Why does my stomach keep hurting?

"Stomach pain" covers an enormous amount of ground. The abdomen holds the stomach, small and large intestine, liver, gallbladder, pancreas, kidneys, and — in women — the uterus and ovaries. So the first question in any consultation is rarely "how bad is it". It is where, when, how long, and what it travels with.

Two features do most of the sorting. Where the pain sits points to an organ. How long it has been going tells you how urgently to act: pain of hours to days is a different problem from pain that has come and gone for months.

Around the navel, crampy, easing after passing stool. This is the pattern of the small and large intestine and, over months, most often reflects a functional bowel disorder. Irritable bowel syndrome typically produces cramping that fluctuates through the day, relates to meals and bowel habit, and comes with bloating and unpredictable stools. The bowel is structurally normal; it is moving and reporting differently.

Upper central, burning, related to meals. This is stomach and duodenum territory: acid-related pain, functional dyspepsia, ulcer disease, or H. pylori infection, which remains common in India. Regular painkillers such as ibuprofen or diclofenac belong on this list — they are among the most frequent contributors and the most frequently forgotten.

Upper right, coming in waves after a rich meal. Gallstones classically produce a build-and-fade pain under the right ribs, sometimes reaching the back or the right side, often an hour or two after a heavy or fried meal. Gallstones are common in North India, particularly in women.

Lower abdomen, cyclical or one-sided. In women, period-related pain, ovarian cysts, endometriosis and pelvic inflammation all present as recurring lower abdominal pain and are frequently attributed to the gut for years before anyone asks about the menstrual cycle.

The one most often missed. Chronic constipation produces genuine, recurring, crampy pain along the left side and lower abdomen. If stool is passing infrequently or incompletely, the pain will keep returning until that is addressed, whatever else is tried.

Less commonly, pain comes from the kidneys and urinary tract, the pancreas, an abdominal wall muscle or nerve rather than anything inside, or inflammatory bowel disease. That last group is a smaller share, but it is the reason recurring pain is assessed rather than assumed.

ⓘThis information is educational and not a diagnosis.

Abdominal pain has a clearer set of emergency features than most symptoms, and they are worth knowing precisely.

Go to an emergency department, not a clinic appointment, if pain came on suddenly and is severe and worsening; if the abdomen has become rigid and hurts to touch or to move; if pain comes with fever and vomiting that stops you keeping fluids down; if you have vomited blood or passed black tarry stools; or if the eyes or skin have turned yellow. Severe lower abdominal pain in a woman with a missed period or with vaginal bleeding also needs same-day assessment.

For pain that has been recurring rather than sudden, arrange a proper appointment if it wakes you from sleep every night, if you are losing weight you did not intend to lose, if there is a lump you can feel, if pain began for the first time after the age of 45, or if it has changed character — a familiar ache that has become sharper, more constant, or has moved.

It is also entirely reasonable to see a doctor simply because pain has been going on for weeks and is shaping how you eat, work and sleep. Recurring pain does not have to be dangerous to be worth solving.

Spend two weeks keeping a record, because pain is the symptom people describe least accurately from memory. Note where it is, what it feels like, how long each episode lasts, what you had eaten, what your bowels did, and — for women — where you are in your cycle. Marking the site on a simple body outline is more useful than any adjective.

Then address the two commonest amplifiers. Sort out constipation if it is present, with fluid, fibre and appropriate treatment; a surprising amount of recurring left-sided pain settles with nothing more. And review painkillers: regular ibuprofen, diclofenac or combination powders for headache, back or joint pain are a common cause of upper abdominal pain, and that is worth raising with your doctor rather than adjusting alone.

Give meal timing an honest trial. Long gaps followed by one large late meal provoke both acid-related and functional pain. Regular, moderate meals for a fortnight is a cheap experiment with a real success rate.

If pain persists beyond four to six weeks, the useful next step is a structured assessment rather than a longer list of avoided foods — a careful history, examination, targeted blood tests, and imaging or endoscopy where the pattern points that way. Bring your two weeks of notes. They shorten the process considerably.