While it's not uncommon to experience a bout of abdominal discomfort after eating, especially if you've eaten a large meal, severe abdominal pain post-nosh is not so ordinary and may be cause for concern.
If the pain is severe and persistent, seek immediate medical attention to rule out or potentially prevent more adverse health issues, says Mir Ali, MD, general and bariatric surgeon at MemorialCare Orange Coast Medical Center in Fountain Valley, Calif.
There are several organs that can be the source of pain in the abdomen, including the gallbladder, pancreas, stomach and small and large intestines. For this reason, severe abdominal pain after eating could have a wide range of causes that need to be evaluated through a physical exam.
"The stomach itself can be the source of pain if there is an ulcer or even just inflammation alone," says Peyton Berookim, MD, a double board-certified gastroenterologist in Los Angeles and director of the Gastroenterology Institute of Southern California.
Learn about seven conditions that might cause severe abdominal pain after eating, and tips for when you should consider seeking medical attention.
Seek immediate medical attention if you have severe pain that doesn't improve quickly, especially if you have other symptoms such as weakness, nausea, vomiting, tar-like or bloody stools, dizziness, loss of consciousness or a high fever.
1. Peptic Ulcers
Peptic ulcers develop when the protective lining of the stomach or first part of the small intestine — called the duodenum — provides inadequate protection against the acid produced by the stomach, resulting in an open sore (or ulcer) in the wall of the stomach or duodenum, according to the Mayo Clinic.
Peptic ulcer pain is usually located in the upper left or upper central part of the abdomen. It is typically a sharp, burning or boring pain that sometimes travels through to the back.
With stomach ulcers, the pain often begins during or shortly after eating. With duodenal ulcers, the pain usually improves with a meal but returns two to three hours after eating.
Peptic ulcers can bleed, producing tar-like or bloody stools and vomit that looks like coffee grounds. When severe, an ulcer can extend through the entire wall of the intestine or stomach, producing a hole. This perforation often causes severe, generalized abdominal pain and symptoms of shock, such as weakness, dizziness or loss of consciousness.
Gallstones are hardened deposits of bile (or digestive fluid) that can form in your gallbladder, the small, golf-ball-sized organ on the right side of your abdomen.
They are most common in females in their 40s who have had children, according to the Mayo Clinic, but other risk factors include being overweight or obese, eating a high-fat and/or high-cholesterol diet, being sedentary, having diabetes or taking oral contraceptives or other drugs that contain estrogen. Those who are Native-American or Mexican-American are also more likely to develop this condition.
Gallstones typically produce a cramping sensation in the upper right area of the abdomen that usually occurs within several hours after eating a meal, especially a meal containing fatty foods, according to the Mayo Clinic. Gallstone pain can last for just a few minutes or for as long as a few hours and is often accompanied by nausea, vomiting and pain that may travel around the right side of the body to the back or right shoulder blade. It may even be felt in the right shoulder.
Read more: Side Effects of Gallstones
If gallstones block the exit of the gallbladder, they can lead to acute inflammation of the gallbladder, called cholecystitis, which can cause severe and persistent abdominal pain, severe nausea, vomiting and a high fever. Gallstones may also block the tubes exiting from the liver or pancreas, producing inflammation of these tubes and organs.
"A diagnosis is typically made with an ultrasound of the abdomen and treatment involves the removal of the gallbladder," says Dr. Ali.
3. Mesenteric Artery Ischemia
Mesenteric ischemia occurs when cholesterol plaques develop within the arteries supplying the intestines, reducing blood flow through these blood vessels, according to MedlinePlus, which is powered by the National Institutes of Health.
When you eat, the cells in your intestines increase their activity level to help digest the food, which requires additional oxygen-carrying blood. When the intestinal arteries contain plaque, eating a meal can cause pain if the blood supply is not adequate to meet the extra needs of these cells.
Abdominal pain caused by mesenteric ischemia is typically severe and generalized, and it's often accompanied by diarrhea, nausea, vomiting or flatulence. It tends to occur 15 to 60 minutes after eating and lasts for up to two hours. Mesenteric ischemia pain is often accompanied by weight loss and food fear — being afraid to eat because of the pain it causes.
According to the Society for Vascular Surgery, chronic mesenteric ischemia is usually caused by atherosclerosis. Risk factors for this condition include gender (more common in males), smoking, high blood pressure, high cholesterol, obesity, lack of physical activity and stress.
There are several tests your doctor can perform to diagnose this hardening of the arteries. In severe cases, surgery will need to be performed to correct the condition.
4. Celiac Disease
Celiac disease is another possible cause of severe abdominal pain after eating. This is a chronic condition in which your immune system responds to any gluten you ingest by damaging your small intestine, explains Dr. Berookim.
If you have celiac disease, you may experience bloating and pain after eating meals containing gluten, a protein found in wheat, rye and barley. But everyone is affected differently by the condition, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Other symptoms may include diarrhea, tingling numbness in the hands and feet, bone or joint pain, headaches, irritability and depression.
As far as causes, the condition only happens to people who have particular genes. Up to 20 percent of people with celiac disease have a close relative who is also affected.
There is no cure for celiac disease, but it can be managed long-term by avoiding foods that contain gluten.
5. Lactose Intolerance
Similar to celiac disease, though typically less symptomatic, lactose intolerance usually produces pain and diarrhea after eating a meal containing lactose, a type of sugar found in dairy products.
"It is not an allergy but rather a deficiency in the enzyme that breaks down lactose," notes Dr. Berookim.
Lactose intolerance is sometimes genetic, or it can be caused by injury or surgery involving the small intestine, according to the Mayo Clinic. It typically appears in adulthood, and it's most common in people of African, American Indian, Asian or Hispanic descent.
If you think you might be lactose intolerant, consider cutting out dairy products to see if you experience a positive change in abdominal sensations after eating, or schedule a visit with your primary care physician to inquire about testing procedures.
This condition is an actual infection of air pockets that form in the lining of the colon and are known as diverticulosis.
Symptoms typically include severe abdominal pain, fever, chills, diarrhea and blood in the stool, and the pain is typically localized to the left lower quadrant, according to Dr. Berookim.
"The air pockets can be formed due to lack of fiber in the diet," he says.
If you suffer from diverticulitis and your case is mild, your doctor may prescribe a course of antibiotics. If your case is severe, urgent surgery may be necessary to prevent additional complications like prominent abscesses, full thickness bowel perforation or systemic infection, notes Rusha Modi, MD, a physician in internal medicine, gastroenterology and hepatology, and assistant professor of clinical medicine at Keck Medical Center of University of Southern California.
If you suspect you have diverticulitis but otherwise feel well, Dr. Modi suggests scheduling a visit with your provider. If you have a fever, severe pain or are unable to hold down any food, then an urgent care or emergency room visit may be necessary.
Though a frequent cause of this condition in the U.S. is alcohol abuse, it is not always the culprit. Pancreatitis can also be triggered by gallstones and, sometimes, the cause cannot be identified, according to the Cleveland Clinic.
Those with pancreatitis may experience severe upper abdominal pain that radiates to the back. It's typically brought on by eating, and slowly gets worse. Other symptoms include a swollen and tender abdomen, nausea, fever, vomiting and an increased heart rate.
Read more: Foods to Avoid if You Have Pancreatitis
Lab tests and computed tomography as well as radiographic imaging can be used to make a proper diagnosis. Immediate care is required, as the condition can have life-threatening complications if left untreated.
Treatment can vary from simple bowel rest to surgery, depending on the severity of the disease, explains Dr. Ali.
Is This an Emergency?
- Mayo Clinic: "Peptic Ulcer"
- Mayo Clinic: "Gallstones"
- National Institutes of Health, MedlinePlus: "Mesenteric Artery Ischemia"
- National Institutes of Health, MedlinePlus: "Abdominal Pain"
- Merck Manual Professional Version: "Peptic Ulcer Disease"
- Society for Vascular Surgery: "Mesenteric Ischemia"
- Johns Hopkins Medicine: "Mesenteric Ischemia"
- Greater Newport Physicians: "Mir B Ali, MD"
- Gastroenterology Institute of Southern California: "Peyton P Berookim, MD, FACG"
- National Institute of Diabetes and Digestive and Kidney Diseases: "Symptoms & Causes of Celiac Disease"
- Mayo Clinic: "Lactose intolerance"
- Keck Medicine of USC: "About Rusha J Modi"
- Cleveland Clinic: "Pancreatitis"
- MedlinePlus: Abdominal pain