Many cases of overnight stomach pain are caused by digestive problems and improve with lifestyle changes or basic medications.
Nighttime stomach pain can also be a sign of more serious health conditions, such as cancer or a cardiac event. Such cases are usually accompanied by additional, more severe symptoms.
Common causes of nighttime stomach pain
Nighttime stomach pain may be caused by eating close to bedtime, acid reflux, or GERD.
Digestive problems are considered the most common cause of stomach pain at night.
Eating close to bedtime means digestion is more likely to occur while lying down, making it easier for stomach acid to travel back up the digestive tract.
Sleeping difficulties and sleep disorders can make conditions like ulcer disease, irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD) more likely or worse.
Lying down can also greatly increase the pressure put on some muscular, joint, or bone injuries. This can make associated pain and discomfort more intense.
Common causes of nighttime stomach pain include:
When stomach acids travel up into the food pipe, a burning sensation occurs. Acid reflux also often causes nausea, vomiting, gas, bloating, sore throat, and cough.
A number of factors are thought to increase the risk of acid reflux, with the most common including:
- excessive alcohol consumption
- overeating, especially close to bedtime
- lying down too soon after eating
- being overweight
- high-fat, spicy, and fried foods, along with chocolate and coffee
Gut and throat conditions
Gastroesophageal reflux disease (GERD) is a common cause. Conditions that inflame the food pipe cause heartburn, nausea, and indigestion. Symptoms often intensify when lying down.
Gastritis is when the stomach walls become irritated and inflamed. This can lead to a sense of pain or burning, as well as nausea, vomiting, and gas. Untreated cases can lead to ulcers, bleeding, and cancer.
Stomach and intestinal, or peptic, ulcers
Stomach and intestinal ulcers can cause a burning sensation in the stomach region. Pain can worsen after eating as well as when the stomach is empty. Nighttime is often the longest stretch of the day between meals.
Most common causes include:
- H. pylori bacteria
- overuse or prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs)
The gallbladder is a small organ beneath the liver that releases bile. Secretions can build up and form hardened lumps called gallstones.
Gallstones can range in size from a speck of sand to a ping pong ball. Pain occurs when gallstones cause a blockage in the duct system of the gallbladder, liver, or pancreas.
Fatty or rich meals often make gallstone symptoms worse, since bile is important in the digestion of fat. Over 80 percent of gallstones in the United States are due to hardened cholesterol.
Some individuals with gallstones do not have symptoms and do not require medical intervention. People with reoccurring episodes of gallbladder pain or inflammation may require surgery to remove the gallbladder.
As well as pain, gallstones can also cause the following complications:
- nausea or vomiting
- yellowing of the skin and eyes
- unexplained exhaustion
- light-colored stool
Irritable bowel syndrome
Some people with IBS experience nighttime stomach pain.
Gas and bloating are common symptoms that can occur especially after eating. Having a large evening meal may make nighttime abdominal pain worse in individuals with IBS.
Around 10-15 percent of people have IBS and most are under the age of 50.
An allergy to gluten, a protein in wheat, barley, rye, and spelt, causes inflammation of the small intestine often with cramping and abdominal pain.
Symptoms also typically include diarrhea, extreme tiredness, and bloating.
Around 1 out of every 100 people globally are impacted by celiac disease. According to the Celiac Disease Foundation, 2.5 million Americans are undiagnosed and at risk of complications such as poor growth, malnutrition, vitamin and mineral deficiencies.
Crohn’s disease is a type of IBD. It is an inflammation of the digestive track lining that causes abdominal pain, weight loss, and extreme tiredness.
An estimated 780,000 Americans may have Crohn’s disease. Cases typically present between the ages of 15 and 35.
Menstrual cramps or endometriosis
Menstrual cramps may cause nighttime stomach pain.
Cramping, bloating, gas, and general discomfort often occur during menstruation as the uterine lining sheds.
With endometriosis, the tissue of the uterine lining grows excessively outside the uterus, often causing severe or long-lasting menstrual pain.
Food allergies or intolerances
Individuals who cannot properly digest or process certain foods often experience pain, bloating, diarrhea, and gas.
Lactose intolerance is a common food intolerance that causes severe stomach cramping and pain.
Overall, food allergies and intolerance, especially in children, has been increasing dramatically over the past 20 years.
- Gas: Gas is a very common cause of stomach pain, especially at night as digestion slows down.
- Constipation: When waste products build up in the colon, stretching, and pressure can cause pain throughout the abdomen.
- Pulled or strained tissues: Lying down may increase the pressure on, or change the blood flow to sore tissues throughout the body, intensifying pain and discomfort.
When to see a doctor
Most cases of nighttime stomach pain are not reason for immediate concern.
If symptoms occur more than once a week or become long-term, a physician should be consulted. If symptoms interfere with everyday activities, especially healthy sleep, medical attention should also be sought.
Certain symptoms, regardless of their severity or frequency, should be assessed by a physician.
Symptoms associated with nighttime stomach pain that require medical attention include:
- severe or ongoing pain that does not lessen with over-the-counter medications
- difficulty breathing
- unexplained weight loss
- swelling or inflammation of the stomach region
- abdomen that is painful to touch
- yellowing of the skin and eyes
- ongoing nausea or vomiting, especially if vomiting blood
- blood in the stool
- pain that occurs during pregnancy
- joint and muscle aches
Though rare, severe stomach pain that occurs suddenly and without a clear reason may be a sign of serious health conditions.
One life-threatening condtion is appendicitis. In some people, the appendix becomes inflamed and infected. It can burst, causing severe infection that requires immediate medical attention and surgery.
Often, appendicitis starts as pain that begins around the belly button and travels downward into the lower right side. It then usually worsens with the slightest activity or movement.
Other conditions associated with intense, unrelenting stomach pain include:
- Kidney stones. Sharp, stabbing pain that begins in the mid back and spreads to the stomach and abdomen. There is often blood in the urine.
- Food poisoning. Intense and sudden onset of vomiting, nausea, diarrhea, and fever or chills. Symptoms lasting longer than 24 hours should be addressed medically.
- Cardiac events or conditions. Stomach pain alongside an increased heart rate, increased sweating, nausea or vomiting, difficulty breathing, tingling sensation in the arms or chest, or pain in the jaw and neck need immediate medical attention.
- Hiatal hernia. Occurs when a part of the stomach passes into the chest cavity. Lying flat can increase reflux symptoms that commonly occur with a hiatal hernia.
- Stomach cancer. Stomach cancer can cause nearly all the symptoms typically associated with general abdominal or digestive pain. Anytime a wide array of symptoms present, or become continuous, medical advice should be sought.
In the case of any of these conditions, medical evaluation is important in order to receive a proper diagnosis and treatment.
Ways to prevent and treat nighttime stomach pain
There are many fairly simple ways to reduce the risk of experiencing nighttime stomach pain.
Lifestyle changes and over-the-counter medications are generally the first recommended line of treatment. Over-the-counter medications that treat gas and indigestion may be helpful.
Avoiding rich and fatty foods close to bedtime is recommended to prevent and manage nighttime stomach pain.
Prescription medications like antibiotics are useful against H. pylori. Pain medications may be used to treat severe cases of certain types of digestive problems.
Surgical options also exist to treat the more serious health conditions associated with nighttime stomach pain.
Common tips for the prevention and management of nighttime stomach pain include:
- avoiding eating close to bedtime
- elevating the head of the bed while sleeping
- avoiding rich or fatty foods, coffee, or chocolate at night
- avoiding or limiting alcohol consumption
- avoiding overeating
- using over-the-counter antacids and gas medications