Trisha Pasricha
Many patients call their doctorsβ offices to get a gut check on a worrisome symptom, and they leave with the same answer: when in doubt, just go to the emergency room.
Itβs rarely the answer someone wants. If theyβre calling instead of already driving over, itβs often because theyβre hoping to hear reassurance that they donβt need to go to the hospital. Believe me, as a physician and as a patient, Iβve been on both sides of that conversation.
The problem is it can be impossible to tell someone definitively that βtheyβre fineβ without actually checking their vitals, performing a physical exam and potentially running some tests. Most people recognise that when their pain is a 10 out 10 β or when they see their toilet bowl filling up with bright red blood β they need help.
But over years of taking patient calls overnight, Iβve heard many symptoms that immediately raise red flags β even when they donβt seem alarming to someone without medical training.
While not meant as individualised medical advice, here are a few warning signs β some surprising β that your abdominal pain may need urgent attention.
Pain thatβs worse when you cough
If your belly pain feels worse when you cough, jump β or if youβre in a car and you roll over a bump β then that may signal an emergency condition called peritonitis.
Peritonitis refers to inflammation of the lining of your abdominal cavity β the space beneath your chest cavity where abdominal organs hang out together. That space becomes inflamed if something bursts open β a perforated bowel, appendix or cyst.
To help make the diagnosis, a physician may order imaging studies or check for βrebound tendernessβ β pain thatβs worse, not when they press down on your abdomen, but when they release pressure. If a doctor confirms you have peritonitis, it could mean youβll need a surgery. So donβt wait to get evaluated if this sounds like you.
You stopped farting
This is no laughing matter. If youβre experiencing abdominal pain and havenβt been having bowel movements or passing flatus, it could be a sign of a bowel obstruction. Thatβs an emergency.
Depending on the obstructionβs location, you may also experience severe vomiting and feel like you canβt keep any food or liquid down β which alone is an important reason to go to the hospital. In some cases of bowel obstruction, people may find their vomit is a darker-green colour. This suggests bile β which normally empties into the small bowel β is actually working its way backward and upward.
Fever and yellowing of the skin or eyes
Abdominal pain, especially on the right side of your body, accompanied by fever is already a problem β it could be a sign of appendicitis or other intestinal infection. But you should also watch out for this symptom: yellowing of the skin, which medical professionals call jaundice, or yellowing of the whites of the eyes. These could mean you have an infection of the bile ducts.
Bile duct infections, sometimes caused by a blockage, are emergencies we must act on fast. These infections have a high risk of developing into full-blown sepsis, where the bacteria enter the blood stream. You may need a special procedure to clear and drain the bile ducts as well as intravenous antibiotics.
Stool thatβs black and shiny like your smartphone
When we think of blood, we picture shiny and red β but thatβs not always the case. Black stool can also be a sign of blood.
When blood mixes with our stomach acid, it can turn black and tarry. And no, really, really dark brown stool isnβt it. I usually ask my patients if it was black like the colour of their smartphone screens (and if youβre throwing up, that mixture of acid and blood can look like coffee grounds). If that describes what youβre seeing, you may need an emergency procedure called an esophagogastroduodenoscopy, or EGD, to find and treat the source of the bleeding.
However, odd-coloured poo in the absence of other symptoms isnβt always a medical emergency. Taking iron pills can cause black stools, and artificial dyes and foods like beetroot can also cause unusual colours that are nothing to be concerned about.
Dizziness or feeling like youβll faint
Any time you have abdominal pain and dizziness, itβs an emergency until proved otherwise. Thatβs because it could be a sign of internal bleeding leading to low blood pressure.
Sometimes, the cause is painful, such as a peptic ulcer. Sometimes it isnβt. For instance, diverticular bleeding famously produces painless bright red blood β and a lot of it β into the toilet bowl. This happens when a vessel in a small pocket of the colon, called a diverticula, bursts.
One dangerous exception that wonβt show up in the toilet is a ruptured abdominal aortic aneurysm. This is a life-threatening emergency where the main artery of your bodyβs blood supply bursts inside the abdominal cavity. People often feel sudden severe pain in their belly, backs and even legs that can quickly lead to shock if enough blood is lost.
What I want my patients to know
The average person survives a ruptured abdominal aortic aneurysm less than 50 per cent of the time, even with immediate surgery. (They are uncommon in young people but the risk rises with age; about 1.4 per cent of people ages 50 to 84 have one.)
What most of my patients donβt know is that weβre supposed to screen for abdominal aortic aneurysms in all men ages 65 to 75 who have ever smoked cigarettes (at least 100 over the course of their lifetime). While some people who have them may notice a pulsating mass in their abdomen, these aneurysms are often totally asymptomatic for years β until they burst. Thatβs why anyone who suddenly feels dizzy and feels pain in their belly β even without seeing blood in the toilet β should get help, fast.
Screening involves a one-time quick outpatient ultrasound to see if you have an aneurysm, and depending on its size and growth, we may offer surgery to fix it before it ever becomes an emergency. We typically screen just once in a personβs lifetime, but if an aneurysm is detected, your physician may follow up with repeat surveillance ultrasounds in future.
Washington Post
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