Abdominal Pain: Causes by Location

Abdominal pain by location

Doctors divide the abdomen into areas. The table shows the organs in each and the most common causes of pain there.

Read more about upper abdominal pain and lower abdominal pain.

Upper central abdominal pain: what it means

Upper central abdominal pain is pain in the area just below the breastbone and above the navel. Doctors call this region the epigastrium, so "epigastric pain" and "upper central abdominal pain" mean the same thing. "Upper abdominal pain" is a broader term that also includes the upper right and upper left.

Common causes of upper central pain

• Indigestion (functional dyspepsia): fullness, bloating and a gnawing ache after meals, with no damage found on testing. Very common.
• Gastritis: inflammation of the stomach lining from NSAIDs such as ibuprofen, alcohol or H. pylori infection. Burning pain, nausea.
• Peptic ulcer: a burning or gnawing pain that may improve or worsen with food and often wakes you at night. Caused mainly by H. pylori and NSAIDs.
• Acid reflux (GERD): burning that rises behind the breastbone, worse lying down or after meals.

Serious causes of upper central pain

• Acute pancreatitis: severe, constant pain that bores through to the back, with vomiting. Usually from gallstones or heavy drinking. Leaning forward may ease it.
• Gallstones: biliary colic often starts in the upper center before settling under the right ribs. See gallstones.
• Perforated ulcer: sudden, severe pain that quickly spreads across the whole belly, which becomes rigid.
• Heart attack: especially in women, older adults and people with diabetes, heart pain can feel like indigestion in the upper belly. Sweating, breathlessness or nausea with upper belly pain needs emergency assessment.

Suprapubic pain: what causes pain above the pubic bone

Suprapubic pain sits low in the center, just above the pubic bone. The main causes are:

• bladder infection (cystitis): burning, frequent urination and urgency. See urinary tract infection
• period pain and other uterine causes such as fibroids or endometriosis
• urinary retention: a full, painful bladder you cannot empty, common in older men with an enlarged prostate
• pelvic inflammatory disease, with fever and abnormal discharge
• interstitial cystitis, a long-term bladder pain condition

See suprapubic pain for more.

Type of pain and what it suggests

• Colicky (comes in waves): a hollow tube is blocked or squeezing, such as the bowel, a kidney stone in the ureter or gallbladder colic.
• Burning: acid-related, such as gastritis, ulcers or reflux.
• Constant and worsening: inflammation, such as appendicitis, pancreatitis or diverticulitis.
• Sudden and severe: a perforation, rupture, twisted organ or blocked blood supply. These need emergency care.
• Sharp and localized: see sharp abdominal pain for stabbing, knife-like pain.
• Cramping relieved by passing stool: irritable bowel syndrome or constipation.

Symptoms that come with abdominal pain

How doctors find the cause

Your doctor will ask where the pain started, whether it has moved, how it began, what it feels like, how long it has lasted, and what makes it better or worse. They will ask about bowel and urine changes, periods and possible pregnancy, medicines (especially NSAIDs), alcohol and previous surgery.

The examination checks where the belly is tender, whether it is rigid, and for lumps or a swollen bladder. Tests may include:

• urine test and pregnancy test
• blood count, liver and kidney tests, lipase for pancreatitis, and inflammatory markers
• an ECG and troponin for upper belly pain in at-risk adults
• ultrasound for gallbladder, kidney and pelvic problems
• CT scan for suspected appendicitis, diverticulitis, obstruction or perforation
• H. pylori breath or stool test, and upper endoscopy for persistent indigestion or alarm features

Relief and home care for mild abdominal pain

• Rest, and sip water or oral rehydration solution if you have diarrhea or vomiting.
• Eat small, bland meals and avoid fatty, spicy foods, alcohol and caffeine until you feel better.
• A warm heating pad can ease cramping.
• For indigestion, an antacid can help. Follow the label dose.
• For cramps, acetaminophen (paracetamol) is a safer choice than ibuprofen or aspirin, which can irritate the stomach.
• Avoid laxatives and strong pain medicine until the cause is clear.

Return for medical review if pain worsens, moves, or comes with fever, vomiting, blood or the warning signs above.

Frequently asked questions

What does upper central abdominal pain mean?

It means pain in the epigastric area, just below the breastbone and above the navel. It most often comes from the stomach or duodenum, such as indigestion, gastritis, reflux or an ulcer. Pancreatitis, gallstones and, occasionally, the heart can also cause pain here.

Is upper abdominal pain the same as epigastric pain?

Not exactly. Epigastric pain is pain in the upper middle area only. Upper abdominal pain is broader and includes the right side, where the gallbladder and liver sit, and the left side, where the spleen and part of the stomach lie.

What causes suprapubic abdominal pain?

Suprapubic pain, low in the center above the pubic bone, is most often from a bladder infection, period pain or other uterine problems, or a bladder that cannot empty. Pelvic infections and interstitial cystitis are less common causes.

When should I worry about abdominal pain?

Seek emergency care for sudden or severe pain, a rigid belly, vomiting blood, black stool, fainting, pain with chest symptoms, or pain in pregnancy. See a doctor soon for pain with fever, yellow skin, pain moving to the lower right, or pain that keeps worsening.

Can stress cause stomach pain?

Yes. Stress and anxiety affect gut nerves and movement and can trigger cramping, indigestion and irritable bowel symptoms. Stress should not be assumed as the cause of new, severe or persistent pain until a doctor has ruled out other causes.

How long should abdominal pain last before seeing a doctor?

Mild pain from gas, indigestion or a stomach bug usually settles within 24 to 48 hours. See a doctor if pain lasts longer than 2 to 3 days, keeps coming back, or is getting worse, and sooner if any warning signs appear.