Causes
The causes are similar to those of upper abdominal pain that occur during the course of the day. However, nocturnal upper abdominal pain is indicative of a high pain intensity, often combined with a high level of suffering on the part of those affected, since restful sleep is only possible to a limited extent. In addition, it should always be noted that many people perceive pain at night differently than they do during the day.
During the day, there are many distractions and activities available, so that pain is generally perceived as less intense than at night, as the body “has the opportunity” to concentrate on the potential problem. Another special feature of upper abdominal pain occurring at night or in the early morning hours is that it falls under the so-called “sobriety pain”. This means that the pain occurs only then or intensifies at the time when the digestive tract, especially the stomach, is largely empty.
The causes of nocturnal pain in the upper abdomen mainly include complaints of the gastrointestinal tract, such as inflammation, food intolerances, heartburn and occasionally malignant tumors. In addition to the digestive tract, the cause of upper abdominal pain can also lie in a completely different part of the body. The pain then projects itself, so to speak, into the upper abdomen area and can be a sign of a life-threatening emergency.
Lung diseases such as pleurisy or pneumonia can also cause upper abdominal pain at night and during the day, especially for children. A life-threatening adult emergency that is accompanied by night-time upper abdominal pain is, for example, an aortic aneurysm (tear of the aorta) or a heart attack. Nocturnal upper abdominal pain is very often localized on the right side, since many organs are located here that can cause problems in this area.
These are mainly the liver and gall bladder. Inflammation of the gallbladder usually occurs in combination with fever. Almost always those affected, usually women, also suffer from gallstones.
In the majority of cases, these are also the triggers of the inflammation. The stones irritate the gallbladder mucosa and thus facilitate the entry of bacteria. The severe pain that lasts throughout the night usually radiates into the right shoulder.
The (deep) inhalation and coughing is cumbersome and painful. In rare cases, it can also occur in the context of blood poisoning, after major traumas such as car accidents and after severe burns, an inflammation of the gall bladder. Gallstones can cause extreme pain in the right upper abdomen even without accompanying inflammation.
Especially small stones slide easily into the bile duct and get stuck there. This leads to undulating, sometimes very severe pain. This symptomatology is known as biliary colic.
Here too, pain radiating into the right shoulder is typical. Like the gall bladder, the liver can also be affected by an inflammation. This is called hepatitis (hepar = liver).Hepatitis also causes pain in the right upper abdomen, which cannot be localized there exactly, i.e. is diffuse.
They can also last into the night. The accompanying symptoms are usually so unspecific that the inflammation is often detected late. In addition to the diffuse pain, they include headache, joint and muscle pain, persistent fatigue and performance slumps, as well as changes in taste and loss of appetite.
If the inflammation persists and enters a chronic phase, yellowing of the skin and eye whites, darker coloring of the urine and lightening of the bowel movements, as well as itching, nausea and vomiting occur. The disease is triggered by various viruses, which are summarized under the term hepatitis viruses. With some viruses, especially the hepatitis C virus, a chronic course of the liver inflammation is almost unstoppable.
More rarely, bacteria or parasites are the cause of the disease. In addition to infections, permanent and excessive alcohol consumption, drug abuse (especially paracetamol) and metabolic diseases (Wilson’s disease) can damage the liver to such an extent that permanent, sometimes nocturnal pain in the right upper abdomen can occur. Important organs on the left side of the abdomen are the spleen and pancreas.
The spleen is surrounded by a hard capsule. If the spleen now swells as a result of various diseases and puts this capsule under tension, this leads to sometimes severe pain, which can often occur suddenly and at any time and which lasts at night as well as during the day. Like the heart, the spleen can also suffer infarctions if a blood clot blocks important blood vessels supplying the organ.
In addition to the severe pain, vomiting and dizziness often prevent the patient from resting. Blood cancer (leukemia), infections and autoimmune diseases, such as lupus erythematosus, can also cause damage to the spleen, typically with creeping pain in the left upper abdomen, which tortures those affected, especially at night. Inflammation of the pancreas causes permanent pain, including severe pain at night, which lies around the abdomen like a belt and has its pain maximum in the left upper abdomen.
In addition to the pain, those affected suffer from nausea, vomiting and flatulence. The pain can be so strong that the intestine pauses its work and in the worst case, an intestinal obstruction can result. Pain radiating from the back into the left upper abdomen can be a sign of a kidney stone that has slipped into the ureter and is blocking it.
Again, no pain maximum can be classified as day or night. The pain occurs at both times and begins when the stone enters the ureter and its narrowness. It is colic pain that occurs in waves, i.e. it flares up and down in its intensity.
They are very strong pains, so that sometimes nausea and vomiting also occur. Women in particular should think of a heart attack if they experience pain in the left upper abdomen, especially in combination with chest pain and shortness of breath, and if they suspect a heart attack, they should consult a doctor as soon as possible. Nocturnal upper abdominal pain, which is located in the middle, occurs in the context of an inflammation of the mucous membrane of the stomach, a gastric or duodenal ulcer.
The latter two are mainly associated with pain symptoms that have been present for a long time. In many patients, the pain improves with food intake, especially in the case of duodenal ulcers. Pain caused by a heart attack can also radiate into this area of the stomach.
Upper abdominal pain that occurs at night and is accompanied by flatulence can have a variety of causes. If they occur after consumption of certain foods, this may be the cause. For example, flatulence and abdominal pain are often described after the evening consumption of beans, fatty foods, onions and fresh, still warm bread.
Nocturnal flatulence and abdominal pain can also be an indication of food intolerance. The intolerance of lactose is widespread. Lactose is present in dairy products.
If flatulence and abdominal pain occur repeatedly after the evening consumption of milk or cheese, for example, this can be an indication of lactose intolerance. In such cases, either tablets can be taken before eating to improve metabolism or the person concerned can fall back on lactose-free dairy products.Also the consumption of carbonated beverages such as cola or mineral water in the evening can lead to nightly stomach aches with flatulence. Such drinks should then be avoided.
Alternatively teas or still water are recommended. Another possible cause for the complaints is the so-called reflux disease. Here it comes particularly at night to backflow of stomach acid into the esophagus.
It is often accompanied by nocturnal heartburn and burning behind the breastbone. Sleeping with a raised upper body can provide some relief. In rare cases, ulcers in the stomach or duodenum area cause night-time flatulence and abdominal pain.
Chronic pancreatitis can also be the cause. The cause in this case is that not enough digestive enzymes are produced. In this case, drugs can be taken that contain these necessary enzymes, and the symptoms are usually significantly reduced.
If the complaints occur during treatment with antibiotics, the cause is usually found here. The complaints usually disappear after the end of the therapy. Pregnant women also often complain of recurring flatulence.
The cause can be a slight decrease in intestinal activity (intestinal inertia). Pregnant women often suffer from pain in the upper abdomen both during the day and at night, especially in an advanced month of pregnancy. The movements of the child in the womb sometimes also affect the pregnant woman’s internal organs, such as the liver, causing short-term upper abdominal pain in the woman.
The periods of rest of the child in the womb do not always coincide with those of the expectant mother, which is why the short-term pain can also occur at night. Care should be taken if non-localizable upper abdominal pain occurs in combination with other accompanying symptoms, such as high blood pressure and extreme water retention (edema), especially in the legs. These can be the first signs of incipient pregnancy poisoning, known as pre-eclampsia.
Persistent upper abdominal pain with a maximum in the right upper abdomen, which occurs independently of fetal movements, should therefore be clarified by the gynecologist. Since the child and the growing uterus press on the stomach from below, pregnant women in advanced pregnancy often suffer from heartburn, which is often made worse at night by the lying position. When lying down, heartburn or worsening of already existing pain is the most common cause. The stomach acid can flow more easily into the esophagus and provoke the corresponding complaints, such as burning behind the breastbone and acidic belching.
