When to go to the ER for stomach pain

It's important to seek medical care if you have ongoing or severe stomach pain.

Many of us have had stomach pain at some point in our lives. Maybe we ate too much, or ate something that didn't agree with us. In many cases, the pain can be enough to send a person to the emergency room. Indeed, abdominal pain is one of the most common causes of emergency room visits in the United States. However, since the emergency room isn't always the appropriate place to seek care, it's important to know when to go to the ER for stomach pain and when to seek treatment elsewhere.

What are the common types of stomach pain?

Stomach or abdominal pain occurs from below the ribs to the pelvis. Although this pain is commonly referred to as stomach pain, the abdomen houses many different vessels and organs, so it's important to determine the type of pain you're experiencing and where it's coming from.

Identifying stomach pain typically boils down to three factors: location, intensity and duration, according to Dr. Husain Abbas, a weight loss surgeon who leads the gastrointestinal program at HCA Florida Memorial Hospital in Jacksonville.

"If something woke you up in the middle of the night and the pain is severe — if that happens once or twice, and it lasts for a few minutes, and then you feel OK, you can wait and see your doctor in the morning," Dr. Abbas says. If that pain gets worse and starts spreading throughout your abdomen, and if you start having other symptoms, such as nausea or a fever, the pain will need to be looked into further.

"If the pain is a nagging pain, maybe for a day or two, and then it suddenly becomes a very sharp and severe pain if you try to move, then it could be appendicitis. Appendicitis starts with a non-specific pain in the abdomen, and then as you start moving you begin to feel the pain," Dr. Abbas adds. People who are suffering from appendicitis often want to curl up into the fetal position, he explains.

Location can also provide insight into what is causing the abdominal pain. Pain from appendicitis, for example, is located in the lower right abdomen, or near the navel, and moves lower. Pain from gallstones, which are hardened deposits of digestive fluid, originates in the upper right abdomen and can spread to the right shoulder blade. Pain in the upper middle abdomen can be due to a peptic ulcer, or a sore on the stomach lining.

What are the common causes of stomach pain?

The stomach is the first organ that interacts with food, and if you've eaten something that was not washed or was cooked improperly, you might get an infection, Dr. Abbas says. A common cause of stomach pain is gastritis, which is caused by inflammation of the stomach lining. As the infection moves down to the intestine, a person might get enteritis, which is inflammation of the small intestine.

"If you have a lot of diarrhea, that can have multiple causes. It generally tends to be infective causes, and if that's the case, you might have a little bit of a cramping pain, but it's not very severe and then goes it away," Dr. Abbas says. "If the pain is persistent — it doesn't go away after you go to the restroom — you will need to have that checked out, because that could be acute inflammation that may precede another major event like diverticulitis." Diverticulitis is an infection or inflammation of diverticula, pouches that can form in the intestines.

Stomach pain can also be caused by a perforation in an organ in the abdomen. "The vast majority of the organs in the abdomen are hollow organs, and just like a gardening hose, they can have a hole in them. That is called a perforation, and it will need to be addressed emergently. That is an actual surgical emergency," Dr. Abbas says.

Other common causes of stomach pain include gas, bloating and constipation. Gas is primarily caused by swallowing air when you eat or drink. Bloating is the feeling of having a full stomach and can often feel tight and painful. The most common cause of bloating is excess intestinal gas. Constipation can be caused by gas buildup as well, but it can also be due to infrequent or difficult bowel movements.

Knowing when to visit the ER

"Intensity and duration are really the most important factors in going to the ER," Dr. Abbas says. "If you have severe pain, do not wait. You have to go to the ER. If you have severe pain for a short period of time but it's just not going away, unless you can get to your doctor right away, you will need to go to the emergency room." Even if you can see your primary care provider (PCP) immediately, most PCPs won't be able to perform imaging exams that can determine the cause of the pain, and they will usually send you to the ER to get checked out.

"If you have severe diarrhea, and you are getting dehydrated, you could possibly go to urgent care. Or if your doctor can get you into the office more rapidly, you can do that as well," Dr. Abbas adds. Pain from food poisoning, menstrual cramps or other non-serious causes can also be treated at an urgent care clinic.

If you have symptoms that do not go away after two days, or if the symptoms get worse during that time, schedule an appointment with your PCP. You should also see your PCP if you have unexplained stomach pain, to make sure it isn't something serious.

Stomach pain doesn't always require treatment. Sometimes you may be able to wait it out and it will go away on its own. Some causes, such as an upset stomach, can be managed at home. But if you are experiencing pain that does not go away, or you're having other symptoms like a high fever, nausea or vomiting, you should see a medical professional.