The perception of what constitutes a hard stomach tends to vary from one person to another. If you are feeling otherwise healthy and well, a hard stomach could simply reflect normal abdominal muscle tension or something usually harmless — although uncomfortable — like constipation.
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Stomach hardness accompanied by other signs or symptoms, however, could signal a potentially serious underlying medical problem.
Normal Muscle Tension
Though it might sound silly, your hard stomach might indicate nothing more than normal abdominal muscle tone. When your healthcare provider examines your abdomen, positioning is key to ensuring your abdominal muscles are completely relaxed. This involves resting your arms by your sides while you lie on the examining table as well as adequate support of your head and legs.
Thus, trying to evaluate your own stomach proves quite challenging because your position and movements can cause your abdominal muscles to tense and feel hard, particularly if you are lean and your abs are well developed. When your abdominal muscles are completely relaxed, your abdomen normally feels soft — similar to the firmness of a well-stuffed throw pillow.
Constipation can make your abdomen feel hard, especially if you are on the thin side. You might feel firmness across the top of your abdomen and/or on one or both sides of your abdomen. Your large intestine, or colon, runs along these areas.
With constipation, the hardness you might feel is actually accumulated fecal matter in your colon. You might also feel bloated for the same reason. Constipation is generally defined as fewer than 3 bowel movements per week, although usual bowel movement frequency varies greatly from one person to another. Common causes of occasional constipation include medication side effects, insufficient dietary fiber and physical inactivity.
Acute cholecystitis describes a gallbladder attack that leads to inflammation of this bile storage organ. The overwhelming majority of cases are due to blockage of a duct that carries bile from the gallbladder to the small intestine by a gallstone.
Typical symptoms include moderate to severe pain, tenderness and rigidity of the right upper abdomen as well as nausea, vomiting and low-grade fever.
Inflammation of the appendix, or appendicitis, occurs most frequently in adolescents and young adults — although it can occur in younger or older persons. The pain associated with appendicitis typically begins near the navel before intensifying and shifting to the lower right abdomen over several hours.
The pain is often accompanied by involuntary tightening of the abdominal muscles and related hardness in the same area. In addition to this symptom, known as involuntary guarding, common accompanying symptoms include loss of appetite, nausea, vomiting and fever.
Other Medical Causes
While the most likely causes of stomach hardness have been discussed, additional medical causes are also possible, each with its own group of likely accompanying signs and symptoms. Some of these medical conditions include:
- Ulcer that has worked its way completely through the wall of the stomach or upper small intestine
- Infection in the abdominal cavity
- Blockage of the intestine
- Acute inflammation of the pancreas
- Tearing of lining of the main artery coming from the heart, the aorta
- Insufficient blood supply to the intestine
- Severe liver disease with fluid accumulation in the abdomen
- Abdominal cancer
Warnings and Precautions
See your doctor if you experience unexplained hardness of your stomach, especially if you have other symptoms. Seek urgent medical care if you experience any warning signs or symptoms, including:
- Severe or worsening abdominal pain
- Persistent nausea and vomiting
- Vomiting blood or material that resembles coffee grounds
- Bloody, maroon or black stools
- Sudden, severe bloating
- Difficulty breathing or shortness of breath
- Dizziness, lightheadedness or fainting
- High fever
- American Family Physician: Evaluation of Acute Abdominal Pain in Adults
- International Journal of General Medicine: Evaluation and Management of Acute Abdominal Pain in the Emergency Department
- Clinical Methods: The History, Physical, and Laboratory Examinations, 3rd Edition; H. K. Walker, W. D. Hall and J. W. Hurst
- Merck Manual Professional Version: Acute Cholecystitis
- Canadian Journal of Gastroenterology: Epidemiology and Burden of Chronic Constipation
- Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th Edition; Mark Feldman, Lawrence S. Friedman, Lawrence J. Brandt