Upper Abdominal Pain

What is upper abdominal pain?

Your upper abdomen is the area of your belly roughly between your ribs and your belly button. Healthcare providers divide the abdomen into regions to help narrow down the many possible causes of abdominal pain. If you have upper abdominal pain, it’s more likely to be related to the organs in that region. It could literally be a stomachache. It could also involve your biliary system or even your muscles.

Which organs cause upper abdominal pain?

Your upper abdominal organs include your:

• Stomach.
• Spleen.
• Liver.
• Pancreas.
• Gallbladder.
• Bile ducts.

Other organs and tissues that might be involved include your:

• Abdominal muscles. Several main abdominal muscles meet in your upper abdomen, and injury to one of them could cause upper abdominal pain.
• Peritoneum. Your peritoneum is the tissue that lines your upper abdominal cavity and surrounds the organs. The space inside is your peritoneal cavity. Conditions affecting your peritoneum and peritoneal cavity could cause upper abdominal pain.
• Intestines. The top parts of both your intestines (your transverse colon and your duodenum) pass through the bottom part of your upper abdominal region. Issues affecting these segments might cause upper abdominal pain.
• Kidneys and ureters. Your kidneys are behind your abdominal organs, closer to your back. Your ureters attach your kidneys to your urinary tract. Pain in these organs might feel like it’s in your back or wrap around to your front, or both.
• Heart or lungs. Sometimes pain in your chest can be referred to your upper abdomen. That means the nerve pathways that tell your brain where it hurts may tell you it’s there. This pain may involve your heart or lungs.

Note: Because of the way chest pain can be referred to your abdomen, occasionally a heart attack may mimic a stomachache. If you have a stomachache accompanied by shortness of breath or a tight, squeezing feeling, it might be your heart. Seek medical attention right away.

What are the different types of upper abdominal pain?

Once you’ve located the pain in your upper abdomen, your healthcare provider will try to further narrow down just where it hurts. For example, they might ask if your pain is in your:

• Upper left. Your upper left quadrant is separated from the right by your sternum. This is where your stomach lives. Your pancreas passes behind it, and your spleen is on the far left.
• Upper right. Your upper right quadrant contains most of your biliary system, including your gallbladder on the far right, half of your pancreas and most of your liver and bile ducts.
• Upper middle. Your stomach and liver overlap with your pancreas in the middle of your upper abdomen. Healthcare providers call this the epigastric region. Epigastric pain could relate to your biliary system or digestive system.

Your healthcare provider may also ask you to describe the type of pain you feel. They may ask if it feels:

• Mild, moderate or severe.
• Dull or sharp.
• Widespread or pinpointed.
• Burning or gnawing.
• Achy or crampy.
• Steady, progressive or colicky (coming in waves ).

You should also tell them if you have repeat episodes of the same pain at certain times or under certain circumstances. For example, you may feel it more:

• After eating.
• After lying down.
• When you bend over.
• When you lift something.

What are the most common causes of upper abdominal pain?

Some of the most common causes include:

• Indigestion. Epigastric pain after eating is one of the defining features of indigestion, particularly with a burning quality. That quality is usually related to stomach acid during digestion. It may be accompanied by gastroesophageal reflux disease (GERD) and heartburn.
• Abdominal muscle strain. A pulled stomach muscle is a common injury. You can get it from lifting, from sports or exercise or even from coughing. An upper abdominal muscle strain is a common cause of upper abdominal pain. Muscle pain tends to have an achy quality.
• Peptic ulcer disease. Erosion by stomach acid or by a common bacterial infection can cause ulcers (sores) in your stomach and duodenum. A stomach ulcer typically causes a burning, gnawing and penetrating type of stomach pain.
• Hernias. A hernia happens when one of your internal organs or tissues pushes through an opening in the muscle wall that usually contains it. A hernia may cause pain when it gets stuck or pinched poking through the opening. Most hernias are abdominal.
• Gallstones. A gallstone that’s gotten stuck somewhere in your biliary tract is a common cause of gallbladder pain and inflammation, and also pancreas inflammation (gallstone pancreatitis). It causes biliary colic — intense abdominal pain that rises to a peak and then slowly subsides. It occurs in episodes, often after eating.
• Upper abdominal pain in pregnancy is common as the fetus grows and begins pushing against your upper abdominal organs. It’s also common to have growing pains from stretching muscles, ligaments and tissues. Persistent, severe or sharp pain may be a warning of pregnancy complications.

Other possible causes include:

• Liver disease. Pain in your liver is usually from inflammation (hepatitis), which has many causes, both chronic and acute. Acute causes, such as toxic or alcohol-induced hepatitis and viral hepatitis infection are more likely to cause pain. Liver cancer is a less common cause.
• Pancreas diseases. Pancreatitis has several causes besides gallstones. More rarely, pancreatic cancer can cause pain in your pancreas. You might feel pancreas pain in your back or in the middle or upper left side of your abdomen.
• Stomach diseases. A passing stomach bug or viral infection may cause temporary inflammation in your stomach and sometimes in your intestines (gastroenteritis). Other conditions can cause longer-lasting inflammation and pain in your stomach. Autoimmune disease, bile reflux and stomach cancer are some of these less-common causes.
• Intestinal obstructions. An obstruction in your colon or in your small intestine where they pass through your upper abdominal region may cause pain there. Backed-up food and gas may cause bloating and swelling that presses against other organs, making the pain feel more widespread.
• Enlarged spleen. A swollen spleen may be the cause of upper left abdominal pain. Infections and liver disease are common causes. If you’ve been injured near your spleen, beware that it may rupture and bleed. A ruptured spleen can cause dangerous internal bleeding and is a life-threatening medical emergency.
• Upper urinary tract and kidney diseases. An infection in your kidneys or in your ureters where they connect to your kidneys will cause inflammation and pain there. So would a kidney stone. Pain in your kidney region might begin in your back and spread to the front.
• Peritonitis. Inflammation in your peritoneum may cause diffuse pain throughout your abdomen. It’s usually caused by a bacterial infection, but can also be caused by a loss of blood flow to the tissues (mesenteric ischemia).
• Heart and lung conditions. Less commonly, a condition in your chest affecting your heart or lungs may refer pain to your upper abdomen. This might include a pulmonary embolism, chest infection, heart attack or pericarditis.

How can I relieve upper abdominal pain?

Not all causes of upper abdominal pain can be effectively treated at home. If it seems like a simple case of indigestion, over-the-counter (OTC) antacids may relieve it. For general pain and inflammation, NSAIDs (nonsteroidal anti-inflammatory drugs) such as aspirin or ibuprofen might help. But these aren’t long-term solutions for persistent pain. If you need pain relief often, or if it’s not working well enough, you should see a healthcare provider about it.

How do healthcare providers treat upper abdominal pain?

A healthcare provider will ask questions about your health history and physically examine you. They may also run tests to narrow down the cause of your upper abdominal pain. These might include imaging tests of your tissues and organs and blood tests that check for infections and inflammation. They’ll offer you a treatment plan based on their diagnosis.

How do I know if my upper abdominal pain is serious?

You can’t always tell how serious abdominal pain is by how you feel. Some serious conditions only cause mild symptoms, and some temporary conditions can be very uncomfortable or painful while they last.

If you have persistent or recurring pain, it’s always a good idea to check with a healthcare provider about it. Seek medical care for severe or worsening pain, or for pain accompanied by red flag symptoms, such as:

• Blood in your poop or vomit.
• High fever.
• Dizziness or confusion.
• Trouble breathing.
• Jaundice (yellowing of your skin and the whites of your eyes).
• Pain worsening with exercise.
• Visible swelling in your abdomen.

A note from Cleveland Clinic

Abdominal pain can be tricky to diagnose, even for healthcare professionals. There are many possible causes, both common and obscure. Healthcare providers try to narrow it down by learning as much as they can about your pain. Locating the pain in your upper abdomen is a great start. They’ll also want to know if it’s more on one side, how often it occurs or in what circumstances, and what the quality is like.