Abdominal Pain: How to Know If Yours Is Physical or Mental

If your stomach hurts, you might think the culprit is some misbehaving organ in your abdomen. That’s a definite possibility, but the offender could actually be your brain. Yup, just like chest pain, abdominal pain can be physical or mental.

Here’s a fascinating fact that might help you win at trivia night: Your mind is connected to your gut by way of the vagus nerve, the longest cranial nerve in your body. (That means this nerve originates from your brain, not your spinal cord). You can think of this nerve as a bidirectional conduit that is constantly communicating back and forth between your brain and your gastrointestinal tract, Emeran A. Mayer, M.D., a professor of medicine, physiology, and psychiatry at the David Geffen School of Medicine at UCLA and author of The Mind-Gut Connection, tells SELF.

In fact, the majority of your body’s production of serotonin, a neurotransmitter that plays a role in mood, takes place in the digestive tract, Jacqueline Sperling, Ph.D., a clinical psychologist and director of training and research the McLean Anxiety Mastery Program, tells SELF. “When you’re experiencing something going on in your brain, it can communicate to the gut and vice versa,” she says.

So, how are you supposed to know if your abdominal pain is actually coming from that area or if your mental health might be behind your discomfort? Here, doctors explain the signs of each.

Here are six signs your abdominal pain could be physical.

1. You recently ate food that might have been contaminated.

Many triggers of abdominal pain are situational, James Marion, M.D., a gastroenterologist and professor of medicine at the Icahn School of Medicine at Mount Sinai in New York, tells SELF. Unfortunately, sometimes the situation in question is a nasty bout of foodborne illness.

Something as seemingly harmless as trying a new dish at a restaurant could leave your stomach feeling wonky. So can making these food safety mistakes when you’re cooking at home.

Foodborne illness can set in hours to days after eating something contaminated, though sometimes it might even take weeks, according to the Mayo Clinic. In any case, food poisoning can cause symptoms such as abdominal pain and cramping, nausea, vomiting, watery or bloody diarrhea, and a fever.

2. You’re burping and/or farting.

While it can seem like gas is only about burping and farting, pain is also a common symptom.

Gas often happens when your body is struggling to break down certain carbohydrates, leading to excess air in your system. For example, about 65 percent of people in the world have some amount of lactose intolerance, meaning they have a hard time processing a kind of sugar that’s present in dairy, according to the U.S. National Library of Medicine. If you’re one of them, going to town on cheese, milk, ice cream, and other products that contain lactose can result in abdominal pain, bloating, gas, nausea, and diarrhea. For many people, lactose intolerance develops in adulthood, so it can take time to pinpoint dairy as the source of your stomach troubles.

You can also burp, fart, have abdominal pain, and experience other gas symptoms due to things like swallowing too much air as you chew or drinking a lot of carbonated beverages. And sometimes gas is a symptom of a condition like irritable bowel syndrome or inflammatory bowel disease, in which case you’ll experience other signs that something is physically wrong, like bloody diarrhea and constant exhaustion. (Here’s how to tell the difference between IBS and IBD.)

If you routinely have stomach pain that you think is due to something you ate but you’re not sure what, talk with your doctor. They may recommend keeping a food journal to pick up on any patterns you haven’t noticed. This could give them a good idea of what kind of tests to run to land on a diagnosis, too.

3. Your stomach is swollen and you can’t poop or are having a hard time keeping food down.

These can be signs of intestinal obstruction, which happens when some sort of blockage is keeping food or fluids from passing through your digestive system, says Dr. Marion. In addition to crampy, irregular abdominal pain, it can cause symptoms like a loss of appetite, constipation, and vomiting, according to the Mayo Clinic. If you notice these issues, Dr. Marion recommends seeing your doctor ASAP for a diagnosis and treatment.

4. You can point to exactly where in your abdomen hurts.

While it’s not always true that specific abdominal issues come with specific kinds of pain, certain conditions do tend to have characteristic types of discomfort that potentially make them easier to identify.

For example, appendicitis often causes pain that starts around the belly button then moves below and to the right of it, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Gallstones usually lead to stabbing pain in the upper right portion of your abdomen.

Point is, if your pain is localized to one part of your abdomen, that could hint at something going on with a certain organ in there.

5. You just took nonsteroidal anti-inflammatory drugs (NSAIDs) without eating enough.

Using nonsteroidal anti-inflammatory drugs (NSAIDs)—pain relievers such as naproxen and ibuprofen—too frequently, and especially without eating, could cause inflammation in the lining of your stomach and intestines that leads to abdominal pain, says Dr. Marion. The pain is usually heartburn-like or confined to your upper abdominal area, he adds.

Make sure to follow the dosage instructions for any medication you’re taking, including eating adequately or drinking enough fluids. This is a big way to prevent GI symptoms that might occur with NSAIDs, according to the Cleveland Clinic.

6. Your pain is severe and comes with a fever, rectal bleeding, nausea, and/or vomiting.

These are signs of a potentially serious GI infection, Dr. Marion says, like appendicitis or an extreme case of viral gastroenteritis (stomach flu). Don’t brush off severe abdominal pain, especially when it comes with other physical signs that something’s wrong. If you’re dealing with extreme abdominal pain and accompanying GI symptoms, you should seek emergency medical treatment.

Here are two signs your abdominal pain could be mental.

1. It flares up when you’re anxious.

Whether your stomach cramps strike every time you have to take a flight or before big work presentations, it could be a sign that you’re so stressed it’s affecting your gut.

“There’s a clear connection between the brain and our emotions and how our body feels,” says Sperling. Realizing that your abdominal pain always crops up around moments of fear, stress, or anxiety can help you figure out that your emotions are behind the discomfort.

If you already know you have anxiety but are having a hard time managing this symptom, talk to your doctor or therapist to see if any tweaks in your treatment may help. If you’re not sure your abdominal pain is connected with changes in your emotions, consider keeping a journal for a few weeks to chart how you feel and how your pain comes and goes in response.

In the event that your GI issues do seem tied with mental health concerns like anxiety, a mental health professional may be able to help you through methods like cognitive behavioral therapy (CBT). This form of therapy aims to help people identify and change unhelpful thoughts and behaviors to live healthier, happier lives. If you’re interested in trying it, here’s a guide on how to find an affordable therapist.

2. Your pain comes with a sense of overwhelming panic.

Panic attacks are harrowing episodes of uncontrollable fear. As with anxiety, panic attacks can cause physical symptoms such as abdominal pain and GI issues like diarrhea. They can also cause symptoms like chest pain, heart palpitations, sweating, shaking, and feeling like you’re going to die.

While undeniably horrible in the moment, panic attacks are highly treatable with medication, therapy such as CBT, and coping mechanisms like deep breathing, according to the Mayo Clinic. See your doctor or therapist for help if you think you’re having panic attacks.

Sometimes abdominal pain is physical and mental.

If you have a gastrointestinal condition such as IBS, Crohn’s disease, or ulcerative colitis, stress or anxiety can exacerbate your symptoms. This can make your physical and mental health even more inextricably linked.

This relationship can be cyclical, Sperling says: Stress or anxiety can prompt gut inflammation and intestinal spasms, leading to more GI symptoms, which can just translate to more stress or anxiety. It’s pretty unfair. If you have a GI condition and feel like you’re stuck in this rhythm, talk to your doctor to see if there’s a way to make your gut and your brain get along a little better so that you don’t have to suffer.

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