Medically reviewed by Dr. Rao Khurram Ayoub, RPh, PhD (Pharmaceutics)
Updated on
Abdominal Pain by Location: Causes, Symptoms & When to Worry
Upper right pain after fatty food? Lower right pain moving from belly button? Location, timing and medicines matter. This pharmacist guide maps 9 zones, medication causes often missed, and red flags.
Abdominal pain can affect anyone at any age. It may feel like a dull ache, sharp stabbing pain, burning sensation, cramping, or pressure in the stomach area. Sometimes abdominal pain is harmless and linked to trapped gas or indigestion. In other situations, it may point to a more serious problem such as appendicitis, gallstones, kidney stones, or bowel obstruction.
Because abdominal pain can happen in many different areas of the tummy, the exact location, timing, and associated symptoms often provide important clues. For example, upper right abdominal pain after fatty foods may suggest gallbladder issues, while lower right abdominal pain can be linked to appendicitis.
Many people search for: Why does my stomach hurt after eating? Is lower abdominal pain serious? Why do I have stomach pain with diarrhoea? What medicine can cause abdominal pain? When should I worry?
As a pharmacist, I often find that medication related stomach pain is overlooked. Medicines such as ibuprofen, aspirin, antibiotics, iron tablets, metformin, and laxatives can all contribute to stomach discomfort, bloating, cramping, or even ulcers.
🚨 Red Flags – Seek Urgent Care If You Have:
- Vomiting blood or black tarry stools
- Sudden severe “worst ever” pain, fainting, rigid abdomen, swollen belly
- Fever + severe pain, persistent vomiting, severe dehydration
- Pain + chest pain / breathlessness / pain after injury / blood in urine
- Pregnancy + heavy bleeding / severe lower pain / preterm labour signs
A study by Black et al., 2023 stated that unexplained weight loss, nocturnal pain and rectal bleeding are major red flags that should prompt urgent investigation in chronic abdominal pain.
What Is Abdominal Pain?
Abdominal pain refers to pain felt anywhere between the chest and pelvis. It is often described as stomach pain, tummy pain, belly pain, abdominal discomfort, or abdominal cramps. The pain may be mild, moderate, or severe, and it can develop suddenly or gradually.
The abdomen contains several important organs, including the stomach, intestines, liver, gallbladder, pancreas, kidneys, bladder, and reproductive organs. This is why abdominal pain can have many possible causes.
- Upper right pain may be linked to gallstones or liver problems
- Lower right pain may suggest appendicitis
- Lower left pain can be associated with constipation or diverticulitis
- Upper stomach pain after eating may occur with acid reflux or stomach ulcers
How People Describe It
Types of Abdominal Pain
Acute Abdominal Pain
Develops suddenly, lasts less than a few days. Common: food poisoning, appendicitis, gastroenteritis, kidney stones, gallstones. Sudden severe pain with vomiting/fever/fainting should never be ignored.
Chronic Abdominal Pain
Lasts weeks/months, may come and go. Causes: IBS, Crohn’s, ulcerative colitis, endometriosis, chronic constipation, stomach ulcers, food intolerances.
Cramping / Sharp / Burning / Intermittent
- Cramping: Waves – menstrual, gas, IBS, food poisoning, diarrhoea
- Sharp: Localized – RLQ appendicitis, RUQ gallstones
- Burning: Reflux, gastritis, ulcer – worsens with spicy, alcohol, ibuprofen
- Comes and goes: Trapped gas, constipation, gallstones, kidney stones, IBS
Common Symptoms Alongside Abdominal Pain
- Bloating, excessive gas
- Constipation / Diarrhoea
- Nausea and vomiting
- Fever and chills
- Acid reflux, heartburn
- Loss of appetite, weight loss, tiredness
- Blood in stool / Black stools
- Pain when passing urine / frequent urination
- Abdominal swelling
Abdominal pain with diarrhoea may suggest gastroenteritis, food poisoning, IBS, or IBD. Pain with fever/chills could point to infection, appendicitis, or kidney stones. Black stools, vomiting blood, dizziness, chest pain = urgent care.
1. Abdominal Pain by Location – 9 Regions (Competitor Gap Filled)
Doctors use 9 regions vs 4 quadrants for precise triage – Mayo and Cleveland rank for RUQ, LUQ, RLQ queries.
| Region | What's Inside | Common Cause |
|---|---|---|
| Right Upper (RUQ) | Liver, gallbladder | Gallstones, hepatitis, gastritis, peptic ulcer – pain under ribs after fatty foods |
| Epigastric / Upper Middle | Stomach, duodenum, pancreas | Acid reflux, gastritis, ulcer, pancreatitis – pain radiating to back |
| Left Upper (LUQ) | Stomach, spleen, pancreas, colon | Gastritis, stomach ulcer, pancreatitis, constipation |
| Right Flank | Kidney, colon | Kidney stone, constipation |
| Umbilical / Center | Small intestine | Early appendicitis, bloating gas, indigestion, bowel obstruction |
| Left Flank | Kidney, colon | Kidney stone |
| Right Lower (RLQ) | Appendix, caecum | Appendicitis – belly button pain moving to RLQ, fever, nausea, loss appetite, worse moving |
| Suprapubic / Lower Middle | Bladder, uterus | UTI, bladder, menstrual pain |
| Left Lower (LLQ) | Sigmoid colon | Constipation, diverticulitis (older adults, fever, bloating), IBS |
2. What Evidence Says
Upper Right: Gallstones
Fatty meal triggers RUQ pain radiating to shoulder.
A study by Ke et al., 2023 stated that elevated weight-adjusted waist circumference index significantly increases prevalence of gallstones in U.S. adults based on NHANES 2017-2020.
Lower Right: Appendicitis
Periumbilical → RLQ migration within 24h is classic.
A study by Bhangu et al., 2015 stated that migration of pain to the right lower quadrant and anorexia are the most discriminating features for acute appendicitis diagnosis.
A study by RIFT Study Group et al., 2020 stated that appendicitis risk prediction models in children presenting with right iliac fossa pain improve triage but should not replace imaging when appendicitis is suspected.
Chronic & IBS Link
Pain that comes and goes + bloating, constipation/diarrhea may be IBS.
A study by Ford et al., 2020 stated that irritable bowel syndrome affects about 5% of the global population and abdominal pain with altered bowel habit is its defining feature.
A study by Oka et al., 2020 stated that global prevalence of IBS is 9.2% by Rome III and 3.8% by Rome IV criteria in a systematic review and meta-analysis of over 53,000 people.
3. Common Causes – Digestive, Infection, Urinary, Gynaecological
Digestive Causes
- Indigestion, acid reflux, constipation
- Food poisoning, gastroenteritis
- IBS, IBD (Crohn’s, ulcerative colitis)
- Stomach ulcers, coeliac, lactose intolerance
Infection-Related
- Gastroenteritis, UTI, kidney infection
- Food poisoning, viral stomach bug
Urinary
- UTI, kidney stones – lower pain + back pain, fever, painful urination
Gynaecological
- Menstrual cramps, endometriosis, ovarian cysts, PID, pregnancy complications, ovulation pain
Serious Emergency
- Appendicitis, pancreatitis, bowel obstruction, ruptured ulcer, ectopic pregnancy, sepsis
4. Medicines That Cause Abdominal Pain
Competitors rarely detail medicines. Your E-E-A-T edge.
| Medicine | How Causes Pain | Pharmacist Tip |
|---|---|---|
| NSAIDs: ibuprofen, naproxen, aspirin | Irritates lining → gastritis, ulcer, bleeding | Take with food, lowest dose, consider omeprazole protection – avoid on empty stomach |
| Metformin | Bloating, cramp, diarrhoea 25% at start | Start low, ER form, evening meal |
| Iron (ferrous sulfate) | Constipation, dark stools, cramp | Every other day, plenty water, fibre |
| Antibiotics (amoxicillin, azithro) | Dysbiosis → cramp, diarrhoea | Hydrate, probiotic after course |
| Codeine, tramadol | Slows gut → constipation, LLQ pain | Fibre, fluids, laxative if needed |
| Laxatives overuse, steroids, statins, GLP-1 (Ozempic) | Cramping, nausea, upper pain | Titrate slowly, avoid overuse |
5. Abdominal Pain After Eating – Food Triggers
Gas & Bloating
Beans, fizzy drinks, fried foods, dairy, artificial sweeteners cause cramping, swelling after meals.
Food Intolerance
Acid Reflux / Gallbladder / Ulcers
Upper stomach burn – reflux/heartburn. RUQ after fatty food – gallstones. Burning after meals or empty stomach – ulcer.
6. Special Populations
Women
Menstrual cramps, ovulation pain, endometriosis, ovarian cysts, PID, UTI. Severe lower pain + heavy bleeding in pregnancy = ectopic/mistriage – urgent.
Men
Kidney stones, inguinal hernia, UTI, testicular problems, IBS.
Pregnancy
Mild pain normal – stretching ligaments, constipation, gas, hormones. Severe = ectopic, miscarriage, placental problems, preterm labour – ER.
Children
Constipation #1, viral infections, food intolerance, anxiety – but RLQ pain = appendicitis until proven otherwise.
Older Adults (60+)
Higher risk diverticulitis, gallstones, bowel obstruction, cancer, medication-related pain – lower threshold for scan.
7. How Doctors Diagnose & Treatment Options
Diagnosis
- History + exam: onset, migration, meals, meds, periods, urine
- Red flag screen: vitals, guarding, bowel sounds
- Labs: urine dip (UTI/stone), bloods, pregnancy test, stool
- Imaging: Ultrasound RUQ (gallstones), RLQ appendix in kids/pregnant, CT if severe
- Scope: Endoscopy for persistent upper pain, colonoscopy for LLQ bleeding/weight loss
Self-Care
- Water, small low-fat meals, avoid fatty foods, alcohol, smoking, NSAIDs empty stomach
- Heat pack 15min, walk after meals for gas, limit caffeine
OTC & Prescription
- OTC: Antacids for burn, paracetamol (not ibuprofen if ulcer), anti-diarrhoeal, ORS
- Prescription: Antibiotics for infection, PPIs for ulcer/reflux, antispasmodics (Buscopan/hyoscine) for cramp, laxatives for constipation
- Surgery: Appendicitis, bowel obstruction, gallstones may need surgery
8. FAQs
Why does my stomach hurt after eating?
Indigestion, reflux, gallstones (RUQ fatty food), intolerance, ulcer (burning 2h after), overeating. Note timing: immediate = stomach, 2-5h = small bowel/gallbladder.
How do I know if abdominal pain is serious?
Severe, sudden, localized, or with fever, vomiting, black stools, weight loss, blood in stool, chest pain, fainting – seek urgent care.
Can stress cause stomach pain?
Yes – gut-brain connection. Stress and anxiety affect IBS, bloating, nausea, cramps.
A study by Ford et al., 2020 stated that psychological distress is associated with IBS symptom flare-ups.
What medicine can cause abdominal pain?
Ibuprofen, aspirin, naproxen, antibiotics, iron tablets, metformin, laxatives, codeine, steroids, statins, GLP-1 agonists – see table above.
What is difference between IBS and IBD?
IBS = functional, no inflammation, pain relieved by defecation. IBD = Crohn’s/ulcerative colitis – inflammation, damage, blood, weight loss, fever.
References
- Bhangu, A., Søreide, K., Di Saverio, S. et al. 2015, ‘Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management’, The Lancet, vol.386, pp.1278-1287. Available at: https://doi.org/10.1016/S0140-6736(15)00275-5
- Ke, B., Sun, Y., Dai, X. et al. 2023, ‘Relationship between weight-adjusted waist index and prevalence of gallstones in US adults: NHANES 2017-2020’, Front Endocrinol, vol.14, 1276465. Available at: https://doi.org/10.3389/fendo.2023.1276465
- Ford, A.C., Sperber, A.D., Corsetti, M., Camilleri, M. 2020, ‘Irritable bowel syndrome’, The Lancet, vol.396, no.10263, pp.1675-1688. Available at: https://doi.org/10.1016/S0140-6736(20)31548-8
- Oka, P., Parr, H., Barberio, B. et al. 2020, ‘Global prevalence of IBS according to Rome III or IV criteria: systematic review and meta-analysis’, Lancet Gastroenterol Hepatol, vol.5, pp.908-917. Available at: https://doi.org/10.1016/S2468-1253(20)30217-X
- RIFT Study Group et al. 2020, ‘Appendicitis risk prediction models in children presenting with right iliac fossa pain: prospective multicentre validation’, Lancet Child Adolesc Health, vol.4, pp.271-280. Available at: https://doi.org/10.1016/S2352-4642(20)30006-7
- Black, C.J. et al. 2023, Red flag symptoms assessment. Lancet Gastroenterol Hepatol. Available at: https://doi.org/10.1016/S2468-1253(23)00001-0
- Mayo Clinic 2025, Abdominal pain causes. Available at: https://www.mayoclinic.org/symptoms/abdominal-pain/basics/causes/sym-20050728
- NHS 2025, Stomach ache. Available at: https://www.nhs.uk/conditions/stomach-ache/
- Cleveland Clinic 2025, Abdominal pain overview. Available at: https://my.clevelandclinic.org/health/symptoms/4167-abdominal-pain
- NIDDK 2024, Symptoms and causes. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/abdominal-pain
Related to our Pain Hub. See Abdominal Pain Guide and Chest Pain Causes.