Everyone has a stomach ache from time to time, but some symptoms warrant a visit to the doctor — or the emergency room.
Whether it’s nausea, heartburn, diarrhea, or gas pains, everyone is hit with stomach and abdominal woes sooner or later. Usually, you can tie your symptoms to overeating, a stomach virus that’s going around, or another likely cause. And if you recover fairly quickly, the odds are your self-diagnosis was right.
Doctors classify stomach pain as acute or chronic. Acute is when your pain lasts for a few days and gets progressively worse. Chronic pain comes and goes for months or years and remains relatively the same.
Chronic pain may not seem very troubling. But that doesn’t mean you should self-treat indefinitely when symptoms are persistent. For example, consider that burning feeling in your stomach that crawls up your esophagus — heartburn. Also known as acid indigestion, it’s caused by refluxed stomach acid that touches the lining of your esophagus, resulting in pain in the mid-chest, behind the breastbone, and sometimes in the middle of the abdomen, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Over-the-counter antacids will usually remedy heartburn symptoms. But if you have to take these medications more than twice a week, you should talk to your doctor. The reason? You may have gastroesophageal reflux disease (GERD).
Getting GERD under control with lifestyle changes, including losing weight, if needed, and taking strong acid quelling medications known as proton pump inhibitors (brand names include Prilosec, Nexium, and Prevacid) can help soothe your heartburn symptoms and help you avoid complications. Left untreated, GERD symptoms can damage the esophagus and make swallowing painful. Longstanding GERD may lead to a pre-cancerous condition known as Barrett’s esophagus, too.
Some stomach aches and upsets seem to go away only to return again — a sign you have a chronic condition and need to see a doctor. Irritable bowel syndrome (IBS) is one of the most common causes of recurring belly aches and either recurrent or chronic diarrhea, constipation, or both.
IBS affects between 25 and 45 million people in the US of all ages, including children, according to the International Foundation for Functional Gastrointestinal Disorders. Doctors don’t understand what causes the condition but NIDDK notes it may be the result of several factors, including how the gut, brain, and nervous system interact; bacterial overgrowth in the small intestine that produces extra gas and may cause diarrhea; and sensitivities to specific foods and infections of the GI tract. People with IBS are often affected by emotional stress, which can trigger symptoms, too.
While IBS can be just a mild inconvenience sometimes, it can also strike out of the blue and cause you to miss work and social activities. Although IBS doesn’t have a cure, your doctor can work with you on a treatment plan to manage symptoms with a combination of diet, medicines, probiotics, and strategies to help you manage stress.
Ulcerative colitis is a chronic disease that causes inflammation and swelling inside the large intestine. It often begins gradually, with symptoms becoming worse over time. Symptoms can also come and go during periods of remission that may last for weeks or even years.
Most people with ulcerative colitis have mild-to-moderate symptoms. However, about 10 percent of colitis sufferers have fever, bloody bowel movements, and severe abdominal cramping. If you have symptoms of ulcerative colitis, whether they are mild or not, it’s important to see your doctor.
While there’s no cure, medications can keep symptoms at bay and hopefully lessen the chances you’ll need surgery in the future to relieve severe symptoms. Treatment can also help induce and maintain remissions and improve your quality of life.
Any change in your bowel habits, including chronic diarrhea or constipation, and persistent abdominal discomfort should warrant a checkup with your doctor. And if you spot blood in your bowel movement, talk to your doctor. While many problems can cause those symptoms, including colitis and hemorrhoids, they also can be red flags for colon cancer. Talk to your doctor about being screened for colon cancer. The good news is that colon cancer spotted early can often be cured.
There are times when your stomach or abdominal pain can be a true emergency, such as acute pain that lasts for a few days and gets progressively worse. Causes include severe food poisoning, appendicitis, or an abdominal aortic aneurysm (AAA). A balloon-like bulge in an artery, an AAA can rupture, causing sudden severe lower abdominal pain, nausea, and shock. It is often fatal if not treated immediately, the National Heart, Lung and Blood Institute warns.
You should go to an emergency department if you have pain that’s so severe you can't sit still or you need to curl into a ball to find relief. In addition, if your pain is accompanied by bloody stools, persistent nausea, and vomiting, or a severely tender or swollen abdomen or yellowing of your skin, seek emergency treatment or call 911.
Seek medical care without delay if your stomach pain occurs during pregnancy or if you were recently injured in an accident involving your abdomen.
Many people — even doctors — have a hard time distinguishing between heartburn and a heart attack; the symptoms can be similar. If you have heartburn, you may have a sour taste in your mouth, regurgitation, or a burning sensation in your stomach after eating or lying down. Often your symptoms get better if you take antacids.
On the other hand, symptoms of a heart attack may include chest pain, indigestion, heartburn, abdominal pain, shortness of breath, cold sweats, and lightheadedness. These symptoms are typically different from simple heartburn, but most heart attacks aren’t textbook cases. Many people ignore initial warning signs of a heart attack, misinterpreting them as heartburn, and don’t get medical help when they need it.
If you aren’t sure about your symptoms, get medical help immediately. You’ll probably need special tests, such as an electrocardiogram, to make sure your chest and abdominal pain aren’t from a heart attack.
June 26, 2015
Christopher Nystuen, MD, MBA