4 am Abdominal Pain: How Serious?

April 5, 2009 3:15 PM

YouAreNotMyDoctorFilter: Last night I was rudely awakened in the very early morning by an intense abdominal pain. I managed to make it to my computer, only to freak myself out about all the possibilities it could be. How serious does this seem, and is it reasonable to just keep a watchful eye on it?

Me: Male, college-aged, reasonably healthy.

Last night, 4:10 am: Sleeping great.

4:15 am: I woke up with what I can only figure to describe as a stabbing pain. It started a inch or so below and to my right of my sternum, and felt like it spread towards the right side of my ribcage. It also seemed to hurt in about the same location on my backside as well. It was intense enough that anything hurt (moving, not moving, sitting up, lying down, walking around, etc.) to the point of provoking audible groans. It was almost like mega-heartburn, just not really that close to my stomach or esophagus (if my med school education from Wikipedia and House, M.D. hasn't failed me). I would have described myself as "in agony".

4:30 am: The pain very gradually began to decrease, but I was still far from having a blast. I was seriously contemplating when and how I would make my way to the nearest ER.

4:45 am: The pain had subsided to "significant discomfort", and my tiredness overtook the pain, and I was able to fall back asleep.

This morning: There still was some residual discomfort/soreness. This has lasted throughout the day.

Long story short, I don't really have the time to go to the doctor if it's not necessary, given the rapidly approaching end of the semester. I'm hoping the hive mind can provide some insight and/or advice on how seriously I need to take this incident, and if sucking it up is a Really Bad Idea or not. Also, I'm looking for some guidance on when/how I should pursue it further with medical professionals. The pages I found earlier via searching basically said "go to a doctor NOW if you have any abdominal pain", which seems to me to be a bit of an over-reaction.

posted by ThyroidBob to Health & Fitness (24 answers total)

Long story short, I don't really have the time to go to the doctor if it's not necessary, given the rapidly approaching end of the semester.

Beset by intense, sudden, unexplained abdominal pain, everyone has time to go to the doctor. Please, show some common sense.
posted by jayder at 3:21 PM on April 5, 2009 [1 favorite]

Doctor. Now. If it's something you should have gotten checked out, and you end up having to be in hospital for a few days, that is a simple and easily proven reason for extensions and incompletes.

The list of things that can cause stabbing, agonizing abdominal pain is lengthy; some are thankfully minor, others not. The ones that are not minor can be either intensely painful (gall stones, for example) or life-threatening (an appendix near rupture, a torsion of some sort, etc.). It's faster to go get a professional diagnosis and treatment than it is to google all the things that could be going on in your gut.
posted by catlet at 3:42 PM on April 5, 2009

What is this, you think we can diagnose you from THAT? In AGONY?

Yes, sucking it up is a Really Bad Idea. It could be literally about 10000 different options. Some of which are no big deal and others need to be dealt with now, and will provide a doctor's note for whatever needs doing while you're getting better.

Part of being an adult is negotiating obligations and emergency situations. I have no idea if this is an emergency...wouldn't you like to know?

Nobody can touch this with a ten-foot pole.

Your name is ThyroidBob....presumably you know the fallibility of the human body. Gimme a break. Get yourself checked out.
posted by barnone at 3:43 PM on April 5, 2009

IANAD. I have worked in an Urgent Care, though, and a lot of (male) patients who came in with abdomen pain like you describe had either appendicitis or kidney stones. Both are extremely painful and potentially dangerous if not treated (particularly appendicitis/ruptured appendix).

I can understand your hesitance ("what if it was just gas?"), but do you really want to take the chance that that's all it was/is?

How serious does this seem, and is it reasonable to just keep a watchful eye on it?

To answer your questions:

Potentially serious, and while understandable, probably not too reasonable.
posted by ourroute at 3:47 PM on April 5, 2009

My best friend's daughter has just gotten home from a lengthy hospital stay involving a ruptured appendix. To include time in intensive care. You don't have time for THAT for reals.

Meanwhile it is possible you had a gallbladder attack altho you would have felt like you needed to burp and would probably have been pretty nauseated as well. Regardless we ain't doctors and if we are we're not YOUR doc so do please just take your study materials with you to the doc's waiting room and get a REAL opinion.
posted by St. Alia of the Bunnies at 3:58 PM on April 5, 2009

Response by poster: Thanks all for your prompt answers. I wasn't trying to imply that I would sit on it if I knew I actually was sick. ourroute hit it head-on: I (and most of you, probably) don't want to go to a doctor just to hear "Oh, I dunno. Might have been a muscle cramp/gas/whatever". I was just trying to get a feel if this is a "oh, something (somewhat) similar happens to me once in a while and it's more than likely that everything's fine" thing, or if it really should get addressed in the near future.

And in retrospect, "agony" may have been a bit overdramatic. It wasn't fun, though.
posted by ThyroidBob at 4:05 PM on April 5, 2009

Response by poster: And I guess I didn't need all the specifics, because my real question was more about finding the balance between being efficient, and not wasting your and your doctor's time about every little thing, and being observant/insightful enough to know when you should go. This probably applies to more people in general, and is a harder question to come up with a quick answer to.
posted by ThyroidBob at 4:08 PM on April 5, 2009

Something very similar happened to me last Friday and it was gas. But I have IBS so (rare) attacks like this are expected and when it eased it was gone (no residual pain). Given you don't appear to have a known underlying problem to cause this plus you're still sore the next day I'd say a Dr visit is a good move. Because, you know, even if it is gas? There are actually things the Dr can give you to stop it happening again.
posted by shelleycat at 4:15 PM on April 5, 2009

Standard IANAD. When I had this pain, though : "It started a inch or so below and to my right of my sternum, and felt like it spread towards the right side of my ribcage" - it was gallstones.

It's rare in young men, but possible. My attacks started the same way as yours - about 30-45 minutes of agony. Like you, I thought that it was just really bad gas. I thought "Oh, I can suck it up. No need for a doctor visit." Then it happened again, and this time it lasted for over hour. I paced and paced, no position made the pain go away, and it was so bad that I could do nothing but walk in circles and concentrate on breathing. The next day, my college clinic doctor prescribed meds for gastritis, but it happened again anyway. 2-3 hours of that kind of pain, so bad I went to the ER, where they informed me that I was no weakling for complaining, that many people with gallstone pain actually get morphine because it's so bad. Went back to college clinic and demanded a CT, got one, gallbladder stuffed to the gills with stones.

St. Alia mentioned a couple of the common gallstone symptoms, but I want to mention that I had neither (burping or nausea).

So, like everyone says, just go get it checked out. It certainly does have the potential to be something serious, and I understand not wanting to make a fuss or waste time, but I wish I'd gone in sooner myself.
posted by HopperFan at 4:25 PM on April 5, 2009

Best answer: For future reference: the NHS Direct self-help guide is pretty decent at distinguishing between things you can probably treat at home, ones that ought to have some kind of professional follow-up, and ones for which you need urgent care. They serve as a useful checklist for an appointment, regardless of where you are.
posted by holgate at 4:26 PM on April 5, 2009 [4 favorites]

Oh, and btw a burst appendix stops hurting... so you may want to at least call the doc and ask them if you should come in.
posted by St. Alia of the Bunnies at 4:35 PM on April 5, 2009

Honestly, it sounds like gas. TMI: I've had gas so bad that yes, I would have described it as "agony."

If it's getting better not worse, then no, you don't need to go to a doctor. But for the love of all that is holy, if you start to notice yourself trending towards MORE pain, just go. "Sucking it up" won't cure any number of potentially serious things that could be causing abdominal pain.

If it is just gas, Immodium works quite well if your doctor isn't able to prescribe you something.
posted by grapefruitmoon at 4:46 PM on April 5, 2009

Seconding HopperFan that it sounds like gallstones. I had an experience like yours last fall, sudden-onset pain to the right of sternum, tender up under rib cage, a "band of pain" that extended around to my back. I was actually on the way to the ER when it subsided, so I went home. Ended up in the ER about four days later when it came back and got worse, stayed to have my gallbladder removed.

It's pretty easy for them to find out if you have gallstones or something, by ultrasound. Yes, it's time-consuming. But they will give you a note for school, and everything will be OK.

Probably better to see a doctor before you end up in the ER.
posted by not that girl at 5:03 PM on April 5, 2009

Middle of the night pain like that sounds like gall bladder to me.
posted by Lame_username at 5:57 PM on April 5, 2009 [1 favorite]

Gallbladder was my first thought too. Stabby spreading pain, can't find any way to get more comfortable, wakes you up in the middle of the night...these are classic symptoms. And not only did I not have burping or nausea, I don't really know anyone who now lacks a gallbladder than did have those symptoms (unless they had other concurrent GI issues.)

I don't think that one need rush to the ER the moment they feel pain. I sure didn't. But pain that wakes you up from sleep is a huge red flag.
posted by desuetude at 6:08 PM on April 5, 2009

What did you eat that night?

I'm betting gallstones. It will happen again if so. I had a similar attack on Halloween. Went to ER at 4am. The doctor pushed under my ribcage and I almost went through the goddamn roof. I got some great IV drugs to stop the pain, had an ultrasound and a EKG (they said they check the heart in ALL cases of abdominal pain because "it presents differently in some people and it's best to check") and was advised to schedule the surgery ASAP but in the meantime, eat a super bland diet so as to not piss off the gallstones again in the interim.

Also, the gallbladder surgery is super easy. I panicked majorly about it beforehand, but it was rather simple.

For what it's worth, I just went to a funeral for a 31 year old who dropped dead of a heart attack. Don't ever feel like you are wasting your doctor's time if something is wrong. You are your own health advocate. If something isn't right, fight until someone understands.
posted by jerseygirl at 6:22 PM on April 5, 2009

Response by poster: Thanks for your suggestions, advice, and personal stories. I also liked holgate's link, with guidelines on how to figure out if/when to seek medical attention. Like I said before, I guess that really is the heart of the issue. Even though I suppose it was poorly phrased, I gave all the details so that someone might be able to pull out some detail and say "you should probably do X because of Y", and not to have you diagnose me. Maybe this is all just common sense stuff that I missed at some point in my life, but having guidelines like desuetude's "pain that wakes you up from sleep is a red flag" helps for future reference. Even if it makes total sense once it's wrote down, it's hard to pull out the "red flag" details sometime when you're the one in the situation.
posted by ThyroidBob at 6:23 PM on April 5, 2009

But given that four people have suggested that what you have sounds EXACTLY like their gallstone attack, you aren't just walking away with a useful checklist, right? You are going to a doctor tomorrow morning, right?
posted by maudlin at 7:44 PM on April 5, 2009

If it's getting better not worse, then no, you don't need to go to a doctor.

Except of course, as has been mentioned, appendicitis pain goes away about the time it's becoming a medical emergency.

Severe pain that wake you up with no already known cause, that's definitely a red flag that needs investigating. I know for sure my attacks are IBS because of two late night ER trips and a couple of emergency doctor visits in past years. And that was just for painful gas, about the most benign cause likely here.
posted by shelleycat at 8:06 PM on April 5, 2009

ThyroidBob, when people found out that I hadn't gone to the ER with my gallbladder pain, I got pretty roundly chastised. But sure, it was fucking agony, and got worse each night, but it's confusing to be in pain when you're half-asleep! My situation was exacerbated by the fact that my first attack was Sunday during Labor Day weekend, and I was traveling.

After my second attack on Monday, well, I called the doc first thing Tues and got an appt for the next day. Did I mention agony? At once point, I literally fell to my knees. But after seeing the doc on Wed and getting an ultrasound, I felt like the "thing" had passed. Thurs I was totally fine. My doc called on Friday to say WTF YOU NEED SURGERY and I tried to hand-wave her off.

I had already started Googling, and was not surprised by the diagnosis. Upset, but not surprised.

Anyway, my point is this: If you can't get in to your doc tomorrow, and you have another attack that wakes you up, go to the ER. And if your symptoms go away, go to the doctor anyway.
posted by desuetude at 11:01 PM on April 5, 2009

That sounds like me when I had gallstones. It took many trips to the ER over 5 years before I was properly diagnosed by an ultrasound (sonogram).

I was just out of college when I had the first attack. The pain radiated more to my back and, because I was waitressing at the time, I just thought I had a bad back like everyone else in my family.

By the time I was properly diagnosed and scheduled for surgery, my gallbladder had become so inflammed it was interfering with my liver. My liver was septic, the enzymes were so elevated I tested false-positive test for lupus, and they had to delay the surgery. My doctor told me that a gallbladder is normally the size of a finger and mine was the size of a banana.
posted by Majorita at 11:42 PM on April 5, 2009

Ditto sounding like gallstones. When I first had pain like this, I wasn't sure what was happening. I thought I might even have been having a heart attack. I went to the ER and they did a few tests and decided it was just gas. (It may have been this time.) I had it several more times over the years and each time waited out the severe pain. Finally I went to the ER again when an episode wasn't going away. They diagnosed me with pancreatitis caused by gallstones. I had to spend a miserable few days in the hospital and a few weeks later had my gall bladder removed. Been fine ever since.
So whenever this happens you should go to the doctor because it could be serious.
posted by various at 12:35 AM on April 6, 2009

N-thing gall bladder attack. My husband had one several years ago and it presented similarly to yours. Here's the potential time spent equations if it is your gall bladder:

Get it diagnosed NOW, get it removed laproscopically: same day surgery, 2 weeks recovery

Wait too long, get it removed traditionally: multi-day hospital stay, 6 weeks+ recovery

That's leaving aside time spent laid up from gall bladder attacks, or the potential for worse problems if it ruptures. If it's being monitored by a doctor, and the attacks are not getting worse/more frequent, you might be able to push surgery to a more convenient time. My husband went a few months between surgical consult and surgery. The key is knowing what you're dealing with.
posted by booksherpa at 10:13 AM on April 6, 2009

I remembered last night that the first time I went to the ER with a similar situation (same pain, same location, same duration) even though it was gas and I did have IBS (so the gas was expected) I was still given an ultrasound to check for gallstones.

Therefore no doctor is going to think you're overreacting by getting this checked out and yeah, gall bladder issues is one avenue you should expect them to be checking.
posted by shelleycat at 3:14 PM on April 6, 2009