woman lying on her side and holding her stomach

What to do if you have a stomachache

Suneeta Krishnareddy, MD
Suneeta Krishnareddy. Photo by John Abbott.

When you tell a doctor you have a stomachache, the doctor will consider everything from the esophagus (which connects the throat and stomach) to the liver, gallbladder, and pancreas (digestive system) to the bladder and kidney (urinary system). Plus intestines. And reproductive organs.  

“Many things get clumped in to ‘stomachache,’” says gastroenterologist Suneeta Krishnareddy, MD, MS, assistant professor of medicine at Columbia University Vagelos College of Physicians and Surgeons. So preliminary assessment—triage—is key. 

Usually, says Krishnareddy, doctors break stomachaches down by time: How long has it being going on? Is it something new, acute, started in the past few days? Or is it a lifelong, chronic condition? Is this normal?

“A patient knows their body. The history of a patient is important and provides clues for a doctor,” says Krishnareddy, “and the more details you can give your provider, the better.” 

Questions a doctor may ask about stomachaches 

  • Do you have food intolerances or allergies? 
  • When and what foods do you eat? 
  • Are your bowel movements normal? 
  • Are you experiencing stress? 

“People who hold stress in their stomachs will always hold stress in their stomach,” says Krishnareddy. Treatment for this type of long-term pain may include a psychiatrist, alternative therapies such as acupuncture, or stress management.  

A primary care physician may refer a patient to a gastrointestinal specialist to confirm the diagnosis or if the issue is more complex. 

Home remedies for common stomachaches 

  • If you have indigestion, take an antacid, such as Tums.  
  • If you have diarrhea and no fever, take an antidiarrheic, such as Pepto Bismol or Imodium.

Avoid nonsteroidal anti-inflammatory drugs—ibuprofen (Advil, Motrin) and naproxen (Aleve)—when you have a stomachache. These drugs are hard on the stomach and can make a stomachache worse.   

When to see a doctor

If your stomachache or surrounding pain is severe, lasts more than two days, or if you have additional symptoms such as fever, weight loss, vomiting, or diarrhea, call your doctor.  

Many patients Krishnareddy sees expect the worst. But fewer than 2% of stomachaches are life-threatening or surgical emergencies. “We can always find the bad stuff,” says Krishnareddy, highlighting gallstones and pancreatic cancer, conditions that occur in less than 15% of the population. Most stomachaches, about 70%, are not severe.  

The trouble for GI docs comes with the 15% or so of stomachaches that fall in between. These not-so-bad stomachaches are harder to identify and treat because diagnostic tests for many do not exist. Therefore, many stomach conditions are categorized as irritable bowel syndrome (IBS). (Until tests were developed, celiac disease was included in this broad category).  

Krishnareddy advises that finding the right treatment for conditions labeled IBS may take some trial and error, so don’t be surprised if the problem isn’t solved at the first visit. Better diagnostic tests to identify other conditions should improve care in the future, and to achieve this goal, Krishnareddy is actively studying and analyzing inflammatory bowel disease and celiac disease with Columbia’s Division of Digestive and Liver Diseases in conjunction with the Department of Immunology & Microbiology. 

In the meantime, talk to your doctor to determine the best ways to keep your stomach healthy.

“Trying to treat chronic conditions with over-the-counter remedies will provide only partial relief,” she warns. 

References

Suneeta Krishnareddy, MD MS, is assistant professor of medicine in the Division of Digestive and Liver Diseases, Columbia University Irving Medical Center. She treats gastrointestinal disorders including inflammatory bowel disease, Crohn's disease, colitis, celiac disease, autoimmune enteropathy, and other autoimmune disorders of the gut. She is actively seeking volunteers to participate in clinical trials for management of Crohn's disease and ulcerative colitis as well as celiac disease.