Chronic abdominal pain: causes, red flags and when to seek help

There is no sharp cut-off, but doctors tend to think of abdominal pain as chronic once it has lasted several weeks, or when the same pain comes and goes over months. That is quite different from the sort of stomach ache that follows a dodgy meal or a stomach bug and fades in a few days.

The pattern you notice is the most useful clue. Pain that eases after you open your bowels points towards the gut itself. Pain that arrives an hour or two after meals, or that wakes you at night, points elsewhere. Pain linked to your periods, to passing urine, or to a particular movement or posture suggests the cause may sit outside the digestive tract altogether.

Keeping a simple diary for two weeks, noting when the pain starts, what you had eaten, what your bowel habit was and where you felt it, often gives your GP more to work with than any single examination.

The NHS describes irritable bowel syndrome (IBS) as a common condition affecting the digestive system, causing stomach cramps, bloating and diarrhoea, and notes it is usually lifelong but can be helped by lifestyle changes and medicine. It is often the first thing a GP considers when cramping has gone on for a long time and the person is otherwise well.

The table below sets out patterns that tend to go with different causes. It is a way of thinking about the problem, not a way of diagnosing yourself.

Most people with long-term tummy pain do not have a dangerous cause, but certain features change the picture and prompt doctors to investigate more fully rather than watch and wait. The NHS IBS pages say that losing a lot of weight for no reason, bleeding from the bottom or bloody diarrhoea, and finding a hard lump or swelling in the tummy could be signs of something more serious.

The NHS also lists, for any stomach ache, difficulty swallowing food, bloating that does not go away or keeps coming back, being pregnant, and unusual bleeding or abnormal discharge from the vagina as reasons to ask for an urgent GP appointment or NHS 111 help.

• Weight loss you cannot explain by dieting or illness.

• Blood in your stool or black, tarry stools.

• A new lump or swelling you can feel in your abdomen.

• Persistent change in bowel habit that is new for you, especially if you are over 50.

• Tiredness, breathlessness or looking paler than usual, which can mean anaemia.

• Difficulty swallowing, or persistent vomiting.

• Pain that wakes you reliably from sleep.

The NHS advises calling 999 or going to A&E if a stomach ache came on very suddenly or is severe, if it hurts when you touch your stomach, if you are vomiting blood or your vomit looks like ground coffee, if your poo is bloody or black, sticky and extremely smelly, if you cannot pee, or if you cannot poo or fart. Chest pain, difficulty breathing, collapse, or vomiting in someone who has diabetes are also on that list.

Do not drive yourself. Ask someone else to take you or call 999 and ask for an ambulance, and bring the medicines you take.

For symptoms that are not an emergency but are getting much worse, ask for an urgent GP appointment or phone NHS 111 rather than waiting for the next routine slot.

For IBS-type symptoms the NHS says the GP will ask what symptoms you have, whether they come and go, how often you get them, when they occur (for example after eating certain foods) and how long you have had them. They may also feel your tummy to check for lumps or swelling.

Expect questions about your weight over recent months, what you eat and drink including alcohol and caffeine, any medicines you take regularly (some painkillers and antibiotics can upset the gut), family history of bowel disease or cancer, and your mood and stress levels, because the gut and the brain influence each other closely.

Women may be asked about periods and pelvic symptoms, and men about urinary symptoms, since pain from outside the gut often masquerades as a bowel problem.

The NHS says IBS cannot be confirmed by a test, but other tests may be used to rule out other causes. It names a blood test to check for problems such as coeliac disease, and tests on a stool sample to look for infections and inflammatory bowel disease. It adds that further hospital tests are not usually needed unless the GP is unsure what is wrong.

If the story includes any warning features, your GP may add a full blood count to look for anaemia, a stool test for hidden blood, or an urgent referral for endoscopy, colonoscopy or imaging. A referral for investigation does not mean cancer has been found; it is how doctors exclude it.

• Blood tests for coeliac disease, anaemia and inflammation.

• Stool tests for infection, inflammation or hidden blood.

• Ultrasound or CT scans when the pain suggests the gallbladder, kidneys or other organs.

• Endoscopy or colonoscopy to look directly at the gut lining.

The NHS says IBS symptoms can be triggered by alcohol, caffeine, certain foods such as spicy or fatty food, stress and anxiety, and regular antibiotic use. Noticing your own triggers, and easing off the obvious ones for a few weeks, is a reasonable first step.

A pharmacist can talk through medicines for constipation and indigestion and suggest treatments that might help. Gentle regular exercise, regular meals and enough fluids are low-risk measures. Avoid repeatedly taking painkillers for tummy pain without advice, as some can irritate the stomach lining.

Start with your GP. The NHS suggests seeing a GP if you think you might have IBS and have had symptoms for over four weeks. If the cause remains unclear, or investigations find something, the next step is usually a gastroenterologist, and sometimes a gynaecologist, urologist or surgeon depending on where the problem lies. Dietitians help with gut symptoms that seem food-related.