Severe stomach pain: what it might mean and what to do

Sharp, crushing, sudden, or worsening stomach pain is not the same as a mild ache. It can come from the gut, gallbladder, pancreas, blood vessels, or even referred pain from the chest. You don’t need to be an expert to spot the dangerous signs. This page helps you figure out likely causes, simple first steps, and when to get emergency care.

Common causes and where the pain points

Location often gives a clue. Pain in the lower right side may mean appendicitis. Upper right pain could be gallstones or gallbladder attack. Pain in the center under your ribs (epigastric) can come from ulcers, pancreatitis, or severe heartburn. Sudden, severe pain that spreads across the belly may signal a bowel obstruction or perforation. Lower abdominal cramps can be constipation, pelvic issues, or, in women, gynecologic problems like an ectopic pregnancy.

Other common causes include food poisoning, gastroenteritis (stomach flu), and medications that upset the stomach. Some drugs—like certain birth-control or migraine medicines—can cause abdominal discomfort. If you’re tracking meds, jot down recent changes and show them to your clinician.

Red flags — get help right away

Call emergency services or go to the ER if you have any of these with the pain: fever over 101°F (38.3°C), vomiting blood or passing blood in stool, fainting or severe dizziness, difficulty breathing, a rigid or very swollen belly, or pain so bad you can’t sit still or find a comfortable position. Also, if you’re pregnant and have severe abdominal pain, seek care immediately.

If pain is severe but none of the red flags are present, see your primary care doctor within 24 hours. If it’s milder, keep an eye on it and make an appointment if it lasts more than a day, gets worse, or you can’t eat or drink.

At home, stop eating heavy foods, sip clear fluids, rest, and avoid NSAIDs if you suspect an ulcer or internal bleeding. Use a warm compress for cramping, but don’t apply heat if you suspect appendicitis or a ruptured organ. Don’t take laxatives if you think you have a bowel obstruction.

Keep a simple symptom log: when the pain started, what makes it better or worse, recent food, recent travel, and a list of medicines and supplements you take. Photos of bloody stools or a swollen belly can help clinicians assess the problem faster.

Want more reading? Our site has related guides that can help you explore causes and medication issues: "Understanding the Connection Between Chronic Constipation and Pelvic Floor Dysfunction" (constipation can cause severe pain), "Provera Birth Control: Uses, Side Effects, and What to Expect" (hormonal meds sometimes cause abdominal pain), "Topamax: Uses, Side Effects" (gastrointestinal side effects), and "Exploring Effective Alternatives to Cytotec" (misoprostol often causes cramping). These articles explain specific causes and what to watch for.

If you’re in immediate pain now, don’t wait. Call emergency services or go to the nearest emergency room.