Abdominal Cramping

What abdominal cramps feel like

Cramping pain builds to a peak, eases, then builds again. It is caused by smooth muscle in a hollow organ, such as the intestine, contracting strongly or against a blockage. Doctors call this pattern colicky pain. It differs from the steady, constant pain of inflammation, such as appendicitis or pancreatitis, though some conditions begin with cramps and become constant.

Where the cramp is felt gives a rough guide:

Common causes of stomach cramps

Stomach bugs and food poisoning

Gastroenteritis from viruses such as norovirus causes sudden cramps with diarrhea, nausea and vomiting, usually lasting 1 to 3 days. Food poisoning produces similar symptoms, often within hours of eating contaminated food. Bloody diarrhea, high fever or symptoms lasting more than a few days suggest bacterial infection.

Gas and bloating

Swallowed air, fizzy drinks, beans, onions, cabbage and sugar alcohols (sorbitol, xylitol) cause gas that stretches the bowel and produces sharp, moving cramps. They ease after passing wind or a bowel movement.

Constipation

Hard, infrequent stools cause lower abdominal cramps, bloating and straining. Low fiber intake, not drinking enough, inactivity and medicines such as opioids and iron are common triggers.

Irritable bowel syndrome

Irritable bowel syndrome (IBS) causes recurring cramps linked to bowel movements, with diarrhea, constipation or both, and bloating. Pain often improves after a bowel movement. Symptoms flare with stress and certain foods but do not cause weight loss or bleeding.

Food intolerances

Lactose intolerance causes cramps, gas and diarrhea 30 minutes to 2 hours after dairy. Celiac disease, triggered by gluten, causes cramps, bloating, diarrhea and sometimes weight loss and anemia.

Period pain

Dysmenorrhea causes cramps in the lower abdomen that can spread to the back and thighs. Pain starts just before or with bleeding and lasts 1 to 3 days. Cramps that worsen over years, or come with pain during sex, may point to endometriosis.

Serious causes not to miss

• Appendicitis: pain starts around the belly button and moves to the lower right, becoming constant, with loss of appetite and fever.
• Bowel obstruction: severe waves of cramping with vomiting, a swollen belly and no passage of gas or stool. More likely after previous abdominal surgery or with a hernia.
• Ectopic pregnancy: one-sided lower cramps with vaginal bleeding, 5 to 10 weeks after a missed period.
• Diverticulitis: lower left pain, fever and a change in bowel habit, usually in people over 50.
• Inflammatory bowel disease: cramps with bloody diarrhea, urgency and weight loss.
• Gallbladder colic: severe upper right pain after fatty meals, lasting 30 minutes to several hours.
• Kidney stones: intense waves of flank pain spreading to the groin.

Accompanying symptoms and what they suggest

How doctors find the cause

A doctor will ask where the pain is, how it started, what it feels like, how long it lasts, and about bowel habits, food, travel, periods and pregnancy. They will examine the abdomen for tenderness, swelling and guarding. Depending on findings, tests may include a pregnancy test, urine test, blood tests, stool tests for infection or inflammation (calprotectin), celiac blood test, and ultrasound or CT scans.

How to relieve abdominal cramps

• Fluids: sip water or oral rehydration solution often, especially with diarrhea or vomiting.
• Heat: a hot water bottle or heating pad on the belly relaxes muscle.
• Eat lightly: small, bland meals once you are hungry again. Avoid fatty, spicy and very sugary foods for a day or two.
• Gas relief: walking, simethicone, and avoiding fizzy drinks and gas-producing foods.
• Constipation: increase fiber and fluids gradually, and try an over-the-counter laxative such as polyethylene glycol if needed.
• Period cramps: an NSAID such as ibuprofen or naproxen started at the first sign of pain, at the label dose, works best. Avoid NSAIDs if you have stomach ulcers or kidney disease.
• Antispasmodics: peppermint oil capsules or pharmacy antispasmodics help IBS cramps.

Avoid anti-diarrhea medicine such as loperamide if you have bloody diarrhea or a high fever. Do not give aspirin to children or teenagers.

Frequently asked questions

What causes sudden stomach cramps?

Sudden cramps are most often from a stomach bug, food poisoning, trapped gas or a food you do not tolerate. If they come with severe constant pain, a rigid belly, persistent vomiting or blood, they can signal appendicitis, bowel obstruction or another emergency.

Why do I have stomach cramps and diarrhea?

The most common cause is viral gastroenteritis or food poisoning, which usually clears in 1 to 3 days. Recurring cramps with diarrhea can be IBS, lactose intolerance, celiac disease or inflammatory bowel disease, especially if there is blood or weight loss.

How long do stomach cramps last?

Cramps from gas last minutes to hours. Cramps with a stomach bug last 1 to 3 days. Period cramps last 1 to 3 days per cycle. Cramps that last longer than 2 days, keep returning or worsen should be checked.

When are stomach cramps serious?

Get help urgently for severe or constant pain, a hard belly, vomiting with no gas passed, high fever, bloody stools, signs of dehydration, or cramps in pregnancy with bleeding or one-sided pain.

Can stress cause abdominal cramps?

Yes. Stress and anxiety affect the gut through the nerves linking brain and bowel, causing cramps, urgency and diarrhea. This is especially common in IBS. New or severe symptoms should still be checked for physical causes.