Abdominal Pain: When to Come In

Come in now, or call 911, if the pain came on suddenly and severely, if your
abdomen is rigid or too tender to touch, if you are vomiting blood or passing
blood, if the pain reaches into your back or shoulder, or if you feel faint.

If you are pregnant or might be, and you have abdominal pain, be seen today.

Everything below is for people who have a moment to read.

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Why abdominal pain is the hardest one to judge from home

Almost everything in your abdomen can hurt, and the organs sit close together.
The same pain can be a stomach bug, a gallstone, appendicitis, or something
that needs surgery in the next few hours — and the difference is often not in
how much it hurts.

That is not a reason to panic. It is the reason the answer usually involves a
scan and a blood test rather than a judgement call, and why "it's probably
gas" is the single most expensive assumption in this article.

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Signs that mean be seen now

Any one of these is enough.

• Sudden, severe onset — pain that arrived in seconds or minutes rather than
  building over a day
• A rigid, board-like abdomen, or pain so tender you cannot bear it being
  touched
• Pain with a fever, especially with chills
• Blood — vomiting blood or something like coffee grounds, or black or
  bloody stools
• Pain that travels to your back, your shoulder blade, or your groin
• Persistent vomiting, or being unable to keep fluids down at all
• Faintness, a racing heart, or clammy pale skin with the pain
• A swollen, hard abdomen with no bowel movement and no wind passing
• Pain after an injury — a fall, a seatbelt, a blow to the abdomen; internal
  bleeding can take hours to declare itself
• Pregnancy, or possible pregnancy, with any abdominal pain
• Pain in the lower right that started near your navel and moved — the
  classic appendicitis pattern, and it does not need to be severe

Groups where the threshold is lower

Pain is a less reliable signal in some people, and the danger is higher rather
than lower:

• Older adults often feel serious abdominal problems as mild discomfort, or
  as confusion and weakness instead of pain.
• People with diabetes may have blunted pain signals.
• Anyone on steroids, chemotherapy, or immune-suppressing medication can
  have a serious infection with very little to show for it, including no fever.
• Young children, who cannot localise pain and go off their food and energy
  before they can explain why.

If you are in one of these groups, take less pain more seriously.

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When it is reasonable to wait

Short-lived, settling pain with a clear cause and nothing from the list above:
mild cramping with a stomach bug that is improving, familiar period pain,
constipation that resolves, heartburn you recognise.

Two rules make waiting safe rather than hopeful:

1. It should be getting better, not worse. Pain that is escalating over
   hours is a reason to come in whatever started it.
2. Set yourself a limit before you begin. "If this is not improving by
   evening, I go in" beats reassessing every hour while your judgement gets
   tired.

And an urgent care is a reasonable first stop for mild, settled abdominal pain
— but not for anything on the red-flag list. An urgent care that suspects
appendicitis has to send you to an emergency room to begin again, and you will
have spent the time twice. ER or urgent care

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What happens when you arrive here

Abdominal pain is one of the presentations where having everything in one
building changes the visit rather than merely shortening it.

• A physician sees you — board-certified, every visit, at every hour.
• CT and X-ray on site, and ultrasound called in from a mobile service. For
  abdominal pain this is the whole
  question: imaging is usually what distinguishes the problem that needs surgery
  from the one that needs fluids and time.
• Laboratory work in the building, so blood counts and organ markers come
  back during the visit.
• A critical care room here for the presentations that need one.
• Monitoring for up to 24 hours — useful in this presentation specifically,
  because some abdominal problems declare themselves over hours. A repeat
  examination and a repeat blood test after several hours can be more
  informative than anything available at the moment you walk in.

If you need surgery or admission, we stabilise you here and arrange the
transfer to a hospital. We are an emergency room, not a hospital, and abdominal
pain is one of the commoner reasons that matters — so it is worth knowing before
you arrive.

Before you come: it helps to be able to say when it started, where it began
and where it is now, what makes it worse, and when you last ate, drank, or had a
bowel movement. Do not take anything for the pain without asking us first —
call (480) 237-4922. Some things mask the signs we need, and if surgery turns
out to be likely, an empty stomach matters.

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El Mirage ER — open 24 hours a day, 7 days a week, 365 days a year.
12000 N El Mirage Rd, El Mirage, AZ 85335 · (480) 237-4922
Walk in. No appointment, no referral.
If this is a medical emergency, call 911.

This article explains when to seek emergency care. It is not medical advice and
cannot account for your history, your medications, or what is happening to you
now. If you are unsure, call us or call 911.

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Sources

The guidance in this article about when to seek emergency care is drawn
from these public sources. Each one is linked so you can read it yourself.

• MedlinePlus (National Library of Medicine) — Abdominal Pain — https://medlineplus.gov/abdominalpain.html

This article is general information, not a diagnosis, and it cannot account
for your history or medications. If you are unsure, call us on (480) 237-4922
or come in. If it might be an emergency, treat it as one and call 911.

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