We’ve all been there: you’re clutching your stomach, wincing in pain, and thinking, “Is this just gas, or am I dying?” Dramatic? Maybe. But here’s the thing — where your belly hurts actually matters. A lot.
Your abdomen is like a packed apartment building. Different organs live on different floors, and when one of them is in trouble, the pain shows up in a very specific neighborhood. Knowing which neighborhood can help you figure out what’s going on — and whether it’s a “take some antacids” situation or a “get to the ER now” situation.
Let’s map it out.
1. Upper Right Pain — Gallbladder, Liver & Friends
Pain in the upper right area of your abdomen (just below your right ribs) is prime real estate for a few important organs.
Gallstones. The #1 suspect. If you feel a sudden, intense pain in the upper right that radiates to your right shoulder or back — especially after a fatty meal — gallstones are very likely. The pain often comes in waves (called biliary colic) and can last 30 minutes to several hours.
Liver problems. Hepatitis, fatty liver disease, or liver abscess can cause a dull, persistent ache in this area. If it comes with yellowing skin or eyes (jaundice), dark urine, or extreme fatigue, see a doctor immediately.
Kidney stones (right side). Sometimes the pain from a right kidney stone radiates to the front. It’s often described as one of the most excruciating pains imaginable — a sharp, cramping pain that comes in waves.
When to worry: Fever + upper right pain = possible gallbladder infection (cholecystitis). Don’t wait. Go to the ER.
2. Upper Left Pain — Stomach, Spleen & Pancreas
The upper left quadrant houses some heavy hitters.
Gastritis or stomach ulcers. A burning, gnawing pain just below the left ribs or in the center-upper area is classic for gastritis (stomach lining inflammation) or peptic ulcers. It often gets worse on an empty stomach and may improve briefly after eating.
Pancreatitis. This one is serious. A severe, boring pain in the upper left that radiates straight through to your back is a hallmark of pancreatitis. It often follows heavy drinking or gallstone complications. This pain typically gets worse after eating and may make you lean forward for relief.
Spleen issues. An enlarged or ruptured spleen (from infections like mono, or trauma) causes upper left pain that can radiate to the left shoulder. A ruptured spleen is a medical emergency.
When to worry: Sudden, severe upper left pain + vomiting + racing heart = possible pancreatitis or splenic rupture. Call emergency services.
3. Lower Right Pain — The Appendix Zone
This is the one everyone knows about — and rightfully fears.
Appendicitis. The classic pattern: pain starts vaguely around your belly button, then migrates to the lower right within 12-24 hours, becoming sharp and localized. It hurts more when you walk, cough, or press on the area and release (rebound tenderness). If untreated, the appendix can burst, which is life-threatening.
Ovarian issues (women). An ovarian cyst rupture or ovarian torsion (twisting) on the right side can mimic appendicitis almost perfectly. If you’re a woman with sudden lower right pain, doctors will check for both.
Inguinal hernia. A bulging or aching pain in the lower right groin area, especially when lifting, coughing, or straining. You might feel or see a visible bulge.
When to worry: Lower right pain + fever + nausea + pain that gets worse over hours = classic appendicitis. Don’t eat anything (in case surgery is needed) and get to the hospital.
4. Lower Left Pain — Colon & Diverticulitis Territory
The lower left side is colon country.
Diverticulitis. Small pouches (diverticula) in the colon wall get infected or inflamed, causing a steady, aching pain in the lower left. It’s sometimes called “left-sided appendicitis” because it feels similar but on the opposite side. More common in people over 40, and often comes with fever, bloating, and changes in bowel habits.
Constipation. Yes, really. Severe constipation can cause significant pain in the lower left, where the descending colon makes its final turn. Before panicking, consider: when was your last bowel movement?
Ovarian issues (women, left side). Same as the right side — cysts, torsion, or ectopic pregnancy can cause sudden, sharp pain in the lower left.
When to worry: Lower left pain + fever + blood in stool = see a doctor urgently. Could be complicated diverticulitis or inflammatory bowel disease.
5. Center / Around the Belly Button — The Crossroads
Pain around the belly button is tricky because it can mean several things.
Early appendicitis. Remember, appendicitis often STARTS here before moving to the lower right. If you have vague pain around your navel that’s getting worse, keep monitoring.
Small intestine problems. Crohn’s disease, intestinal obstruction, or mesenteric ischemia (reduced blood flow to the intestines) all cause central abdominal pain. Obstruction typically comes with vomiting, bloating, and inability to pass gas.
Abdominal aortic aneurysm. In older adults, a pulsating pain near the belly button could indicate an aortic aneurysm. This is rare but extremely serious — a ruptured aneurysm is fatal without emergency surgery.
When to worry: Central pain + vomiting + inability to pass gas or stool = possible bowel obstruction. Go to the ER.
Bonus Fact
Here’s something fascinating: your brain can’t precisely locate organ pain. Internal organs share nerve pathways with skin and muscles, so the pain often feels “referred” — meaning it shows up somewhere different from the actual source. That’s why a heart attack can feel like arm pain, and a gallbladder attack can feel like shoulder pain. Your body is a terrible GPS, but a pretty good alarm system.
The Bottom Line
Your belly is basically a map, and the location of your pain is the first clue to figuring out what’s wrong. Upper right? Think gallbladder. Upper left? Stomach or pancreas. Lower right? Appendix alarm. Lower left? Colon issues. Center? Keep watching — it might be moving.
Of course, this guide is for awareness, not self-diagnosis. If your pain is severe, sudden, accompanied by fever, vomiting, or blood — skip Google and call your doctor or go to the emergency room.
Your body is talking to you. The least you can do is listen to where it’s pointing.
Sources
- Cartwright, S.L. & Knudson, M.P. (2008). Evaluation of acute abdominal pain in adults. American Family Physician, 77(7).
- Macaluso, C.R. & McNamara, R.M. (2012). Evaluation and management of acute abdominal pain in the emergency department. International Journal of General Medicine, 5.
- Natesan, S. et al. (2016). Evidence-based medicine approach to abdominal pain. Emergency Medicine Clinics of North America, 34(2).
- Grundmann, O. & Yoon, S.L. (2010). Irritable bowel syndrome: epidemiology, diagnosis and treatment. Journal of Gastroenterology and Hepatology, 25(4).