When to Go to the ER for Stomach Pain

It's hard to know when stomach pain is due to something serious. As a general rule of thumb, you should go to the ER for stomach pain if it's severe, very sudden, radiates to other parts of your body, or is accompanied by symptoms like vomiting or chills. But some harmless causes - like gas pain - can feel severe and very painful. And other more serious causes - like appendicitis - can sometimes feel mild.

Let's take a closer look at the signs and symptoms to look for that can help you decide if it's time to go to an ER to get checked out.

How do you know when abdominal pain is serious?

Serious abdominal pain can show up in all sorts of ways. Some signs that there might be a more serious problem include:

• Severe pain: This is one of the main ways your body tells you something is wrong. Abdominal pain is more concerning if you feel like moving or being touched will make the pain much worse.

• Bleeding: Vaginal bleeding, rectal bleeding, bloody stool, bloody vomit, or bloody urine are all concerning - especially when paired with abdominal pain.

• Whole-body effects: If your stomach pain starts to feel like it's affecting your whole body, this can be a red flag. Examples include fever, shaking chills, sweating, chest pain, shortness of breath, or severe weakness.

• Low blood pressure: This can be a sign of dehydration, internal bleeding, or worsening infection. People with low blood pressure often feel faint, dizzy when they sit or stand up, or extremely weak.

With this in mind, reasons to go to the ER for stomach pain include:

• Severe, prolonged, or worsening abdominal pain

• Fever

• Sweating or chills

• Fainting or feeling like you might faint

• Any type of bleeding

• Large amounts of diarrhea, especially if it's bloody or looks like black tar

• Nonstop vomiting

• Extreme bloating, especially if you can't pass gas or stool

• Inability to urinate or significant pain or blood with urination

• Pregnancy or possible pregnancy

Causes of abdominal pain that are medical emergencies

There are many different organs in your abdomen, and even more things that can go wrong with each of them. This means the list of causes of serious stomach pain is quite long.

Let's review some of the more common causes of serious abdominal pain.

Appendicitis

Appendicitis happens when the appendix - a small part of your colon - gets infected. It's common, with about 1 in 20 people developing it at some point in their lives. It's also the most common reason people end up in the operating room after having abdominal pain.

When you have appendicitis, the pain will be localized to the lower right side of your belly, and you'll likely lose your appetite. If you have symptoms of appendicitis, go to the emergency room right away. If appendicitis isn't caught early, it can cause your appendix to burst. This is a medical emergency that can lead to a serious abdominal infection.

Diverticulitis

Diverticulitis is another common cause of abdominal pain. It happens when pockets in your colon wall (diverticula) become infected with bacteria. Diverticulitis can happen anywhere along your colon. Most of the time it occurs on the left side of your lower abdomen.

If left untreated, diverticulitis can lead to severe infections, small holes in your colon, or abscesses. Diverticulitis is usually treated with antibiotics, but in very severe cases, surgery may be needed.

Bleeding

Imagine if you were bleeding but couldn't see it. Your bleeding would likely go on for days, causing you to lose large amounts of blood. This is what happens when you have internal bleeding from your gastrointestinal (GI) tract. GI bleeding can be a real medical emergency. If you notice blood in your stool or if your stools turn dark black or tarry, go to the ER right away.

Other causes of serious abdominal pain

There are many other causes of serious abdominal pain, including:

• An infected gallbladder from gallstones

• Heart attack (this can sometimes cause pain in your stomach area)

• Bowel obstruction (when the intestines get blocked)

• Pancreatitis

• Internal bleeding

• Ischemic bowel (when blood supply to your gut is cut off)

• Kidney stones

• Kidney infection or UTI

• Ovarian torsion

• Ectopic pregnancy or miscarriage

• Aortic aneurysm or dissection

Because there are so many causes of medical emergencies, it can be tricky to know whether your symptoms are serious. If you need a quick guide, this brief screen may help:

• Is the pain severe? If the pain is a 10 out of 10 - the worst pain you've ever felt - go to the ER.

• Are you experiencing any fever, dizziness, unexpected bleeding, or uncontrollable vomiting? If yes, go to the ER.

• Are you pregnant or could you be pregnant? Always get evaluated right away if you have abdominal pain during pregnancy.

Causes of abdominal pain that do not require a trip to the ER

Stomach pain is a very common symptom. And you're probably better at figuring out if it's serious than you think. Most likely, there have been many times when you experienced belly pain and knew it would pass on its own.

You'll likely recognize some of these common causes of stomach pain that don't require a trip to the ER:

• Heartburn: This common condition may cause a burning sensation in your upper abdomen (around your esophagus).

• Gas pains: Gas can cause pain in a specific part of your belly, or you can feel it all over your belly at once. Gas pain can also make your belly feel swollen or tight.

• Menstrual cramps: This is another common cause of abdominal pain in women. Menstrual cramps can feel like a sharp or dull pain in your lower abdomen.

• Constipation: When you're constipated and not having frequent bowel movements, stool can back up in your colon. This causes pain throughout your belly.

• Diarrhea: This causes more frequent bowel movements and cramping pain in your lower belly. Cramping pain usually gets worse right before a bowel movement and improves afterward.

• Urinary tract infection (UTI): A UTI can cause pain in your lower back or lower abdomen. Other key symptoms are burning when you pee and peeing more frequently than usual.

Of course, there are times when you should still have a healthcare professional check these issues. But this can usually happen in your primary care provider's office rather than the ER.

The hard part is that more serious conditions can sometimes cause similar symptoms. So, if the pain feels new and there's no obvious explanation, it might be time to head to the ER.

ER vs. urgent care for abdominal pain

The ER is usually the better place to go for stomach and abdominal pain. That's because they can do much more testing and treatment.

In general, the ER is better if you think you might need any of the following:

• Pain medication

• IV (intravenous) fluids

• Close monitoring

• Blood tests

• Imaging, particularly a CT scan or ultrasound

In many cases, healthcare professionals in urgent care settings will send people to the ER if the abdominal pain is severe or worrisome.

What does the ER do to check abdominal pain?

Any visit to the ER starts with a review of your symptoms, vital signs, and a physical exam. This helps an ER healthcare professional gather important information about what might be causing your abdominal pain.

Since the abdomen has many organs, you may need other tests to find the specific cause. These may include:

• Urine sample: This checks for blood, infection, and pregnancy.

• Blood tests: This includes things like a CBC (complete blood count) to look for signs of infection or blood loss. An electrolyte (metabolic) panel can check liver, kidney, blood glucose, and electrolyte levels.

• Imaging: An X-ray, ultrasound, or CT scan are the most common ways to get a picture of what's going on inside your abdomen.

What is the average cost of an ER visit for abdominal pain?

Each ER visit is different, so estimating the cost is difficult. But your out-of-pocket cost depends on:

• The testing you need, like blood tests and imaging

• The treatment you receive, like fluids, pain medication, or antibiotics

• Your insurance status and type

• Whether you've met your deductible

The good news is that ERs are focused on providing care when it's needed. They will never turn you away based on your ability to pay.

Billing typically happens after your visit and generally includes three cost areas:

• Copayment: Depending on your insurance, this often ranges from $50 to $250.

• ER costs: This covers the facility, testing, nursing care, and treatment.

• Physician costs: Sometimes the cost of the consultation fee is billed separately from the ER bill.

Frequently asked questions