Sharp stomach pain that comes and goes is one of the most common reasons adults come to our ER, and one of the most deceptive. The intermittent pattern feels reassuring. The pain eases, you start to feel like maybe it’s passing, and you talk yourself out of going in. Then it returns, sometimes worse, sometimes from a different spot, sometimes paired with new symptoms you didn’t expect.
Here’s what most articles on this keyword won’t tell you: the “comes and goes” pattern is the classic presentation of several surgical emergencies. Appendicitis often starts as vague intermittent pain before becoming severe and localized. Bowel obstruction causes waves of cramping pain. Kidney stones are textbook colicky pain. Ectopic pregnancy can cause intermittent cramping for hours before rupture. Intermittent pain is not the same as harmless pain.
This article walks through when sharp intermittent abdominal pain needs an ER, the most important underlying causes (especially the ones that can’t wait), and how an ER actually figures out what’s happening. If you’re symptomatic now, skip ahead to the warning signs first.
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Paired with intermittent sharp stomach pain, any of these signs means don’t wait:
- Pain that becomes severe, constant, or rapidly worsens
- Pain that’s the worst of your life or feels qualitatively different from anything before
- Pain that localizes to one specific area, especially the lower right side (possible appendicitis)
- Severe pain with a rigid, hard, or board-like abdomen
- Pain with vomiting blood or vomit that looks like coffee grounds
- Blood in stool, black or tarry stools, or rectal bleeding
- Pain with high fever (above 101°F), chills, or shaking
- Pain with chest pressure, shortness of breath, sweating, or jaw discomfort (atypical heart attack)
- Pain with dizziness, fainting, rapid heart rate, or pale clammy skin (possible internal bleeding)
- Sudden severe back pain combined with abdominal pain, especially in adults over 60 (possible abdominal aortic aneurysm)
- Pain in a pregnant woman, or a woman of reproductive age with a possibly missed period
- Pain in a child under 12, different evaluation thresholds apply
- Pain with confusion, severe weakness, or altered mental state
- Inability to pass gas or have a bowel movement, with vomiting and a swollen abdomen (possible bowel obstruction)
- Pain after recent surgery, trauma, or in someone on blood thinners
- Testicular pain or swelling (in men, possible torsion, a surgical emergency)
When in doubt, come in. Abdominal pain is exactly the kind of symptom where evaluation gives you a real answer fast, and “watching and waiting” can mean missing a window when a problem was easier to treat.
Why “Comes and Goes” Matters Clinically
In medicine, the pattern of pain often points to what’s causing it. “Colicky” pain, pain that comes in waves, building up and easing off, happens when a hollow tube in your body (intestine, ureter, bile duct, fallopian tube) is being stretched, blocked, or contracting forcefully against an obstruction.
That’s why the most common causes of intermittent sharp abdominal pain involve hollow organs:
- Intestines, obstruction, severe gastroenteritis, IBS, appendicitis (early phase), bowel ischemia
- Ureters, kidney stones moving through the urinary tract
- Gallbladder and bile ducts, gallstones
- Uterus and fallopian tubes, menstrual cramping (usually benign) but also ectopic pregnancy, ovarian cysts, ovarian torsion (emergencies)
- Pancreas, pancreatitis (often constant by the time it presents, but can wax and wane)
The intermittent nature of the pain is not the same as the seriousness of the cause. Some of the most dangerous abdominal emergencies start with intermittent pain that then becomes constant once complications develop (e.g., a ruptured appendix, a strangulated bowel, a ruptured ectopic pregnancy). By that point, treatment is more complicated and outcomes are worse.
What Your Pain Location Can Suggest
Where the pain is in your abdomen gives doctors useful hints, but only hints. Many conditions can cause pain in multiple locations, and pain often shifts as a condition evolves. Use the following as general orientation, not as a diagnostic tool.
| Pain Location | Common Causes (Partial List) |
| Upper right (just under the right ribs) | Gallbladder problems (gallstones, cholecystitis), liver issues, hepatitis, sometimes lung-related |
| Upper middle (just below the breastbone) | Stomach issues (ulcer, gastritis), pancreatitis, GERD, heart-related (atypical heart attack) |
| Upper left | Pancreatitis, stomach issues, spleen-related, sometimes lung-related |
| Lower middle | Bladder, uterus, intestines, early appendicitis (often starts here before shifting), ovarian issues |
| Pain Location | Common Causes (Partial List) |
| Lower right | Appendicitis, ovarian issues (in women), kidney stones, hernia, colon-related |
| Lower left | Diverticulitis, ovarian issues (in women), kidney stones, colon-related, constipation |
| Flank (side of abdomen / back) | Kidney stones, kidney infection, sometimes abdominal aortic aneurysm in older adults |
Two important patterns worth knowing: pain that starts vaguely around the belly button and shifts to the lower right side is a classic appendicitis pattern. Pain that radiates from the back/flank around to the groin in waves is a classic kidney stone pattern. Either deserves prompt evaluation.
The “Must Rule Out” Surgical Emergencies
These are the diagnoses an emergency physician is actively considering when you walk in with sharp intermittent abdominal pain. Each one can become life-threatening if missed:
Appendicitis. Often starts as vague intermittent pain around the belly button, then localizes to the lower right side over hours. Pain typically becomes more constant and severe over time. May include nausea, vomiting, low-grade fever, and loss of appetite. A ruptured appendix can cause severe sepsis.
Bowel obstruction. Cramping waves of pain, often accompanied by vomiting (sometimes of bile or stool-like material), abdominal distension, and inability to pass gas or have a bowel movement. Causes include scar tissue from prior surgeries, hernias, and tumors. Untreated obstruction can lead to bowel death and rupture.
Ectopic pregnancy. A pregnancy that implants outside the uterus (usually in a fallopian tube). Can present with intermittent crampy lower abdominal pain, sometimes with light vaginal bleeding, sometimes with shoulder pain or fainting if internal bleeding has started. Any woman of reproductive age with new lower abdominal pain needs a pregnancy test, ectopic pregnancy rupture causes severe internal bleeding that can kill within hours.
Mesenteric ischemia. Blocked blood flow to part of the intestines, usually in older adults with vascular disease or atrial fibrillation. Classic presentation is “pain out of proportion to physical exam”, the patient is in severe distress but the abdomen feels surprisingly soft. Time-critical; the intestine can die without blood flow.
Abdominal aortic aneurysm (AAA) rupture or leak. Usually in adults over 60, often with cardiovascular risk factors. Can present with sudden severe abdominal or flank pain radiating to the back, sometimes with fainting, fast heart rate, or pallor. Rupture is rapidly fatal without immediate surgical intervention.
Ovarian torsion. The ovary twists on its blood supply, causing severe intermittent or sudden lower abdominal pain with nausea and vomiting. Surgical emergency; the ovary can be lost within hours.
Strangulated hernia. A hernia where bowel becomes trapped and loses blood supply. Often a previously known hernia that becomes painful and tender, with vomiting and inability to push it back in. Surgical emergency.
Testicular torsion (in men). Can present with abdominal pain that radiates to the groin, with testicular swelling and tenderness. Surgical emergency, the testicle can be lost within hours.
Perforated viscus. A hole in the stomach or intestine (from a perforated ulcer, ruptured appendix, severe diverticulitis, or trauma). Sudden severe pain, often with rapid decline. Requires emergency surgery.
Common Non-Surgical Causes That Still Need Evaluation
Kidney stones. One of the textbook causes of severe colicky abdominal/flank pain that comes and goes in waves of 20–60 minutes. Pain can radiate from the back/flank around to the groin, sometimes with nausea, vomiting, blood in the urine, and frequent urination. Kidney stones rarely improve without intervention once they’re large enough to cause severe symptoms. See our kidney stones service page for full detail on evaluation and treatment.
Gallbladder attack (biliary colic). Sudden severe pain in the upper right abdomen, often after fatty meals. Can radiate to the right shoulder or back. Episodes typically last 30 minutes to several hours. Complicated gallbladder disease (cholecystitis, gallstone pancreatitis) is more serious and needs prompt care.
Pancreatitis. Severe upper abdominal pain that often radiates to the back, with nausea and vomiting. Can be triggered by gallstones, alcohol use, certain medications, high triglycerides, or trauma. Requires hospital evaluation, severity ranges from mild to life-threatening.
Kidney infection (pyelonephritis). Flank pain, fever, chills, urinary symptoms, sometimes vomiting. Can progress to sepsis if untreated.
Ulcer or severe gastritis. Upper abdominal pain, often described as burning or sharp, sometimes worsened or relieved by eating depending on location. Severe cases can cause perforation or bleeding.
Diverticulitis. Inflamed pouches in the colon, classically causing lower left abdominal pain, fever, and changes in bowel habits. Mild cases may be treated as outpatient; complicated cases (abscess, perforation) need hospital care.
Severe constipation or fecal impaction. Especially in elderly patients, can cause sharp intermittent pain, bloating, and sometimes vomiting. Needs evaluation to rule out obstruction.
Severe gastroenteritis with intestinal cramping. Viral or bacterial gut infection. Usually self-limited, but severe dehydration or signs of complications warrant evaluation.
Causes That Are Usually Manageable, But Need a Diagnosis
These are typically not emergencies, but you can’t reliably tell them apart from more serious causes without evaluation. The mistake is assuming the diagnosis from the couch.
- Irritable bowel syndrome (IBS), crampy abdominal pain, often relieved by bowel movement, with patterns of diarrhea, constipation, or both
- GERD and acid reflux, burning or sharp upper abdominal pain, often after meals or when lying down
- Trapped gas, sharp localized pain that can shift around the abdomen, usually resolves with passing gas
- Functional abdominal pain, recurrent pain without identifiable structural cause
- Mild muscle strain, typically reproducible with movement
- Mild food intolerance or food poisoning that’s clearly resolving
If you’ve had recurrent intermittent abdominal pain that fits these patterns, see your primary care doctor or a gastroenterologist for proper workup. The diagnosis matters; symptoms that look benign can occasionally be the first sign of something that isn’t.
Sex-Specific Causes, Women
Women have additional causes of intermittent lower abdominal pain that deserve specific attention. Any woman of reproductive age with new lower abdominal pain should be evaluated for pregnancy-related causes until proven otherwise:
- Ectopic pregnancy, see the surgical emergencies section. Any positive pregnancy test plus lower abdominal pain is an ER visit until ectopic is ruled out.
- Ovarian cysts, can cause intermittent lower abdominal pain. Rupture or torsion is more serious.
- Ovarian torsion, surgical emergency.
- Pelvic inflammatory disease (PID), infection of the upper female genital tract, often with fever, abnormal discharge, and pelvic pain.
- Endometriosis, chronic intermittent pelvic pain, often related to menstrual cycle.
- Menstrual cramps, usually benign but severe or worsening menstrual pain deserves evaluation, especially if new or different.
- Pregnancy complications, placental abruption, preterm labor, preeclampsia (with severe upper abdominal pain especially) all need urgent evaluation.
Sex-Specific Causes, Men
Some causes of abdominal pain in men require specific attention:
- Testicular torsion, surgical emergency. Pain can radiate to the lower abdomen and may distract from the testicular component. Any sudden severe testicular pain, with or without swelling, is an immediate ER visit.
- Hernias, a previously known hernia that becomes painful, tender, or can’t be pushed back in may be strangulated. Surgical emergency.
- Prostatitis, inflammation or infection of the prostate, sometimes presenting with lower abdominal or pelvic pain plus urinary symptoms.
Special Populations, Lower the Threshold to Come In
Adults over 65
Older adults often present with subtler symptoms than younger people, they may have appendicitis, mesenteric ischemia, or AAA without dramatic pain or classic signs. They also have higher risk of vascular complications. Lower your threshold to come in.
Immunocompromised patients
People on chemotherapy, transplant recipients, those on long-term steroids, and patients with HIV may not develop classic signs of infection or peritonitis. What looks mild can be severe.
Pregnant women
Pregnancy changes the location of the appendix and other abdominal organs and can mask classic symptoms. Any new abdominal pain in pregnancy needs evaluation, both for pregnancy complications and for non-obstetric causes (appendicitis in pregnancy can be deceptively mild on exam).
People on blood thinners
Higher risk of internal bleeding from any cause, ulcer, ruptured cyst, hemorrhagic stroke of bowel blood supply. Lower your threshold to come in.
Diabetics
Can have atypical presentations and are at higher risk of complications including diabetic ketoacidosis, which itself can cause abdominal pain.
Recent abdominal surgery patients
New abdominal pain after recent surgery can indicate post-surgical complications. Come in promptly.
How an ER Evaluates Sharp Intermittent Abdominal Pain
At ER of Dallas, abdominal pain evaluation is systematic and fast. The goal is to identify time-critical conditions quickly while controlling pain and stabilizing you. Here’s what happens:
- Triage and vital signs, heart rate, blood pressure, temperature, oxygen saturation, pain assessment
- Detailed history, when did pain start, character (sharp, crampy, dull), location and migration, pattern (constant vs. intermittent), what makes it better/worse, associated symptoms, your medical and surgical history
- Focused physical exam, looking for signs of peritonitis (rebound tenderness, rigidity), masses, hernias, organomegaly, signs of obstruction or sepsis
- IV access and IV fluids when indicated, to stabilize, replace fluid losses, and prepare for further testing
- IV pain control when indicated, contrary to old myths, pain control does not mask serious causes on exam and is now standard of care
- Lab work, complete blood count (infection, anemia, bleeding), basic metabolic panel (electrolytes, kidney function), liver function, lipase (pancreatitis), pregnancy test (women of reproductive age), urinalysis
- Imaging, abdominal CT, ultrasound, or X-ray depending on what’s being considered. On-site at ER of Dallas with results in minutes.
- EKG when atypical cardiac causes are possible
- Specialist consultation or surgical evaluation when needed, we coordinate transfer to a surgical hospital when operative intervention is required
Most patients leave the ER with a clear diagnosis (or a clear plan for follow-up) within 2–4 hours. For surgical or critical findings, we stabilize and coordinate immediate transfer to a hospital with surgical or specialized capability.
When to Come to ER of Dallas vs. Manage at Home
| Situation | What to Do |
| Mild intermittent pain with a clear, reassuring pattern (e.g., known IBS, mild constipation, gas after a heavy meal). No red flags. No risk factors. | Rest, hydrate, see your primary care doctor if symptoms persist or recur. |
| Sharp intermittent pain that’s persistent, recurring, worsening, or interfering with daily activity, with no red flags but no clear benign explanation | Come to ER of Dallas for evaluation. Don’t wait for an outpatient appointment. |
| ANY red flag from earlier in this article, severe pain, localizing pain, vomiting blood, blood in stool, fever, neurologic or cardiac symptoms, severe back pain in older adults, possible pregnancy, signs of internal bleeding | 🚨 Call 911 or come straight to ER of Dallas immediately. |
When you’re unsure, lean toward coming in. Abdominal pain is the symptom where a thorough ER evaluation provides the most diagnostic value, you walk out knowing what it is, not guessing.
What to Do While You’re Symptomatic
If you’re managing mild abdominal pain at home and watching for escalation:
- Avoid strenuous activity. Try lying in whatever position is most comfortable, often on your side with knees drawn up.
- Sip small amounts of clear fluids. Do not push solid food while you’re actively in pain.
- Avoid alcohol, caffeine, fatty foods, and anything that has previously worsened your symptoms.
- Do NOT use heating pads, ice packs, or self-administered remedies on the abdomen without consulting a healthcare provider, they can mask diagnostic findings or worsen certain conditions.
- Do NOT take new over-the-counter medications, herbal remedies, or supplements without checking with a pharmacist or physician, many can worsen specific causes of abdominal pain.
- Track the pain, when it started, location, character, what makes it better or worse, associated symptoms. This information is useful for the ER team if you come in.
- Stay near someone if you live alone. If pain escalates and you become weak or dizzy, you’ll want help.
- If any red flag appears, or if pain becomes severe or persistent, come to the ER. Do not wait until you’re completely incapacitated.
Frequently Asked Questions
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Q: If the pain comes and goes, doesn’t that mean it’s not serious?
A: No. “Colicky” pain, pain that comes and goes in waves, is actually the classic presentation of several surgical emergencies including appendicitis, bowel obstruction, kidney stones, and ectopic pregnancy. The intermittent pattern is not a reassuring sign by itself.
Q: Can I tell appendicitis from regular stomach pain?
A: Not reliably. Appendicitis classically starts as vague intermittent pain around the belly button and shifts to the lower right side, often with nausea, vomiting, low-grade fever, and loss of appetite. But appendicitis often presents atypically, especially in children, pregnant women, and older adults. Imaging is what definitively rules it in or out.
Q: I’m a woman with new lower abdominal pain. What should I know?
A: Any woman of reproductive age with new lower abdominal pain needs to be evaluated for ectopic pregnancy, even if you don’t think you could be pregnant. A pregnancy test is part of the standard ER workup. Ovarian torsion and ovarian cyst rupture are also possibilities. Don’t self-diagnose as menstrual pain.
Q: How is sharp stomach pain evaluated at an ER?
A: Through detailed history, physical exam, lab work (including a pregnancy test in women of reproductive age), and imaging (CT, ultrasound, or X-ray depending on what’s being considered). Most diagnoses are made within a few hours.
Q: Is it okay to take pain medication before going to the ER?
A: Best practice is to come in first and let the ER manage pain. Some over-the-counter medications can worsen certain causes of abdominal pain (e.g., NSAIDs and ulcers, or aspirin and bleeding). The old concern that pain medication “masks” the diagnosis is outdated, modern emergency medicine treats pain promptly without compromising diagnosis.
Q: Should I drive myself if the pain is severe?
A: If you’re in severe pain, dizzy, or feeling faint, don’t drive. Have someone else drive, take a rideshare, or call 911.
Q: Will my insurance cover an ER visit for abdominal pain?
A: Under the federal No Surprises Act, your insurance is required to process emergency visits at your in-network benefit level. ER of Dallas accepts most major insurance plans. We don’t accept Medicare, Medicaid, CHIP, or TRICARE.
Q: Do I need an appointment?
A: No. ER of Dallas is a 24/7 walk-in emergency room. Just come in, or call +1 214-613-6694.
Q: Where is ER of Dallas located?
A: 4535 Frankford Rd, Dallas, TX 75287, Far North Dallas, easily reached from Carrollton, Addison, Plano, Frisco, and surrounding neighborhoods. Open 24/7.
If the Pain Keeps Coming Back, Get the Answer.
Sharp stomach pain that comes and goes is exactly the kind of symptom that benefits from emergency room evaluation. ER physicians see this presentation every day. We know what the dangerous causes look like, we have the imaging and labs on-site to rule them in or out fast, and we can coordinate surgical care directly if needed.
Trying to figure it out at home, while you’re symptomatic, with limited information, is the worst possible context for that decision. ER of Dallas is open 24/7 at 4535 Frankford Rd. Walk in or call ahead.
🚨 Severe pain or red-flag symptoms: Call 911 or come straight in.
📍 Address: 4535 Frankford Rd, Dallas, TX 75287
📞 Phone: +1 214-613-6694
🕐 Hours: Open 24/7, every day, every holiday
🌐 Website: https://erofdallastx.com/
