SymptomWhole body & general
Tenderness: What It Means and What Causes It
Tenderness is pain or discomfort that appears or gets worse when an area is pressed or touched. Doctors check for it during an exam because it helps pinpoint where a problem is. Suprapubic tenderness, pain when the lower middle belly just above the pubic bone is pressed, usually points to a bladder infection or a full, retained bladder, and in women sometimes to the uterus or pelvic organs. Tenderness with fever, swelling, redness or a rigid belly needs prompt medical care.
Also called: Pain on palpation, sore to touch, point tenderness, suprapubic tenderness, rebound tenderness
At a glance
- What it is
- Pain triggered or worsened by pressure on a part of the body.
- Suprapubic tenderness
- Usually bladder infection or urinary retention; in women also uterine or pelvic causes.
- Why it matters
- Its location helps doctors find the organ or tissue involved.
- Warning types
- Rebound tenderness, guarding and a rigid belly suggest peritonitis.
- Other common causes
- Muscle strain, bruises, inflamed joints or tendons, skin infection, costochondritis.
When to get help
Call 911 or go to the ER
- A rigid, board-like belly, or severe pain that gets much worse when pressure is released or when moving, coughing or going over bumps (possible peritonitis)
- Severe abdominal tenderness with vomiting, fever, fainting or a swollen abdomen
- Tenderness in the lower belly in pregnancy or with a missed period, especially with bleeding or dizziness
See a doctor within a day or two
- Suprapubic tenderness with inability to pass urine, or only dribbling
- Suprapubic or side tenderness with fever, chills or back pain (possible kidney infection)
- Tenderness in the lower right abdomen that is getting worse over hours (possible appendicitis)
- Lower left abdominal tenderness with fever in someone over 40 (possible diverticulitis)
- A red, hot, swollen tender area of skin that is spreading
- Tender bone after an injury, or a tender, swollen calf
Book a routine appointment
- Mild suprapubic tenderness with burning on urination and frequency
- Tender spots in muscles or joints lasting more than 2 weeks
- Skin that is tender to clothing without a rash
What tenderness means
Pain is something you feel. Tenderness is something a doctor finds: pain provoked by pressing. Some conditions cause pain without tenderness, while others are mainly tender. Doctors note:
- Where the tenderness is, which suggests the organ involved
- How deep the pressure must be: superficial tenderness points to the skin or muscle, deep tenderness to organs
- Associated signs: guarding, rebound and rigidity
| Term | Meaning |
|---|---|
| Point tenderness | Tenderness at one precise spot, such as over a fracture or inflamed tendon |
| Guarding | Tensing of the abdominal muscles when pressed, to protect an inflamed area |
| Rebound tenderness | Pain that is worse when pressure is suddenly released; suggests irritation of the abdominal lining |
| Rigidity | A hard, board-like belly from involuntary muscle spasm; a sign of peritonitis |
| Allodynia | Light touch that would normally not hurt is painful; a nerve-related phenomenon |
Suprapubic tenderness
The suprapubic region is the lower middle part of the abdomen, just above the pubic bone. The bladder sits directly behind it, and in women the uterus is close by.
Causes of suprapubic tenderness
| Cause | Clues |
|---|---|
| Bladder infection (cystitis) | Burning when urinating, frequency, urgency, cloudy or smelly urine |
| Urinary retention | Unable to pass urine or passing only small amounts; a swollen, tender lower belly |
| Interstitial cystitis (bladder pain syndrome) | Long-term bladder pain that eases after urinating, no infection |
| Uterine causes | Period pain, endometritis after childbirth, fibroids |
| Pelvic inflammatory disease | Lower abdominal tenderness on both sides, discharge, fever, pain with sex |
| Prostatitis | Pain between the scrotum and anus, painful urination, fever in acute cases |
| Bladder stones | Pain with urination, interrupted stream, blood in urine |
| Appendicitis or diverticulitis | Occasionally felt in the lower middle region, especially with a pelvic appendix |
A simple urine test is usually the first step. Doctors may also do a bladder scan to check whether urine is being retained, a pregnancy test, and a pelvic exam or ultrasound.
Abdominal tenderness by location
| Location | Common causes |
|---|---|
| Upper right | Gallbladder (cholecystitis), liver, duodenal ulcer |
| Upper middle | Stomach (gastritis, ulcer), pancreas |
| Upper left | Spleen, stomach, pancreas |
| Lower right | Appendicitis, ovarian cyst, ectopic pregnancy, Crohn's disease |
| Lower left | Diverticulitis, constipation, ovarian cyst, ectopic pregnancy |
| Side or flank | Kidney infection, kidney stones |
| Lower middle (suprapubic) | Bladder, uterus, pelvic infection |
Tenderness on the left side
Lower left abdominal tenderness in adults over 40 is most often diverticulitis, especially with fever and a change in bowel habit. Tenderness higher up on the left can come from the spleen, stomach or a kidney. In women, the left ovary or tube can be the source. Left chest wall tenderness that hurts when pressed is often costochondritis rather than the heart.
Tenderness elsewhere in the body
- Chest wall: costochondritis, inflammation where ribs join the breastbone, is sharply tender when pressed. Heart pain is not usually reproduced by pressing, though tenderness does not completely rule out a heart problem.
- Muscles: strains, overuse and fibromyalgia, which causes widespread tender points.
- Joints and tendons: arthritis, gout, bursitis and tendinitis.
- Bones: fractures and stress fractures cause point tenderness. Bone infection (osteomyelitis) causes tenderness with fever.
- Skin: cellulitis and abscesses are red, warm and tender. Shingles and nerve problems can make skin tender without a rash. See skin pain.
- Breasts: cyclical breast tenderness before periods, pregnancy, or mastitis.
- Calf: tenderness with swelling may be a deep vein thrombosis.
Tenderness that comes and goes, even to clothing
Areas that hurt to light touch or clothing, but not all the time, suggest nerve sensitization (allodynia), as seen in shingles before the rash, migraine, fibromyalgia and peripheral neuropathy. If it persists or follows a band on one side, see a doctor.
How doctors evaluate tenderness
The doctor asks when the pain started, what makes it worse, and about fever, urination, bowel habits, periods, injuries and other symptoms. They press gently, starting away from the painful area, and check for guarding and rebound. Tests depend on location: urine tests, blood tests (blood count, inflammatory markers), pregnancy test, ultrasound, CT scan or X-rays.
Treatment
Treatment targets the cause: antibiotics for urinary or skin infections, catheter drainage for urinary retention, surgery for appendicitis, rest and anti-inflammatory measures for muscle and joint problems. For mild musculoskeletal tenderness, rest, ice or heat, and over-the-counter pain relievers help. Follow the label dose, and avoid NSAIDs if you have kidney problems or stomach ulcers.
Frequently asked questions
What is suprapubic tenderness?
Suprapubic tenderness is pain when a doctor presses the lower middle abdomen, just above the pubic bone. It most often indicates a bladder problem, such as a urinary tract infection or a bladder that is not emptying. In women, the uterus and pelvic organs are other possible sources.
What is the difference between pain and tenderness?
Pain is what you feel on your own. Tenderness is pain that is triggered or made worse by pressing on an area. Doctors use tenderness to locate the source of a problem during a physical examination.
What does rebound tenderness mean?
Rebound tenderness is pain that gets worse when a doctor presses on the abdomen and then quickly lets go. It suggests that the lining of the abdomen (peritoneum) is inflamed, as in appendicitis or peritonitis, and needs urgent assessment.
What causes tenderness in the lower left abdomen?
In adults over 40, diverticulitis is the most common cause, often with fever and changed bowel habits. Constipation, irritable bowel syndrome, ovarian cysts, ectopic pregnancy and kidney stones are other causes. Persistent or worsening tenderness should be examined.
Why does an area hurt to touch, even from clothing?
Pain from light touch or clothing is called allodynia. It happens when nerves become oversensitive, for example in shingles before the rash appears, migraine, fibromyalgia or nerve damage. If it lasts more than a few days or follows a band on one side, see a doctor.
Sources
This guide was written from current patient and clinical guidance, including:
- MedlinePlus: Abdominal tenderness
- Merck Manual Professional: Evaluation of the patient with abdominal pain
- NHS: Urinary tract infections
- American Urological Association: Urinary retention guidance
- StatPearls (NCBI Bookshelf): Physical examination of the abdomen