Abdominal Pain

Abdominal pain covers everything from trapped wind to a surgical emergency, and severity alone is a poor guide — trapped wind can be agonising while a serious problem can start mildly.

Location is the most useful single piece of information, followed by what the pain does over time and what comes with it.

Upper abdomen — reflux, indigestion and ulcers centrally; gallstones on the right, classically after fatty food; pancreatitis, boring through to the back.

Lower abdomen — urinary infection; constipation; diverticulitis on the left; appendicitis, classically starting centrally and moving to the right.

Pelvic, in women — period pain, endometriosis, ovarian cysts, and pelvic inflammatory disease. Always consider pregnancy.

Anywhere, and coming and going — IBS is the commonest cause of recurrent abdominal pain and is characteristically relieved by opening the bowels. Coeliac disease and inflammatory bowel disease also present this way.

Remote assessment of abdominal pain has a real and specific limitation: we cannot feel your abdomen, and for acute pain that examination is the single most informative thing a doctor does. We will say so rather than work around it.

Where remote consultation genuinely helps is recurrent or long-standing abdominal pain — the pattern over months, what triggers it, what relieves it, and what testing is worth doing.

We arrange coeliac screening, inflammatory markers and faecal calprotectin, liver function, ultrasound for suspected gallstones or pelvic causes, and H. pylori testing for upper abdominal pain.

What does the location tell you?

A great deal. Upper right suggests gallbladder or liver. Upper middle suggests stomach, ulcer or pancreas. Loin radiating to the groin in waves suggests a kidney stone. Lower right raises appendicitis. Lower left raises diverticulitis, particularly over 50. Lower central suggests bladder or gynaecological causes.

Pain that migrates is especially informative — and the most important example is appendicitis, which characteristically begins as a vague ache around the navel before localising to the lower right over several hours.

How do I know if it's appendicitis?

The pattern to recognise: a dull central ache that becomes a sharper lower-right pain over 6 to 24 hours, with loss of appetite, nausea, a low-grade fever, and pain that is worse on movement, coughing or going over speed bumps.

Loss of appetite is a genuinely useful sign — appendicitis without it is unusual. Anyone with this pattern should be assessed the same day, because an appendix that perforates is a much bigger problem than one removed in time.

Should I avoid painkillers so the doctors can assess me properly?

No — that advice is outdated and was never kind. Research showed decades ago that pain relief does not obscure the findings that matter in an acute abdomen. Take paracetamol. What is worth avoiding is ibuprofen if the pain is upper and burning, and opioids like codeine, which slow the gut.

Is it just trapped wind?

Often it is — wind pain can be genuinely severe and is one of the commonest causes of a frightening abdominal pain. The reassuring features are that it moves about, comes and goes in waves, eases after passing wind or opening the bowels, and leaves you otherwise entirely well. Pain that stays in one place, steadily worsens, and comes with fever or vomiting is not wind.

Could it be an ectopic pregnancy?

If you could conceivably be pregnant and have one-sided lower abdominal pain, this has to be excluded today. An ectopic pregnancy often presents before a period is even noticeably late, with pain, sometimes light bleeding, and occasionally shoulder-tip pain. It can be life-threatening. Do a pregnancy test; if positive, go to A&E or an early pregnancy unit the same day.

I have IBS. How do I know when it's something else?

By what is new. IBS pain is typically crampy, relieved by opening the bowels, associated with bloating, and long-standing in its pattern. What does not belong to IBS: bleeding, weight loss, waking at night with pain, fever, or a change in your usual pattern — and IBS does not cause anaemia. Any of those deserves a fresh assessment rather than being attributed to a diagnosis you already have.

How long can I safely wait?

Severe pain, a rigid abdomen, vomiting with no wind passing, blood, or a positive pregnancy test with one-sided pain — A&E now. Moderate pain with fever, or pain worsening over hours — same day. Recurrent grumbling pain related to food or bowels, with no red flags — a routine appointment, but do arrange one rather than living with it.

What can be done remotely?

More than you might expect, and less than everything. The history does most of the diagnostic work in abdominal pain, and we can take it thoroughly, arrange bloods, liver function, inflammatory markers and urine testing, arrange an ultrasound or CT, and treat the many causes that are straightforward.

What we cannot do is press on your abdomen, and for an acute severe pain that examination is decisive. Where the story sounds surgical we will say so immediately and send you to be examined, rather than arranging a scan for next week.