When Abdominal Pain Becomes an Emergency

Many things can cause pain in the abdomen. Sometimes, it’s a minor problem, like a virus or a stomachache from something you ate. Other times, abdominal pain can be a sign that you need immediate medical attention.

How can you tell the difference? The type of pain, the location of your pain, and accompanying symptoms can help you determine if you need a visit to an urgent care or emergency room (ER).

Should I go to the emergency room?

Mennatallah Omar, MD, general surgeon at ProMedica, says there are some warning signs that shouldn’t be ignored. If you experience any of these along with abdominal pain, you should seek immediate medical attention: 

• Severe or worsening abdominal pain 
• Fever 
• Persistent nausea or vomiting 
• Inability to pass gas or have a bowel movement 
• A rigid or extremely tender abdomen 
• Dizziness, confusion or a rapid heart rate 

“If someone has severe pain, they can't get comfortable at home, they can't fall asleep — that's severe enough that they shouldn’t wait and see what happens,” says Dr. Omar. “The faster it gets diagnosed and treated, the better outcome the patient will have.” 

If your pain is keeping you from getting comfortable, sleeping or carrying out normal daily activities, it’s time to seek medical evaluation.

Common Medical Emergencies: Appendicitis, Gallbladder Disease, Hernia  

One reason people delay getting care is because of the fear of surgery. Not all abdominal pain is a surgical emergency, but sometimes, surgery is the best course of treatment.  

Appendicitis, gallbladder disease and hernias are among the most common conditions that require emergency surgical care.  

Is it appendicitis? 

The appendix is a small pouch at the end of the large intestine. If you have appendicitis, it means that your appendix is swollen and infected. 

“Appendicitis often causes pain that begins near the belly button before moving to the lower right side of the abdomen. An untreated appendix can rupture, so it’s important to go to the ER” says Dr. Omar. 

Acute appendicitis that causes this type of pain doesn’t usually have any preventable risk factors; it just happens. However, the condition does tend to occur more often in young adults rather than those in middle or older age.  

Younger adults tend to delay care as they push through the pain. Older adults may show unusual or vague symptoms, such as confusion or the inability to eat. Recognizing the symptoms and getting quick care is important to avoid an appendix rupture. 

Is it gallbladder disease? 

Gallbladder disease may cause pain in the upper right abdomen, particularly after eating fatty foods. This is because the gallbladder helps digest fats. 

Gallbladder disease is a term used to describe many problems with the gallbladder, including infection or the formation of gallstones.  

“Sometimes patients will experience gallbladder attacks that may last for hours, and then they go away on their own,” says Dr. Omar.  

When that happens, a patient may choose to have surgery to remove the gallbladder later. If the pain is accompanied by other warning signs, such as severe pain, fever, nausea or vomiting, urgent medical care is important. Surgery may be needed to remove the gallbladder as soon as possible. 

“If left untreated, gallbladder disease can lead to a tear in the organ or gangrene,” Dr. Omar explains.  

Gallbladder disease tends to be more common in women during their fertile years, as pregnancy can increase the risk of the disease. There’s also an increased risk with obesity.  

Is it a hernia? 

“A hernia is a weakness in the abdominal wall,” says Dr. Omar. “It will typically present with a very tender mass at the site of the hernia.” 

The most common sites for hernias are the groin and belly button.  

Not all hernias are an emergency. Sometimes a hernia can cause no symptoms, so patients may want to keep an eye on it with medical monitoring. A hernia with severe pain, nausea, fever, vomiting and a tender mass that cannot be pushed back in is an emergency. 

A hernia can trap part of the intestine and cut off its blood supply. The bowel could burst or tear. Seeking care early often helps prevent these complications and may lead to a smoother recovery. 

Risk factors for a hernia include obesity, smoking, a history of chronic obstructive pulmonary disease, or a history of heavy lifting. Anything that increases the pressure within the abdomen can increase your risk.  

How is abdominal pain diagnosed? 

The abdomen includes all the organs between the bottom of the ribs and the top of the pelvic bones. This includes the stomach, liver, gallbladder, pancreas, intestines and appendix.  

When there’s pain in the abdomen, medical professionals must consider many organs and types of conditions that could be causing the problem. 

If you arrive to the emergency room with abdominal pain, they will ask you questions about your symptoms and health history. Imaging tests, such as an ultrasound or CT scan, will likely be needed to get a better look at your organs to see if they are healthy.  

Advances in Surgical Care

Surgery is not always needed for abdominal pain, but sometimes it can be the best treatment. Whether the surgery is emergent or elective, surgical advances have made it easier for patients to recover.  

Minimally invasive surgery can be used to remove the gallbladder or appendix. These surgeries require a few small openings for surgical tools. Robotic-assisted surgical systems can also help surgeons be incredibly precise with their movements.  

For patients, that often means less pain, shorter hospital stays and a faster return to normal activities. Most of Dr. Omar’s patients are back to normal within one or two weeks.  

Don’t Delay Treatment 

No one wants to make an unnecessary trip to the emergency room. However, physicians would much rather evaluate a patient early than treat a condition that has progressed because symptoms were ignored. 

When it comes to abdominal pain, trust your instincts. If symptoms are severe, worsening or simply don't feel right, seeking medical attention sooner rather than later could prevent a minor problem from becoming a major one.  

Dr. Omar says, “Listen to your body. If there’s a problem, getting it treated quickly will typically mean a smoother process with fewer complications.” 

Mennatallah Omar, MD
This article was reviewed for accuracy by Dr. Omar. Dr. Omar is a general surgeon at ProMedica who specializes in minimally invasive surgery, hernia surgery and surgeries in the upper digestive tract. View her profile.