Recurring stomach pain has dozens of possible causes, but most fall into a surprisingly short list of common culprits. The answer depends on where the pain is, what triggers it, and how long it’s been happening. In about 90% of cases of chronic abdominal pain, no structural problem like an ulcer or tumor is found. That doesn’t mean the pain isn’t real; it means the cause is often functional, meaning your gut’s nerves and muscles aren’t working the way they should.
The Most Common Causes by Age
What’s likely behind your pain shifts depending on how old you are. In children, the usual suspects are lactose intolerance, constipation, and acid reflux. In young adults, the list expands to include irritable bowel syndrome (IBS), indigestion from ulcers or painkillers like ibuprofen, gallbladder problems, and inflammatory bowel disease like Crohn’s. In older adults, the same conditions apply, but cancers of the stomach, pancreas, colon, or ovaries become more common and worth ruling out.
Across all age groups, two conditions account for a huge share of recurring stomach pain: IBS and functional dyspepsia. Both are “functional” disorders, meaning standard tests like imaging and bloodwork come back normal. The pain comes from how your digestive system processes food and signals, not from visible damage.
Where It Hurts Matters
The location of your pain is one of the most useful clues to what’s going on. Your abdomen contains different organs in different zones, and pain tends to cluster near the source of the problem.
- Upper middle (just below the ribs): Acid reflux, gastritis, stomach ulcers, or pancreas problems. This is also where heart-related pain can show up, especially in older adults.
- Upper right (under the right rib cage): Gallbladder issues like gallstones or inflammation, liver problems, or sometimes a kidney stone on that side.
- Around the belly button: Early appendicitis often starts here before moving to the lower right. Ulcers and small bowel problems can also cause pain in this area.
- Lower right: Appendicitis is the classic concern, but IBS, inflammatory bowel disease, and in women, ovarian cysts or ectopic pregnancy can cause pain here too.
- Lower left: Diverticulitis is common in older adults. IBS and inflammatory bowel disease also frequently cause left-sided pain.
- Low center (above the pubic bone): Bladder infections, IBS, and gynecologic conditions like fibroids or pelvic inflammatory disease.
Pain that moves around or seems to affect your entire abdomen is harder to pin down. Bowel obstructions, widespread inflammation, and even muscle strain or shingles can cause pain that doesn’t stay in one spot.
IBS: The Most Overlooked Explanation
If your stomach has been hurting on and off for months and your tests keep coming back normal, IBS is one of the most likely explanations. The formal diagnostic criteria require abdominal pain at least one day per week for three months, with symptoms starting at least six months before diagnosis. The pain also needs to connect to bowel habits in at least two ways: it gets better or worse with bowel movements, it comes with changes in how often you go, or it comes with changes in stool consistency.
IBS pain can range from mild cramping to severe enough to keep you home from work. It tends to flare with stress, certain foods, and hormonal shifts. A dietary approach called the low-FODMAP diet, which temporarily removes certain fermentable carbohydrates, reduces symptoms in up to 86% of people. The elimination phase typically lasts two to six weeks before you start reintroducing foods one at a time to identify your specific triggers.
Functional Dyspepsia: Pain Centered Higher Up
If your pain is mainly in the upper abdomen and doesn’t seem connected to bowel movements, functional dyspepsia is the more likely diagnosis. This feels like a gnawing or burning discomfort in the area just below your breastbone, and it often gets worse after eating. Unlike IBS, going to the bathroom doesn’t change the pain.
The two conditions overlap quite a bit, and some people have both. Functional dyspepsia is essentially your stomach being overly sensitive to normal amounts of food and acid, even when there’s no ulcer or visible inflammation.
Your Nerves May Be Amplifying the Pain
One reason stomach pain can persist even when nothing looks wrong on scans or scopes is a phenomenon called visceral hypersensitivity. Normally, you don’t feel the routine work of digestion: gas moving, muscles contracting, food passing through. But if the nerves in your gut become chronically overexcited, your pain threshold drops. Normal amounts of internal pressure from gas, fluids, or solids start registering as discomfort or outright pain.
This can start after an infection, a period of intense stress, or sometimes without a clear trigger. Once the nervous system has been primed for a hyper-reactive pain response, the pain can originate either from the gut itself or from the brain’s exaggerated interpretation of normal signals. Stress makes this worse because it further lowers your pain threshold, creating a cycle where anxiety about the pain actually intensifies it.
Common Painkillers Can Be the Cause
Here’s an irony many people miss: if you’re taking ibuprofen, aspirin, or other anti-inflammatory painkillers regularly, they may be causing the very stomach pain you’re trying to treat. These drugs damage the stomach’s protective lining through two separate mechanisms. They irritate the tissue directly on contact, and they also block the enzymes that help maintain the mucus barrier protecting your stomach wall from its own acid.
Over time, this weakened barrier lets stomach acid create inflammation (gastritis) or open sores (ulcers). Even a few weeks of daily use can cause problems, and some people are more susceptible than others. Cola beverages, alcohol, and spicy foods can worsen the irritation. If you’ve been taking these painkillers regularly and your stomach has started hurting, that connection is worth exploring.
H. Pylori: A Hidden Infection
More than half of all people worldwide carry a bacterial infection called H. pylori at some point in their lives. Most never know it because it causes no symptoms. But in some people, the bacteria damage the protective lining of the stomach and small intestine, leading to chronic gastritis or ulcers. The resulting pain is typically a burning or gnawing sensation in the upper abdomen, often worse on an empty stomach.
H. pylori is detected through a simple breath test, stool test, or blood test, and it’s treatable with a course of antibiotics. If you’ve had persistent upper stomach pain that hasn’t responded to antacids or dietary changes, this infection is worth testing for.
Warning Signs That Need Urgent Attention
Most recurring stomach pain isn’t dangerous, but certain patterns signal something more serious. Seek emergency care if your pain is sudden and severe, or if it doesn’t ease within 30 minutes. Continuous severe pain accompanied by nonstop vomiting can indicate a life-threatening condition like a bowel obstruction or pancreatitis.
Other red flags that warrant prompt evaluation, even if the pain isn’t at emergency-room levels:
- Unintended weight loss alongside the pain
- Blood in your stool or black, tarry stools
- Pain that wakes you from sleep
- Fever with abdominal pain, especially in the lower right (possible appendicitis) or upper middle with a rapid pulse (possible pancreatitis)
- Severe lower abdominal pain with vaginal bleeding, which could indicate an ectopic pregnancy
Narrowing Down Your Triggers
Because so many conditions share similar symptoms, paying attention to patterns gives you (and your doctor) the best chance at a clear answer. Track when the pain happens: before meals, after meals, or unrelated to eating. Note whether it improves or worsens with bowel movements. Record what you eat for a couple of weeks and flag the days when pain flares. Notice whether stress, poor sleep, or your menstrual cycle seem to play a role.
This kind of tracking often reveals a pattern that points toward a specific category. Pain after eating that doesn’t relate to bowel habits suggests a stomach-level issue like dyspepsia or gastritis. Pain relieved by a bowel movement with changes in stool patterns points toward IBS. Pain tied to dairy consumption suggests lactose intolerance. And pain that started around the same time you began taking a new medication, especially an anti-inflammatory painkiller, may resolve simply by switching to a different option.