Stomach Pain: When to Go to the ER

Stomach pain is one of the most common reasons people wonder: should I go to the ER, or wait it out? The tricky part is that how much it hurts doesn't always tell you how serious it is. A stomach bug can cause very strong cramps and then pass, while appendicitis can start as a mild ache. What matters more is where exactly the pain is, how it changes over time, and what comes with it. This guide sorts it by location, then sets out the signs that mean calling 911 or going to the ER now.

When is severe abdominal pain a reason to worry?

Call 911 for

• Sudden, severe pain with fainting, collapse, severe dizziness, or cold, pale skin.
• Vomiting blood, or vomit that looks like coffee grounds.
• Black, sticky, very foul-smelling stools, or heavy bleeding from the bottom.
• A rigid, board-hard belly that hurts badly with any touch or movement.
• Upper belly pain with chest pressure, breathlessness, sweating, or pain spreading to the arm or jaw.

Go to the ER now for

• Pain that is severe, came on suddenly, or is getting worse hour by hour.
• A belly that hurts when pressed, or pain that gets worse when you walk or cough.
• Fever with severe abdominal pain.
• Repeated vomiting that stops you keeping fluids down, or green vomit.
• A swollen belly with no stool or wind and vomiting: this can be a bowel obstruction.
• Being unable to pee.
• Pain after a blow, crash or fall, even if it seemed mild at first.
• Pregnancy or possible pregnancy, with any severe pain or bleeding.
• Sudden pain in a testicle or the scrotum, even if the pain feels mostly in the belly.
• Having diabetes and vomiting.

Same-day urgent care for

• Moderate pain that isn't improving, or keeps coming back.
• Burning or pain when peeing, or peeing often with lower belly pain.
• Diarrhoea or vomiting with mild dehydration: thirst, dark and scanty urine, dizziness on standing.
• Pain under the right ribs after fatty meals that eases and then returns.

Home care is usually fine for

• Mild cramps with wind or bloating that ease after passing wind or opening your bowels.
• Mild heartburn after a heavy meal that settles within hours.
• A mild stomach bug while you are drinking well and peeing normally.
• Your usual, familiar period pain.

Even with mild symptoms, see a doctor if discomfort lasts a week or longer, pain doesn't improve within 24 to 48 hours, bloating lasts more than 2 days, diarrhoea lasts more than 5 days, or you are losing weight without trying.

What does the location of your stomach pain mean?

Where it hurts gives the doctor the first clue about which organ is involved. Pain spread over most of the belly is more often a stomach bug or wind, while pain fixed in one spot points more to a problem in a specific organ, such as the appendix, gallbladder or stomach. This table is a rough guide, not a substitute for an examination:

Lower right abdominal pain: is it my appendix?

Appendicitis is the best-known serious cause of pain low on the right. The usual pattern is a vague ache around the navel that moves over several hours to the lower right, becomes sharper and more constant, and gets worse with walking, coughing or bumps in the road, along with loss of appetite, nausea and sometimes a mild fever. Don't wait until the pain is unbearable: an inflamed appendix can burst. Full details are in our guide to appendicitis symptoms in adults and children.

Upper abdominal pain after eating: stomach, gallbladder or heart?

Burning in the upper middle of the belly after a big, fatty or spicy meal is usually indigestion or reflux. Pain under the right ribs that starts after eating and lasts an hour or more, sometimes spreading to the back or right shoulder, suggests gallstones. Add a fever or yellowing of the skin or eyes and it becomes an emergency. Severe, constant upper pain that bores through to the back, with vomiting, can be pancreatitis and needs the ER.

If the pain started after very spicy food, with vomiting or chest pain, see our guide to chest pain or vomiting after spicy food. Most importantly, upper belly pain can come from the heart, especially in older adults, women and people with diabetes. If it comes with chest pressure, breathlessness or sweating, call 911, and read our guide to chest pain and when to go to the ER.

Side pain that moves to the groin: is it a kidney stone?

Waves of severe pain in the side or back below the ribs, spreading to the lower belly and groin, that keep you moving because no position is comfortable, is the classic picture of a kidney stone. Blood in the urine and nausea are common. Any fever or shivering with this pain means the ER, now. Read more in our guide to kidney stone symptoms and when to go to the ER.

Lower abdominal pain in women: when is it an emergency?

For any woman who could be pregnant, the first question with lower belly pain is: could I be pregnant? An ectopic pregnancy usually causes symptoms between the 4th and 12th week of pregnancy: pain low down on one side, vaginal bleeding or a brown watery discharge, and sometimes pain in the tip of the shoulder. With sudden, sharp pain and feeling very dizzy, fainting or looking very pale, the fallopian tube may have ruptured: call 911 at once. A twisted ovary or a burst ovarian cyst can also cause sudden, severe one-sided pain with vomiting, and also needs the ER.

Any severe abdominal pain during a known pregnancy, at any stage, needs prompt assessment.

Cramping all over with vomiting or diarrhoea

Cramps that come and go all over the belly, with diarrhoea or vomiting, are usually a stomach bug or food poisoning, and usually improve within a day or two. The real risk here is dehydration. Learn the signs that need a visit in our guide to food poisoning and when to go to the ER. Cramping with a belly that keeps swelling, no stool or wind, and vomiting can mean a bowel obstruction, especially if you have had abdominal surgery before or have a hernia. That needs the ER.

Constipation is a very common cause of belly pain and bloating, often low on the left. It usually improves with fluids, fibre and moving about, and a pharmacist can suggest a suitable treatment. But don't take laxatives if the pain is severe or you don't know the cause.

Stomach pain in children, older adults and people on weight-loss injections

Children

Most tummy aches in children are constipation or a stomach bug. But go to the ER if a child doesn't want to walk or jump because of the pain, the pain moves to the lower right, the vomit is green, they are very drowsy, pale or peeing much less, or they have bouts of screaming while drawing their knees up to the belly. In boys, belly pain can actually come from a twisted testicle, so always ask about pain or swelling there.

Older adults

In older adults, symptoms can be milder than the illness deserves, and fever may not appear even with a serious infection. Causes such as an aortic aneurysm, reduced blood supply to the bowel, diverticulitis and heart problems also become more common with age. So take any new, severe belly pain in someone over 60 more seriously, get it checked the same day, and call 911 if it comes with dizziness or fainting.

People on Ozempic and other GLP-1 medicines

Nausea and mild discomfort are common on medicines such as Ozempic and Mounjaro, especially after a dose increase. But severe, constant upper belly pain that goes through to the back, pain under the right ribs with fever or yellowing, or vomiting that stops you keeping fluids down needs urgent assessment to rule out pancreatitis, gallbladder problems or dehydration. See our guide to the Ozempic warning signs that need emergency care.

What should you do while you decide?

• Sip water or clear fluids in small amounts.
• Avoid solid food for a few hours, then start with light foods. Stay away from heavy, fatty, fried or spicy meals, caffeine and fizzy drinks.
• Don't take laxatives or suppositories if the pain is severe, low on the right, or comes with vomiting: if it is appendicitis or a blockage, they can make things worse.
• Avoid ibuprofen and aspirin, which can irritate the stomach. Paracetamol is safe for most people, but check with a pharmacist.
• If you have diabetes, check your blood sugar regularly while you are ill.
• Watch: is the pain getting worse? Is it settling in one spot? Has a fever appeared? Any of these means getting checked.
• If you need the ER and the pain is severe, don't drive yourself: ask someone to take you, or call 911. Bring a list of your medicines.

Jordan's emergency number is 911. For more on choosing between the two, see our guide to ER vs urgent care.

Urgent care or the ER? What happens when you arrive

If the pain is moderate and there are no warning signs, urgent care sees walk-ins around the clock. With severe or worsening pain, fever with pain, ongoing vomiting, pregnancy or any of the red flags above, go straight to the emergency department. Critical cases are seen first.

The doctor starts with questions: where the pain started, whether it has moved, when it began, what makes it better or worse, whether you could be pregnant, and what medicines you take. Then they examine your belly. They may order blood and urine tests, a pregnancy test for women, and an ultrasound or X-ray, all available on site. Based on the results, the doctor decides whether this can be managed at home, or whether you need a test or treatment that isn't available on site, in which case the team will tell you where to go.

Sources

• NHS — Stomach Ache
• MedlinePlus — Abdominal Pain
• Cleveland Clinic — Abdominal Pain: Causes, Types and Treatment
• NHS — Ectopic Pregnancy