Abdominal Pain:
When to Worry

Common causes of abdominal pain by location, when to see a doctor, and when to go to the ER.

Abdominal Pain by Location

One of the most useful clues in evaluating abdominal pain is its location. The abdomen is commonly divided into four quadrants — right upper, left upper, right lower, and left lower — and each region houses different organs. Pain in a specific area often points toward the structures beneath it, helping providers narrow down the likely cause before any tests are ordered.

For example, right upper quadrant pain frequently involves the gallbladder or liver, while left lower quadrant pain in older adults often suggests diverticulitis. Epigastric pain (the area just below the breastbone) is commonly associated with acid reflux or GERD, gastritis, or peptic ulcers. Pain that is diffuse — spread across the entire abdomen without a clear focal point — may indicate a more generalized process such as gastroenteritis, constipation, or irritable bowel syndrome.

While location is a helpful starting point, it is not a definitive diagnosis on its own. Referred pain (pain felt in a different area than its source), overlapping organ locations, and individual variation all mean that a thorough clinical history and examination are essential for accurate assessment.

Right Side Pain Causes

Right-sided abdominal pain is one of the most common reasons people seek urgent medical evaluation. The specific cause often depends on whether the pain is in the upper or lower right quadrant, as well as associated symptoms such as fever, nausea, or vomiting.

Common causes of right-sided abdominal pain include:

• Appendicitis — typically starts near the navel and migrates to the right lower quadrant; often accompanied by fever, loss of appetite, and worsening pain with movement
• Gallbladder disease — right upper quadrant pain that may radiate to the right shoulder, often triggered by fatty meals
• Kidney stones — flank pain that radiates to the lower abdomen and groin, frequently described as the most intense pain a person has experienced
• Ovarian cyst or torsion — in women, sudden onset right lower quadrant pain may indicate a ruptured or twisted ovarian cyst
• Hepatitis or liver inflammation — dull right upper quadrant discomfort with fatigue, jaundice, or dark urine

Right lower quadrant pain that worsens over several hours should always be evaluated promptly, as appendicitis requires surgical intervention if confirmed. An abdominal pain evaluation can help determine whether imaging or an in-person visit is needed.

Left Side Pain Causes

Left-sided abdominal pain has its own set of common causes, many of which can be effectively assessed through a detailed symptom history. As with right-sided pain, the distinction between upper and lower quadrant matters significantly.

Common causes of left-sided abdominal pain include:

• Diverticulitis — inflammation or infection of small pouches in the colon wall, most common in adults over 50; presents with left lower quadrant pain, fever, and changes in bowel habits
• Kidney stones or infection — left flank pain radiating downward, often with painful urination or blood in the urine
• Constipation — the descending colon runs along the left side, and stool buildup frequently causes crampy left-sided discomfort
• Splenic conditions — the spleen sits in the left upper quadrant; enlargement from infection or blood disorders can cause fullness or sharp pain
• Gastritis or peptic ulcer — upper left or epigastric pain that worsens with eating or on an empty stomach

Left lower quadrant pain in older adults should raise suspicion for diverticulitis, especially when accompanied by fever and a change in bowel habits. Younger patients with similar symptoms may be experiencing ovarian pathology, musculoskeletal strain, or inflammatory bowel disease.

Upper Abdominal Pain

Upper abdominal pain — felt above the navel — is frequently related to the stomach, esophagus, gallbladder, pancreas, or liver. This is one of the most common areas for pain related to eating, and the timing of symptoms relative to meals can provide important diagnostic clues.

Gastroesophageal reflux disease (GERD) is a leading cause of upper abdominal and chest discomfort, producing a burning sensation that often worsens after meals or when lying down. Gastritis and peptic ulcers cause gnawing or burning epigastric pain that may improve or worsen with food depending on the ulcer location. Gallbladder attacks typically produce right upper quadrant pain after fatty meals, sometimes radiating to the back or right shoulder blade.

Pancreatitis — inflammation of the pancreas — causes severe upper abdominal pain that often radiates straight through to the back and is associated with nausea and vomiting. This condition can be triggered by gallstones, heavy alcohol use, or elevated triglycerides and typically requires urgent evaluation. Any upper abdominal pain that is severe, persistent, or accompanied by vomiting should be assessed by a provider to rule out serious conditions.

Lower Abdominal Pain

Lower abdominal pain — below the navel — involves the intestines, bladder, and reproductive organs. In many cases, this type of pain is related to common conditions that respond well to treatment, but certain causes require prompt medical attention.

Frequent causes of lower abdominal pain include:

• Urinary tract infection (UTI) — suprapubic pain with burning urination, urgency, and frequency
• Irritable bowel syndrome (IBS) — cramping pain often relieved by bowel movements, associated with bloating and alternating diarrhea or constipation
• Menstrual cramps or endometriosis — cyclical lower abdominal pain in women, sometimes with heavy bleeding
• Inguinal hernia — a bulge in the groin area with pain that worsens with lifting, coughing, or straining
• Appendicitis or diverticulitis — depending on the side, as described in the sections above

Lower abdominal pain in women of reproductive age should always prompt consideration of pregnancy-related causes, including ectopic pregnancy, which is a medical emergency. If you are experiencing persistent or worsening lower abdominal pain, an abdominal pain evaluation can help determine the appropriate next steps.

When to See a Provider

Many episodes of abdominal pain are caused by self-limiting conditions such as gastroenteritis, gas, or mild constipation and resolve within a day or two with basic home care. However, certain patterns and features warrant a visit with a healthcare provider, even if the pain does not seem severe.

You should schedule a provider visit if you experience:

• Abdominal pain lasting more than a few days without improvement
• Recurring pain in the same location, even if it comes and goes
• Pain associated with unintentional weight loss or loss of appetite
• Persistent bloating, changes in bowel habits, or blood in the stool
• Pain that disrupts sleep or interferes with daily activities
• Nausea or vomiting that persists beyond 24 hours

A telehealth visit is often an ideal first step for non-emergency abdominal pain. Your provider can review your symptoms, recommend initial testing or imaging, prescribe medication for symptom relief, and advise whether an in-person examination is needed.

When to Go to the ER

Sudden severe abdominal pain with fever, vomiting, or bloody stool requires emergency evaluation.

While most abdominal pain can be managed in an outpatient or telehealth setting, certain symptoms indicate a potentially life-threatening condition that requires emergency care. Do not delay seeking help if you recognize any of the following warning signs.

Go to the emergency room or call 911 if you experience:

• Sudden, severe abdominal pain that comes on rapidly
• Pain with high fever (above 101.5 F) and chills
• Vomiting blood or passing black, tarry stools
• Abdominal pain after a recent injury or trauma
• Rigid, board-like abdomen that is extremely tender to touch
• Signs of shock — rapid heartbeat, dizziness, cold sweats, or confusion
• Inability to pass gas or have a bowel movement combined with vomiting (possible bowel obstruction)
• Abdominal pain during pregnancy

These symptoms may indicate appendicitis, bowel perforation, internal bleeding, ectopic pregnancy, or other surgical emergencies. Early intervention significantly improves outcomes for these conditions.

Getting Evaluated Online

Telehealth has become a practical and effective way to evaluate many types of abdominal pain without the wait times and expense of an in-person visit. During a virtual appointment, your provider can take a thorough history, ask targeted questions about your pain's location, timing, and associated symptoms, and formulate a clinical impression to guide next steps.

An online abdominal pain evaluation at InnoCre Telehealth may include prescriptions for symptom relief such as antacids, antispasmodics, or anti-nausea medication; orders for laboratory work or imaging studies at a facility near you; and referrals to gastroenterology or surgery if indicated. Your provider can also help you distinguish between symptoms that are safe to monitor at home and those that need urgent in-person attention.

If you are dealing with abdominal discomfort and are unsure whether you need to be seen, a same-day telehealth visit can provide clarity and peace of mind. InnoCre Telehealth is available to patients in Maryland, Washington, and Delaware.

Frequently Asked Questions