The egg salad didn't taste quite right, but you were hungry. Or maybe your craving for cheesecake overrode the punishment you knew your lactose intolerance would inflict. You expect stomach distress in situations like these, but other times, abdominal pain can come out of nowhere. Sometimes it's severe enough or lasts for so long that you know it's not simply a matter of eating something that didn't agree with you.

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Digestive system issues account for 51 million visits to doctors' offices and emergency departments yearly, according to the Centers for Disease Control and Prevention (CDC). The severity of the pain, its location within your abdominal area, and accompanying symptoms may provide clues to the origin of the pain — and whether or not you should seek help immediately. Here, experts talk about the most common signs your tummy troubles need more than an over-the-counter remedy.

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Severe stomach pain after eating a fatty meal

If you find yourself doubled over after eating a high-fat meal, you may be experiencing a gallbladder attack. "Women are especially prone to gallbladder disease," says Hardeep Singh, MD, gastroenterologist from St. Joseph Hospital, Orange, CA. "Overweight women in their 40s are at highest risk." The pain becomes worse after eating, lasts 30 to 60 minutes and may come and go, becoming more constant and severe over time, says Singh.

Crampy pain with diarrhea or constipation

Lower "crampy" abdominal pain accompanied by bloating and diarrhea or constipation can be signs of irritable bowel syndrome (IBS), says Singh. "It's exceptionally common and affects 15% of the U.S. population, particularly younger women, although it can happen at any age." Symptoms of IBS can usually be controlled by managing diet, lifestyle and stress. Medication and counseling may be needed in some cases. 

Upper abdominal pain between the ribcage

If you develop an aching or stabbing pain or pressure in the upper abdominal area just under the ribs, this may indicate a heart-related problem, says Kristine Arthur, MD, internist at Orange Coast Memorial Medical Center in Fountain Valley, CA. "This is particularly true if the pain persists or you have other symptoms like shortness of breath. Many people blame these symptoms on heartburn or indigestion." While indigestion may be the case, anyone with risk factors such as diabetes or hypertension should see a doctor as soon as possible, Arthur says.

Severe, acute pain in the lower right side of the abdomen

​A sudden pain in the lower part of the abdomen may be signs of appendicitis. It may also be accompanied by a fever. Pain often begins around the belly button area and becomes worse with time. Vomiting or constipation or diarrhea along with the pain also indicate it's time to go to the emergency room. "If the pain is persistent and comes on rather suddenly over several hours or a day you should be seen by a doctor that day," says Arthur. Appendicitis often requires surgery. If left untreated, a ruptured appendix can be deadly.

Vague upper abdominal pain associated with nausea and belching

​In older patients, vague upper and mid-abdominal pain associated with nausea, burping and belching could be signs of a heart attack, says Robert Glatter, MD, emergency physician at Lenox Hill Hospital, New York, and national spokesman for the American College of Emergency Physicians (ACEP). "Obtaining a simple ECG and even ordering cardiac markers known as troponin may be lifesaving." Vomiting that occurs with back or jaw pain and shortness of breath may also indicate a life threatening emergency.

​Sudden and severe onset stomach pain

​When mid-abdominal pain occurs suddenly — especially in people with a history of peptic ulcer disease or in those who take excessive amounts of aspirin or NSAIDs — it could indicate a perforation, which is a surgical emergency, says Glatter. "Plus, the presence of free air and gastric contents can lead to a condition known as peritonitis. This may lead to septic shock as a result of contamination in the abdominal cavity." Such an event requires surgery to seal the leak.

Right or left lower abdominal pain in women

​Sudden onset of right lower abdominal pain or left lower abdominal pain can indicate a ruptured ovarian cyst in a woman who is mid-cycle, says Glatter. "Such pain could also indicate ovarian torsion (rotation of the ovary and portion of the fallopian tube), or even a twisted ovary as a result of a compromised blood supply." Seek treatment immediately at the nearest emergency department. Surgery to remove the ovary may be required.

Knife-like pain in the lower abdomen

​Pain that wraps around the lower stomach area, commonly accompanied by nausea,vomiting, fever and chills, may be a sign of kidney stones. Ultrasound or a CT scan is used to diagnose the stone, and NSAIDs provide some pain relief, says Glatter. "Rescue narcotics (potent, immediate relief drugs) may be required to relieve continued pain," says Glatter. "Alpha blockers (medications used to relax blood vessels and lead to increased blood flow) may also be helpful in allowing larger stones to pass."

Belly pain in the lower left side that's worse when you move

​Abdominal pain in the left lower area of the abdomen may signify diverticulitis, small pockets in the colon that can become obstructed and perforate, says Glatter. Traditional treatment includes antibiotics and stool softeners to reduce the risk of abscess formation. "Newer research suggests that antibiotics actually may not be required and simple pain medications such as acetaminophen may be enough," Glatter adds. 


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