Waking up with stomach pain is not only uncomfortable, but possibly anxiety-inducing. You may find yourself spiraling as you try to determine whether the cause is merely something you ate or a sign that something is seriously wrong.
If you've ruled out the usual causes — an urge to relieve yourself, an empty stomach signaling it's time for breakfast, gas and ordinary heartburn — another condition may be at play.
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Here, Ronald Omino, MD, a gastroenterologist at UCLA Health Services, explains why you might wake up with abdominal pain, and what to do when it happens.
Talk to a doctor right away if your morning stomach pain is accompanied by other symptoms like fever, nausea, vomiting, severe pain or rigidity or the inability to pass gas or a bowel movement. These can be signs of life-threatening GI conditions, Dr. Omino says.
1. You Have GERD
If you wake up often with heartburn, the taste of acid in your mouth or gnawing, sharp abdominal pain, you may have gastroesophageal reflux disease (GERD), or chronic, severe acid reflux. GERD occurs when your lower esophageal sphincter (the flap between the bottom of your esophagus and the top of your stomach that prevents digestive juices from flowing upward) becomes weak or relaxes when it shouldn't.
A healthy esophageal sphincter will keep digestive acids in your stomach when you lie down. But when you have GERD, digestive acids flow in the wrong direction, resulting in gastric distress, according to the Mayo Clinic.
Signs that GERD is causing your morning stomach pain, according to Dr. Omino, include:
- Heartburn and burning in the chest or upper abdomen
- Regurgitation, or the feeling of bringing up food, liquid or other contents of your stomach into your mouth or throat
- Difficulty swallowing
“If you experience any of these symptoms, try taking an acid-reducing medication, such as a histamine type 2 receptor antagonist (or H2 blockers) like famotidine or antacids like Tums,” Dr. Omino says. Consult with a primary care doctor or gastroenterologist if symptoms persist or worsen.
To prevent waking up with reflux, Dr. Omino recommends these lifestyle changes:
- Maintain a weight recommended by doctors
- Avoid trigger foods (e.g., acidic foods, spicy foods, citrus fruits, chocolate, coffee, onions, mint and carbonated beverages)
- Avoid eating at least two to three hours before going to sleep
- Elevate your head at night with an extra pillow to let gravity help keep digestive juices down
- Eat small, frequent meals throughout the day
- Avoid alcohol and tobacco, especially before bed
2. You're Constipated
If you wake up in the morning with lower abdominal pain (or generalized abdominal pain or discomfort), think back to the last time you had a regular bowel movement. You might be constipated.
Constipation is more than going a few days without pooping: Other symptoms of constipation include, per the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK):
- Fewer than three bowel movements a week
- Stools that are hard, dry or lumpy
- Stools that are difficult or painful to pass
- Feeling that not all stool has passed
Dr. Omino suggests eating a nutritious diet, drinking plenty of fluids and exercising regularly. “Treatment can be as simple as making nutritious lifestyle changes, such as increasing fiber and fluid intake."
While constipation medication can also be used if needed, it’s best to consult with your primary care doctor or gastroenterologist before taking an over-the-counter remedy for constipation.
3. You Have a Stomach Ulcer
"Peptic ulcer disease, also known as a stomach ulcer, can present as acute or chronic abdominal pain generally in the upper abdomen," Dr. Omino says.
Peptic ulcers are open sores that develop on the inner lining of your stomach and upper portion of your small intestine, per the Mayo Clinic. Ulcer pain can occur a few hours after eating (when the body is producing more acid), or on an empty stomach, leading to burning abdominal pain in the morning.
The most common causes of peptic ulcers include, per Dr. Omino:
- Nonsteroidal anti-inflammatory drug (NSAIDs) overuse
- Infection from Helicobacter pylori (H. pylori) bacteria
Left untreated, a peptic ulcer can lead to upper gastrointestinal (GI) bleeding. See a doctor right away if you see bright red blood in the stool or black stool, Dr. Omino says. A doctor will evaluate your upper GI tract with an upper endoscopy procedure to confirm a diagnosis.
Peptic ulcers are treated based on their cause. If the cause is NSAID overuse, discontinue use immediately, Dr. Omino says. If the cause is bacterial (H. pylori or others), antibiotics may be prescribed, along with medications to minimize acid production and protect the lining of the stomach.
Try eating foods that do not cause peptic ulcer flare-ups. Avoid tobacco and alcohol while treating ulcers, according to the Mayo Clinic.
4. You Have IBS
When it comes to IBS, the doctor's old saying, "it's not what you're eating, but what's eating you," can apply. In other words, IBS is a functional gastrointestinal disorder — meaning it's related to problems with your gut-brain connection, or how the gut and brain work together, per the NIDDK. A malfunction in this connection can cause your gut to feel sensitive, altering how the muscles in your bowel contract.
Research suggests a link between IBS and mental health conditions like anxiety and depression. In one December 2021 review in General Psychiatry, people with IBS were more likely to have moderate and severe depression and anxiety than people without IBS.
Symptoms of IBS can include abdominal pain and bloating, as well as changes in your bowel movements, including diarrhea and/or constipation.
Doctors may treat IBS by recommending diet changes (such as following a low-FODMAP diet, which involves avoiding foods with dairy, wheat, artificial sweeteners and certain fruits and vegetables) and lifestyle changes including medication, probiotics and mental health treatment, per the NIDDK.
When to See a Doctor
If your morning stomach pain is severe or accompanied by fever, nausea, vomiting, jaundice or inability to pass gas or poop, talk to your doctor as soon as you can, Dr. Omino says. And that goes for any time of day, not just after waking up.
These symptoms could be signs of serious GI conditions like appendicitis, diverticulitis or pancreatitis, according to Dr. Omino, or other non-GI concerns. Your doctor can help you narrow down the causes and evaluate your treatment options.
- Mayo Clinic: "Peptic Ulcer Symptoms and Causes"
- NIDDK: "Definition and Facts for Irritable Bowel Syndrome"
- General Psychiatry: "Association of anxiety-depressive disorders with irritable bowel syndrome among patients attending a rural family practice center: a comparative cross-sectional study"
- Mayo Clinic: "Gastroesophageal Reflux Disease (GERD)"
- NIDDK: "Constipation"
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.