Abdominal Pain: What Can Wait and What Cannot

Abdominal pain becomes an emergency when it is sudden and severe, when it is constant rather than coming in waves, when the abdomen goes rigid or hurts at the lightest touch, or when it comes with fever, persistent vomiting, no gas or stool passing, or blood. Those situations need a hospital, not a home visit. Pain that fluctuates, eases after opening the bowels, and leaves the person otherwise well usually points to a benign digestive cause.

Six questions that steer the diagnosis

Before any examination, the way the pain behaves already tells you a great deal:

1. Where? Pain starting around the navel and moving down to the right is classic for appendicitis. Pain under the right ribs suggests the gallbladder; flank pain radiating to the groin suggests a kidney stone.
2. How long, and how did it start? Pain that arrives within seconds is more worrying than pain that builds over hours.
3. Constant or in waves? Colic comes and goes; constant, increasing pain suggests inflammation.
4. What changes it? Relieved by passing stool or gas: more likely functional. Worse with any movement or a car journey: suggests peritoneal irritation.
5. What comes with it? Fever, vomiting, diarrhoea, blood, burning urine, a missed period.
6. Any history? Previous abdominal surgery (risk of adhesion obstruction), ulcer, known stones, inflammatory bowel disease.

When to call the emergency services (15)

• Sudden, stabbing, very severe pain.
• A board-like abdomen, unbearable to touch.
• Abdominal pain with faintness, pallor, sweating, a fast pulse.
• Vomiting blood, or black tarry stools.
• Upper abdominal pain with chest pain or breathlessness — a heart attack can present this way.
• Pain in a woman of childbearing age with a missed period and faintness: ectopic pregnancy is a life-threatening emergency.

When to go to a hospital emergency department

• Pain localised to the lower right, building over hours, particularly with fever: suspected appendicitis.
• No gas or stool passing, a distended abdomen and vomiting: suspected obstruction.
• Pain under the right ribs with fever and jaundice.
• Flank pain with fever and burning urine: suspected kidney infection.
• Recent abdominal trauma, even without a visible wound.

These need an ultrasound, a scan or blood tests. No home examination substitutes for that.

When a home consultation fits

• Diffuse cramps with diarrhoea, in the context of gastroenteritis or a dietary indiscretion.
• Long-standing, familiar pain that matches previous episodes.
• Painful constipation with gas still passing.
• Burning urine with pain above the pubic bone, without fever or back pain.
• Moderate, fluctuating pain in someone eating, drinking and moving normally.

The classic mistake while you wait

Do not take anti-inflammatories or aspirin for unexplained abdominal pain: they can worsen an ulcer and mask the signs of a surgical emergency. Paracetamol is safer. Avoid a hot water bottle on pain that is increasing, and do not eat until a surgical cause has been excluded — if an operation is needed, a full stomach delays it.

What the doctor does on a home visit

They palpate the abdomen quadrant by quadrant, look for guarding or rigidity, test rebound tenderness, listen for bowel sounds, take temperature and blood pressure, and check the urine if relevant. The main aim is not always treatment: it is often to answer one question — does this need hospital now? A clear answer to that, given at the bedside, prevents as many unnecessary journeys as it triggers necessary ones.