Waking Up With Stomach Pain? Here's What Your Body's Trying to Tell You

Waking up with stomach pain is not only uncomfortable, but possibly anxiety-inducing. You may find yourself spiraling as you try to determine whether the cause is merely something you ate or a sign that something is seriously wrong.

If you've ruled out the usual causes — an urge to relieve yourself, an empty stomach signaling it's time for breakfast, gas and ordinaryheartburn— another condition may be at play.

Here,Ronald Omino, MD, a gastroenterologist at UCLA Health Services, explains why you might wake up with abdominal pain, and what to do when it happens.

If you wake up often with heartburn, the taste of acid in your mouth or gnawing, sharp abdominal pain, you may havegastroesophageal reflux disease (GERD), or chronic, severe acid reflux. GERD occurs when your lower esophageal sphincter (the flap at the top of your esophagus that prevents digestive juices from flowing upward) becomes weak or relaxes when it shouldn't.

A healthy esophageal sphincter will keep digestive acids in your stomach when you lie down. But when you have GERD, digestive acids flow in the wrong direction, resulting in gastric distress, according to theMayo Clinic.

Signs that GERD is causing your morning stomach pain, according to Dr. Omino, include:

• Heartburn and burning in the chest or upper abdomen
  
• Regurgitation, or the feeling of bringing up food, liquid or other contents of your stomach into your mouth or throat
  
• Difficulty swallowing
  

If you wake up in the morning with lower abdominal pain (or generalized abdominal pain or discomfort), think back to the last time you had a regular bowel movement. You might be constipated.

Constipation is more than going a few days without pooping: Othersymptoms of constipationinclude, per theNational Institute of Diabetes and Digestive and Kidney Diseases(NIDDK):

• Fewer than three bowel movements a week
  
• Stools that are hard, dry or lumpy
  
• Stools that are difficult or painful to pass
• Feeling that not all stool has passed
  

"Peptic ulcer disease, also known as a stomach ulcer, can present as acute or chronic abdominal pain generally in the upper abdomen," Dr. Omino says.

Peptic ulcers are open sores that develop on the inner lining of your stomach and upper portion of your small intestine, per theMayo Clinic. Ulcer pain can occur a few hours after eating (when the body is producing more acid), or on an empty stomach, leading to burning abdominal pain in the morning.

The most common causes of peptic ulcers include, per Dr. Omino:

• Nonsteroidal anti-inflammatory drug (NSAIDs) overuse
• Infection from Heliobacter pylori (H. pylori) bacteria

While stress and spicy foods can worsen the symptoms of peptic ulcer disease, they cannot cause peptic ulcers.

Left untreated, a peptic ulcer can lead to upper gastrointestinal (GI) bleeding. See a doctor right away if you seebright red blood in the stoolor black stool, Dr. Omino says. A doctor will evaluate your upper GI tract with an upper endoscopy procedure to confirm a diagnosis.

If you oftenwake up with nauseaand asudden urge to poop, you may have irritable bowel syndrome, or IBS.

When it comes to IBS, the doctor's old saying, "it's notwhatyou're eating, butwhat's eating you," can apply. In other words, IBS is a functional gastrointestinal disorder — meaning it's related to problems with yourgut-brain connection, or how the gut and brain work together, per theNIDDK. A malfunction in this connection can cause your gut to feel sensitive, altering how the muscles in your bowel contract.

Research suggests a link between IBS and mental health conditions like anxiety and depression. In one December 2021 review inGeneral Psychiatry, people with IBS were more likely to have moderate and severe depression and anxiety than people without IBS.

Symptoms of IBScan include abdominal pain and bloating, as well as changes in your bowel movements, including diarrhea and/or constipation.

If your morning stomach pain is severe or accompanied by fever, nausea, vomiting, jaundice or inability to pass gas or poop, talk to your doctor as soon as you can, Dr. Omino says. And that goes for any time of day, not just after waking up.

These symptoms could be signs of serious GI conditions like appendicitis, diverticulitis or pancreatitis, according to Dr. Omino, or other non-GI concerns. Your doctor can help you narrow down the causes and evaluate your treatment options.