Abdominal Pain: Symptoms and When to See a Specialist in Singapore

Abdominal pain is discomfort or pain felt anywhere between the chest and the groin. The abdomen houses many organs: the stomach, small and large bowel, liver, gallbladder, pancreas, kidneys, bladder and reproductive organs. Pain in this region can originate from any of them.

What Are the Abdominal Pain Symptoms to Take Note Of?

Abdominal pain varies widely in character, location, pattern, timing and radiation. These five qualities are what a doctor uses to narrow down the likely source. The more precisely each can be described, the more useful the information.

Character

Character describes how the pain feels. Your doctor will usually ask you to describe the abdominal pain in your own words first, before prompting with specific terms.

Pain may be described as:

Sharp or stabbing
Cramping or colicky
Dull, aching or heavy
Burning or gnawing
Pressure-like or squeezing
Constant, persistent or intermittent

Location

For clinical assessment, the abdomen is divided into nine regions. Right abdominal pain and left abdominal pain carry different diagnostic implications, as do upper abdominal pain and lower abdominal pain. Specifying the exact region helps shorten the list of likely causes:

Epigastric (upper central): stomach (e.g. ulcer, gastritis), oesophagus (e.g. reflux), pancreas (e.g. pancreatitis), liver (e.g. hepatitis).
Right hypochondriac (right upper section): gallbladder (e.g. gallstones), liver (e.g. hepatitis, liver abscess), bile duct (e.g. bile duct stones), colon (e.g. diverticulitis).
Left hypochondriac (left upper section): stomach (e.g. gastritis, ulcer), pancreas (e.g. pancreatitis), colon (e.g. diverticulitis), spleen (e.g. abscess).
Umbilical (central): small bowel (e.g. gastroenteritis, bowel obstruction), colon (e.g. constipation, obstruction), aorta (e.g. aortic aneurysm).
Right lumbar (right side of the umbilical region): right kidney (e.g. kidney stones), gallbladder (e.g. gallstones), colon (e.g. colitis, diverticulitis).
Left lumbar (left side of the umbilical region): left kidney (e.g. kidney stones), colon (e.g. colitis, diverticulitis).
Right iliac (right lower section): appendix (e.g. appendicitis), colon (e.g. colitis), female reproductive organs (e.g. ovarian cyst, ectopic pregnancy, endometriosis), lymph nodes (e.g. mesenteric adenitis).
Left iliac (left lower section): female reproductive organs (e.g. ovarian cyst, ectopic pregnancy, endometriosis), colon (e.g. colitis, constipation).
Hypogastric (lower central): bladder (e.g. urinary tract infection), female reproductive organs (e.g. fibroids, endometriosis), colon (e.g. colitis, diverticulitis), prostate (e.g. prostatitis).

Pattern

Pattern describes how abdominal pain behaves over time. Because the abdomen contains both hollow organs (such as the bowel, gallbladder and ureters) and solid organs (such as the liver and pancreas), pain from each behaves differently. Hollow organs tend to produce pain that comes in waves, while solid organ inflammation tends to produce pain that stays.

Pain may be described as:

Constant, present without breaks
Intermittent, coming and going with periods of relief in between
Colicky, rising and falling in waves
Steadily worsening over hours or days
Episodic, occurring in distinct attacks separated by symptom-free intervals

Timing

Timing describes when abdominal pain occurs and what it appears to be linked to. Many abdominal organs are activated by eating, digestion or bowel transit, so pain in the abdomen often follows a recognisable rhythm tied to these activities. Identifying that rhythm helps separate pain arising from the digestive tract from pain arising elsewhere.

Pain may be:

Related to meals, occurring during, shortly after or several hours after eating
Linked to particular foods, such as fatty or spicy meals
Related to bowel movements, occurring before, during or after passing stool
Affected by posture or movement, such as bending forward, lying flat or walking
Present at rest, with no clear trigger
Worse at night, or severe enough to wake the patient from sleep
Cyclical in women, occurring in relation to the menstrual cycle

Radiation

Radiation describes whether abdominal pain stays in one place or is also felt elsewhere in the body. Abdominal organs share nerve pathways with structures outside the abdomen, which is why pain from an organ inside the abdomen can be felt in the back, shoulder, chest or groin. The site where pain is most intense is often a clue to the organ involved, while the direction it spreads to provides additional information.

Pain may:

Stay localised to a single area of the abdomen
Be felt diffusely across the whole abdomen
Radiate to the back
Radiate to the shoulder or shoulder tip
Radiate to the chest
Radiate to the groin or down into the thigh
Move from one region of the abdomen to another over time

When Should You Seek Medical Attention for Abdominal Pain?

Most cases of abdominal pain settle on their own within hours or a couple of days. A specialist review is appropriate sooner rather than later when any of the following are present:

Sudden, severe abdominal pain that comes on without warning.
Abdominal pain accompanied by fever, chills or rigors.
Persistent vomiting or inability to keep fluids down.
Abdominal rigidity or visible swelling of the abdomen.
Blood in stools, black tarry stools, or vomiting of blood.
Yellowing of the skin or eyes.
Unintentional weight loss alongside persistent abdominal pain.
Pain that wakes you from sleep, or pain that is steadily worsening over days rather than improving.

How Will Your Doctor Evaluate Abdominal Pain?

Specialist assessment begins with a detailed clinical history and a physical examination. During consultation, your doctor will ask about the history of the pain and some of these questions:

Where exactly is the pain located, and has it moved or spread since it started?
When did the pain begin, and how long has it been present?
How would you describe the pain: sharp, cramping, dull or burning?
Is the pain constant, or does it come and go?
What makes it better or worse: food, movement, certain positions, bowel movements?
Are there associated symptoms such as nausea, vomiting, fever or changes in bowel habits?
Have you experienced similar episodes in the past, and if so, how were they investigated?

What Investigations May Be Ordered for Abdominal Pain?

After your consultation, your doctor may order a series of tests based on the findings. Common tests include:

Blood tests: full blood count, liver function tests, pancreatic enzyme levels (amylase and lipase), inflammatory markers and tumour markers where indicated.
Urine and stool tests: to assess for infection, occult blood or other abnormalities relevant to the suspected diagnosis.
Abdominal ultrasound: a common first-line imaging test for assessing the liver, gallbladder, pancreas and surrounding structures. It is non-invasive, widely available and particularly useful for biliary disease.
CT scan or MRI: for more detailed assessment where the diagnosis remains unclear, or where staging of a known condition is needed. CT is often used to investigate acute abdominal pain, while MRI and MRCP are useful for biliary and pancreatic evaluation.
Endoscopy: gastroscopy or colonoscopy where the gastrointestinal tract requires direct visualisation, biopsy or therapeutic intervention.

Consult Dr. Thng Yongxian, HPB Surgeon in Singapore

Dr. Thng Yongxian is a Hepatopancreatobiliary (HPB) and General Surgeon in Singapore. He manages a broad range of conditions that present with abdominal pain, including gallbladder disease, pancreatitis, liver conditions, hernias and appendicitis. Where surgery is appropriate, Dr. Thng employs minimally invasive (laparoscopic) techniques wherever the clinical situation allows.

If your abdominal pain has been persistent, recurrent or accompanied by any of these warning signs, a specialist consultation can clarify the cause and the appropriate next step. Contact hepatobiliary specialist Dr. Thng’s clinic to arrange an assessment.

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