pregnancy-Related and Gynecologic Causes (Ectopic Pregnancy, Ovarian Cyst Rupture, Ovarian Torsion)

What it is: In women and other people of reproductive age, some causes of lower abdominal or pelvic pain are related to pregnancy or the reproductive organs. These include ectopic pregnancy (a fertilized egg implanting outside the uterus, most often in a fallopian tube), ovarian cyst rupture, and ovarian torsion (twisting of an ovary that cuts off its own blood supply).

Why it happens: In an ectopic pregnancy, the fertilized egg cannot reach the uterus and implants elsewhere; as it grows it can stretch and rupture the fallopian tube, causing internal bleeding. Ovarian cysts are fluid-filled sacs on the ovary that can rupture or cause the ovary to twist (torsion), cutting off blood flow, both are surgical emergencies.

Common symptoms: Sudden or worsening lower abdominal or pelvic pain, often one-sided; a missed period or other early pregnancy signs; vaginal bleeding or spotting; dizziness, lightheadedness, or fainting; pain at the tip of the shoulder (from internal bleeding irritating the diaphragm); nausea.

Risk factors: Sexual activity with a chance of pregnancy, prior ectopic pregnancy, pelvic inflammatory disease, fertility treatment, tubal surgery, known ovarian cysts.

When to seek evaluation: These are potential emergencies. Anyone who could be pregnant and has abdominal or pelvic pain should tell their provider they might be pregnant, even before a pregnancy test is confirmed, ectopic pregnancy must be considered in any reproductive-age person with lower abdominal pain, and untreated it is a leading cause of pregnancy-related death in the first trimester. Call 911 or go to the emergency room immediately for sudden or severe lower abdominal/pelvic pain accompanied by a missed period, vaginal bleeding, dizziness or fainting, or shoulder-tip pain.

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