Bellyaches: Red Flags and Reasons to See a Doctor

Modern life is busy, and visits to the doctor are generally the furthest thing from efficient.   Figuring out just when to see your physician is a challenge, especially in the internet era, in which we can convince ourselves in 5 minutes of googling that our minor nausea is in fact a rare parasite only found 5000 miles away.   With that in mind, today we will cover a few of the prototypical “red flags” for abdominal pain, and what you should do if these symptoms are happening to you.

There are two ways in which pain presents, acute and chronic.  First, let’s talk about the acute issues.  Acute sharp pain in your abdomen is generally worrisome, and depending on the degree of pain is enough to warrant a doctor’s visit all on its own.  However, the things that should get you mobilized to the emergency room include vomiting blood, inability to tolerate liquids, vomiting bile (bile will look green, either dark or very bright), or uncontrollable vomiting.   While I think most people know to go to the ER if they start vomiting blood, it’s important to know that this can be a manifestation of many diseases, and acutely life threatening.  If this happens to you, especially if there is no inciting factor (like having a nosebleed and swallowing a lot of blood) you need to head to the ER straightaway.

If you are unable to tolerate liquids, you need to present to the ER even if nothing serious is happening, as dehydration can absolutely become serious, and it raises the possibility that a serious medical issue is occurring.  This is the same reasoning behind seeing a doctor for uncontrollable vomiting. We can do something about it, and it can be dangerous or indicate that something serious is happening.  Vomiting bile is concerning for something called an “obstruction” in which a section of the intestine is blocked.  If you block the way out, everything comes back up the way in, and you will see significant abdominal pain, vomiting, and vomiting of bile.

Lastly, it’s worth noting that if you have severe abdominal pain associated with high fever, this could also indicate a serious infection, and you should see a physician.

Chronic abdominal pain works slightly differently.  Many of the causes of chronic pain are relatively benign, like functional abdominal pain, gas, or constipation.  However, there are many red flags that clue you in to needing to get to the doctor.  First and foremost, weight loss. If you are having chronic abdominal pain and unintended weight loss, you need to see a physician.  There are many possible causes of this, and many of them are quite unpleasant (such as celiac disease or inflammatory bowel disease), so getting to the doctor ASAP is a must.

Second, the location.  A persistent pain in your right upper quadrant could indicate an issue with your liver or gall bladder, which are slightly more important areas than your left lower side, which is most likely affected by gas pain.  As always, if your pain is really severe, go see a doctor even if the area of the pain isn’t too high risk.

Third, the timing.  If pain is waking you up from sleep, that’s a big deal.  A lot of abdominal pain can feel excruciating but once you’ve gone to sleep you can rest easy (see: Gas).  This usually indicates that you do not have a severe problem.  However, if pain persistently wakes you up, that is a great reason to drop into your doctor.

Last but not least is the presence of other symptoms.  Chronic abdominal pain with new or unexplained rash, unexplained fevers, ulcerations in your mouth or other sensitive areas, or joint pain is much more likely to be caused by a systemic illness like an autoimmune disease, and definitely suggests it is time to make the trip your doc.

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