{"id":4705,"date":"2025-07-02T00:34:07","date_gmt":"2025-07-02T00:34:07","guid":{"rendered":"https:\/\/peykmagazine.com\/en\/?p=4705"},"modified":"2025-07-02T00:34:08","modified_gmt":"2025-07-02T00:34:08","slug":"when-to-worry-about","status":"publish","type":"post","link":"http:\/\/peykmagazine.com\/en\/2025\/07\/02\/when-to-worry-about\/","title":{"rendered":"WHEN TO WORRY ABOUT…"},"content":{"rendered":"

WHEN TO WORRY ABOUT ABDOMINAL PAIN<\/span><\/h3>\n

By Sanaz Majd, MD<\/p>\n

\n

\"\"Over a third of abdominal pain visits in the ER are discharged without a known cause.\u00a0How can doctors send a patient home without revealing the specific cause of a patient\u2019s abdominal pain, you may be wondering?\u00a0The truth is that docs are trained to search for \u201cred flags,” or more serious features of symptoms.\u00a0And once those are ruled out in the ER, the patient is deemed safe enough to go home for outpatient follow-up with their primary doctor in search of less worrisome root causes.<\/p>\n

So let’s say it’s 2:00 a.m. and you wake up with abdominal pain, or perhaps it is your child who wakes you up with a stomachache.\u00a0What are these red flags? When should you worry?<\/p>\n

I\u2019ll try to give you some loose guidelines as to when a symptom is worrisome, and when it is okay to wait.\u00a0This may be a Peyk<\/i> issue you may want to keep on your shelf for future reference. Let me emphasize, however, that this is general<\/i>\u00a0guidance that doesn\u2019t apply to all circumstances.\u00a0It is far better to be seen for a problem that ends up not being serious than to sit at home with a potentially serious condition.<\/p>\n

Anatomy of the Abdomen<\/b><\/span><\/p>\n

Before we decide how serious abdominal pain is, we need to understand the basic anatomy and the typical conditions that can cause pain in various sites of the abdomen. The abdomen is divided up into 4 sections referred to as “quadrants.”\u00a0The location of the pain can often help in determining what the culprit is, and hence, whether it is worrisome or not.<\/p>\n

You can follow along using this online diagram: https:\/\/medlineplus.gov\/ency\/imagepages\/19578.htm<\/span><\/p>\n

Here are the main quadrants:<\/p>\n

\u2022\u00a0 <\/span><\/b>Upper right quadrant<\/b><\/span>:<\/b>\u00a0(This refers to your<\/i> right) It contains the liver<\/b> and gallbladder<\/b>, which sit right beneath the rib cage.\u00a0The large intestine (aka colon<\/b>) also shares a little space here.<\/p>\n

\u2022\u00a0 <\/span><\/b>Upper left quadrant<\/b><\/span>:<\/b>\u00a0This contains part of the true stomach<\/b> and the spleen<\/b>.\u00a0The colon<\/b> spends time here, as well.<\/p>\n

\u2022\u00a0 <\/span><\/b>Upper middle section (“epigastric”)<\/b><\/span>:<\/b>\u00a0Between the above 2 quadrants, in the middle of the abdomen above the belly button, is a section known as the epigastrium.\u00a0This is an important site because it contains the majority of the stomach <\/b>and pancreas,<\/b> along with a segment of the small intestine<\/b>\u2014all of which can cause pain.<\/p>\n

\u2022\u00a0 <\/span><\/b>Right lower quadrant<\/b><\/span>:<\/b>\u00a0This quadrant contains more colon<\/b>, the last part of the\u00a0small intestine<\/b>, and the appendix<\/b>.\u00a0In women, one of the ovaries<\/b> is located in\/near this section.<\/p>\n

\u2022\u00a0 <\/span><\/b>Lower left quadrant<\/b><\/span>:<\/b>\u00a0The other ovary<\/b> lives in the left lower quadrant, along with the colon<\/b> that ends in the rectum where stool and gas are finally released.<\/p>\n

What Causes Abdominal Pain?<\/b><\/span><\/p>\n

There are a few more common troublemakers in the abdomen.\u00a0I\u2019ll give you the list of the \u201cabdomen\u2019s most wanted,\u201d and where they tend to hang out.<\/p>\n

The appendix<\/b><\/span>:<\/b> This is a small tube that can become infected and cause a dangerous problem.\u00a0Appendicitis<\/b> is a pain that usually begins around the belly button, but then settles in the right lower quadrant<\/span>.\u00a0Pain is often very severe.<\/p>\n

The gallbladder<\/b><\/span>:<\/b>\u00a0This organ is a sack that collects a digestive juice called bile that breaks down the fatty foods we ingest.\u00a0It can form gallstones<\/b> and get infected if the stone gets stuck while trying to escape into the connecting bile duct. It usually causes severe pain in the right upper quadrant<\/span>, and less often so in the epigastric<\/span> region (middle upper). Female patients often compare the severity of pain akin to childbirth\u2014it’s often that bad.<\/p>\n

The stomach and first part of the small intestine<\/b><\/span>: <\/b>Inflammation of the stomach lining called “gastritis<\/b>,” and its progression to more severe stomach<\/b>\u00a0ulcers<\/b>, can cause pain, bleeding, and occasionally a life-threatening perforation, leaking stomach acid into the abdominal cavity.\u00a0Gastritis and ulcers commonly cause pain in the epigastric<\/span> region. Pain can range from mild to severe. Many (but not all) patients report accompanying acid reflux and\/or heartburn as well.<\/p>\n

The pancreas<\/b><\/span>:<\/b>\u00a0This organ releases strong digestive juices and also produces insulin.\u00a0Excessive alcohol intake or gallstones stuck in the neighboring biliary ducts can cause \u201cpancreatitis<\/b>,\u201d or inflammation of the pancreas that causes severe pain in the epigastric region<\/span>. It is a severe pain which causes many patients to land in the hospital, however, it is not nearly as common as gastritis\/heartburn\/acid reflux as a cause of epigastric pain.<\/p>\n

The colon<\/b><\/span>:<\/b>\u00a0Pain in the colon can occur at nearly any site in the abdomen, but is most often in the left lower quadrant<\/span>. The most common causes of pain in the colon by far are due to constipation<\/b> and gas<\/b>. However, one of the most serious colon conditions is called\u00a0diverticulitis<\/i><\/b>, an infection of the tiny pouches that line the inside of the colon. Also, various types of colitis<\/b> (a general term referring to inflammation of the colon lining) can also cause colon pain\u2014examples include the hereditary Crohn’s and Ulcerative Colitis, or infection due to a virus or, less commonly, bacteria.<\/p>\n

When Should You Worry About Abdominal Pain?<\/b><\/span><\/p>\n

Location is important, but the nature of the pain itself is even more so.\u00a0Here are some of the things that make stomach pain more worrisome:<\/p>\n

\u2022\u00a0 <\/span><\/b>Severity<\/b><\/span>:<\/b>\u00a0Pain that wakes you up from sleep or stops you in your tracks is always worth worrying about.<\/p>\n

\u2022\u00a0 <\/span><\/b>Persistence<\/b><\/span>:\u00a0<\/b>Pain that is chronic or recurrent is generally<\/i> more worrisome than a brief episode of mild pain that is self-resolving.<\/p>\n

\u2022\u00a0 <\/span><\/b>Tenderness<\/b><\/span>:<\/b>\u00a0Doctors use the term\u00a0tenderness<\/i>\u00a0to signify pain that results when pressure is manually applied to that part of the body.\u00a0From a patient\u2019s perspective, tenderness could also be when movement makes the pain worse. People with appendicitis, for instance, don’t want to move or be touched.<\/p>\n

\u2022\u00a0 <\/span><\/b>Loss of appetite<\/b><\/span>:\u00a0<\/b>When a serious problem happens in the abdomen, the digestive tract slows down, and nausea and\/or diminished appetite can occur.\u00a0It\u2019s rare for someone with appendicitis, for example, to want to eat.\u00a0Significant unintentional weight loss<\/b> as a result of an appetite slump is also especially worrisome.<\/p>\n

\u2022\u00a0 <\/span><\/b><\/span>Vomiting<\/b><\/span>:<\/b>\u00a0The extreme of a digestive shut-down can cause vomiting, which is why vomiting can sometimes be cause for concern. Vomiting blood especially is almost always an emergent issue.<\/span><\/p>\n

\u2022\u00a0 <\/span><\/b>Blood in stool<\/b><\/span>:<\/b>\u00a0Mild occasional painless rectal bleeding is most often due to hemorrhoids, which are annoying but not necessarily concerning. However, rectal bleeding does warrant a doctor\u2019s evaluation to be sure of a benign cause, because more serious conditions could also cause blood in the stool.\u00a0But bleeding along with abdominal pain is a more emergent <\/i>concern.<\/p>\n

\u2022 <\/b>Melena<\/b><\/span>:\u00a0<\/b>The word\u00a0melena\u00a0<\/i>refers to black, tarry stool\u2014think charcoal.\u00a0That could be a sign of bleeding from the upper gastrointestinal tract, like the stomach.\u00a0Bleeding in the stomach turns black by the time it exits the rectum.\u00a0If something is causing enough bleeding to cause melena, it is usually something more serious, like a bleeding ulcer<\/b>.\u00a0This requires an urgent\/emergent evaluation, even if there is no associated pain.<\/p>\n

\u2022\u00a0 <\/span><\/b><\/span>Change in caliber of stool<\/b><\/span>: Constipation can do this. However, obstruction such as with a tumor or mass in the colon can do so as well (although it\u2019s less common).\u00a0 <\/span>It\u2019s always worth seeing your doctor for any changes in the caliber of the stool, such as “skinny stools” or “little bits” of stooling or simply the inability to have any stool at all.<\/span><\/p>\n

It\u2019s also vital to point out that certain patient populations are considered higher risk and may present more atypically when it comes to abdominal pain\u2014those who are immune compromised, women (due to a more complex female anatomy), and the elderly.\u00a0There is a particularly higher mortality and complication risk in the over 65 population, who often report more vague and non-specific symptoms that can worsen their prognosis. So these populations should have a much lower threshold to seek medical care for abdominal pain.<\/p>\n

When Don\u2019t You Need to Worry About Abdominal Pain?<\/b><\/span><\/p>\n

The more reassuring signs on the flip-side are:<\/p>\n

\u2022\u00a0 <\/span><\/b>Mild severity in a discomfort that is self-resolving and short-lived<\/span>
\n\u2022\u00a0 <\/span><\/b>Pain that isn\u2019t worse with pressing or movement
\n\u2022\u00a0 <\/span><\/b>Pain isn\u2019t associated with a lack of appetite, nausea, or vomiting<\/span>
\n\u2022\u00a0 <\/span><\/b>Pain doesn\u2019t interfere with regular activity
\n\u2022\u00a0 <\/span><\/b>No associated unintentional weight loss<\/p>\n

Furthermore, the\u00a0passage of normal stool and gas\u00a0shows that the digestive tract is working, which is also reassuring.\u00a0That\u2019s why surgeons ask people if they are passing gas after they perform surgery.<\/span><\/p>\n

Generally, the top causes of less worrisome abdominal pain are:<\/p>\n

\u2022\u00a0 <\/span><\/b>Constipation
\n<\/b>\u2022\u00a0 <\/span><\/b>Gas
\n<\/b>\u2022\u00a0 <\/span><\/b>Viral gastroenteritis<\/b> (such as the “stomach flu”)\u2014as long as it does not cause dehydration
\n\u2022\u00a0 <\/span><\/b>Irritable Bowel Syndrome (IBS)
\n<\/b>\u2022\u00a0 <\/span><\/b>Benign, tolerable medication side effects<\/b> (such as mild diarrhea or constipation)
\n\u2022\u00a0 <\/span><\/b>Infrequent acid reflux<\/b> or heartburn<\/b>\u2014while if infrequent it is often benign (let’s say after consuming spicy chicken at an Indian restaurant one day), more frequent or severe symptoms should not be ignored<\/i><\/i><\/p>\n

The bottom line, of course, is that it is always better to get checked out by a doctor than to stay at home with something potentially more serious.\u00a0Abdominal pain can be complex, and the experience and knowledge of your doctor is well worth the effort.<\/p>\n

Let me once again remind you that this article is for informational purposes only.\u00a0My goal is to add to your medical knowledge and translate some of the complex medical jargon you hear, so that when you do go to\u00a0your doctor, your visits will be more fruitful. I don\u2019t\u00a0intend to\u00a0replace your doctor; he or she is the one you should always consult about your own medical condition.<\/p>\n

\n

Sanaz Majd, MD, is a board-certified Family Medicine physician and host of the Majd MD YouTube channel, reviewing the most popular medical topics: www.youtube.com\/MajdMD. You can also follow her on Facebook or Instagram: @SMajdMD.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

WHEN TO WORRY ABOUT ABDOMINAL PAIN By Sanaz Majd, MD Over a third of abdominal pain visits in the ER are discharged without a known cause.\u00a0How can doctors send a patient home without revealing the specific cause of a patient\u2019s abdominal pain, you may be wondering?\u00a0The truth is that docs are trained to search for<\/p>\n","protected":false},"author":2,"featured_media":4631,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"two_page_speed":[],"footnotes":""},"categories":[4,67],"tags":[],"class_list":["post-4705","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-lifestyle","category-sanaz-majd-md"],"yoast_head":"\nWHEN TO WORRY ABOUT... - Peyk Magazine<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/peykmagazine.com\/en\/2025\/07\/02\/when-to-worry-about\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"WHEN TO WORRY ABOUT... - 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