Abdomen pain clinic: how abdominal pain is assessed, tested and treated

Abdominal pain is a symptom rather than a diagnosis, and the tummy holds the stomach, gallbladder, liver, pancreas, small and large bowel, kidneys, bladder and, in women, the womb and ovaries. A clinic dedicated to abdominal pain exists because working out which of these is responsible usually takes more than one test and more than one specialist viewpoint.

The clinical question is different for sudden and persistent pain. Sudden, severe pain is an emergency pathway through A&E or an acute surgical unit. A clinic is set up for the slower problem: weeks or months of cramps, burning, bloating or aching where the first round of GP blood tests has not given an answer. The aim is to rule out structural disease, name a functional cause if that is what it is, and give you a plan you can follow.

The people involved are typically a consultant gastroenterologist or consultant general surgeon, specialist nurses who run endoscopy and bowel services, radiologists who report the scans, and dietitians. Consultants complete general medical or surgical training followed by several years of specialist training in their own field. Gynaecologists, urologists and pain specialists are brought in when the cause points to the pelvis, urinary tract or nerve pain.

The same location of pain can come from very different causes, so the pattern matters more than the spot. The pain that is worse after eating and better after opening your bowels points towards the bowel. Pain in the upper middle that eases when leaning forward can suggest the pancreas. Severe pain just under the right ribs lasting several hours is typical of gallstones.

• Irritable bowel syndrome: cramps, bloating and a change in stool, with good days and flare-ups. The NHS notes that there is no single test for it; blood tests for coeliac disease and stool tests for infection and inflammatory bowel disease are used to rule other things out.

• Gallstones: biliary colic is typically severe, constant, lasts more than 30 minutes and may last several hours, in the middle of the tummy or under the right ribs, with nausea.

• Chronic pancreatitis: long-term inflammation and scarring causing upper abdominal pain that is often worse after eating, sometimes with weight loss and greasy, hard-to-flush stools.

• Stomach ulcers and reflux: the NHS describes ulcer pain as usually in the upper tummy, burning and often worse at night, caused mainly by H pylori infection or regular anti-inflammatory painkillers; a gastroscopy may be arranged.

• Coeliac disease and small bowel bacterial overgrowth: bloating, loose stools and cramping that can follow eating particular foods.

• Adhesions after earlier surgery and hernias: pulling or localised pain, sometimes with intermittent obstruction.

• Functional abdominal pain: ongoing pain with no structural cause found, where the gut and brain signalling is thought to be involved.

Expect a detailed history before anything else. The doctor will want to know where the pain starts and whether it moves, how long each episode lasts, what brings it on or eases it, how it relates to meals and bowel movements, and whether you have had weight loss, fevers, night sweats or bleeding. A food and symptom diary kept for two weeks beforehand is genuinely useful. Bring a list of every medicine you take, including anti-inflammatory painkillers, which can irritate the stomach lining.

The examination checks the tummy for tenderness, swelling, lumps and hernias. Depending on what you describe, there may be a rectal examination, a check of skin and eyes for yellowing, or a pelvic assessment. Blood tests commonly include a full blood count, inflammatory markers, liver and pancreatic enzymes and a coeliac screen; a stool sample can test for infection and for markers of bowel inflammation.

A reasonable plan is explained at this stage: either reassurance and a watch-and-review approach, or targeted imaging and endoscopy. If the history is typical of a functional disorder and there are no warning signs, imaging may be deliberately avoided, which is not neglect but good practice.

Each test answers a specific question, and the choice depends on where the pain is and what the earlier results showed.

Where a structural cause is found, treatment follows it: gallstones that cause repeated pain are usually treated by removing the gallbladder, and stones lodged in the bile duct may be cleared by ERCP, a procedure carried out through an endoscope. Stomach ulcers are treated according to cause: antibiotics for H pylori infection and medicines such as proton pump inhibitors that reduce stomach acid, with changes to any medicines that may be making symptoms worse.

For irritable bowel syndrome and other functional pain the picture is different. Treatment is a mix of dietary adjustment, regular meals, gut-directed medicines and sometimes psychological approaches, and the NHS notes IBS is usually lifelong but manageable. Chronic pancreatitis has no cure; the focus is pain control, replacing digestive enzymes, treating diabetes or bone thinning and stopping alcohol and smoking, which slow the damage.

A pain clinic that handles persistent cases may involve a pain specialist for nerve blocks, a topic covered under pain management, and a dietitian when food avoidance has itself caused weight loss.

On the NHS in England the usual route is through your GP, who refers you via the e-Referral Service. The maximum waiting time for non-urgent consultant-led care is 18 weeks from referral. If cancer is suspected, an urgent referral aims to confirm or rule it out within 28 days, and you will often be seen or have tests within about two weeks. You have a legal right to choose the hospital or team for most NHS referrals, and the My Planned Care website lets you compare waiting times.

Privately, you can usually self-refer for a consultation or be referred by your GP. If you have health insurance, most insurers expect you to obtain a pre-authorisation code before the first appointment and before scans or scopes, and some insurers only cover investigation of new symptoms rather than long-standing conditions. For self-pay patients, total cost varies with the consultant fee, the number of tests and whether a day-case procedure under sedation is needed, so an itemised quote covering the consultation, imaging, endoscopy fees and pathology is worth requesting. The Private Healthcare Information Network publishes information on private hospitals and consultants.

Call 999 or go to A&E for a stomach ache that came on very suddenly or is severe, a tummy that hurts when touched, vomiting blood or vomit like ground coffee, black sticky smelly stools or blood in your stool, being unable to pass urine, or being unable to pass wind or stool. These are the NHS emergency thresholds for stomach pain.

Ask for an urgent GP appointment or call NHS 111 if pain gets much worse, will not go away or keeps coming back, if you have difficulty swallowing food, unexplained weight loss, persistent bloating, bleeding from the bottom, or diarrhoea that lasts more than a few days. The NHS also lists being pregnant with a stomach ache as a reason to seek urgent advice.