Stomach pain at night usually comes from acid reflux, gastritis, a peptic ulcer, gallstones, IBS or constipation, and lying down after a late meal makes most of them worse. Tonight, sit up, take an antacid, drink water and avoid ibuprofen; for the long term, finish dinner 3 to 4 hours before bed and raise the head of the bed. Sudden severe pain, chest pain, vomiting blood or pain moving to the lower right side needs a hospital now.
Why does stomach pain get worse at night?
Stomach pain gets worse at night because lying flat lets acid rise, a late or heavy dinner is still being digested, and an empty stomach after midnight exposes an ulcer. The NHS says heartburn and acid reflux symptoms often get worse after eating, lying down or bending over, so a meal followed by bed is the worst sequence for reflux. For a stomach ulcer, the NHS says the pain may feel like burning and "is often worse at night". Gallbladder attacks follow the same clock: the US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says they commonly follow large meals and happen in the evening or at night.
The position of the pain is the first clue. The NHS stomach ache page matches patterns to causes: heartburn with fullness after eating points to indigestion; cramps with bloating, diarrhoea or constipation point to irritable bowel syndrome (IBS); severe pain lasting hours in the centre of the tummy or under the right ribs points to gallstones; sudden pain in the lower right side points to appendicitis. Most stomach aches, the NHS says, are not serious and settle in a few days. The rest of this guide covers the six common causes, what to do tonight, the signs that mean hospital now, and the changes that stop it returning.
What are the common causes of stomach pain at night?
Six conditions explain most night-time stomach pain: acid reflux, gastritis, a peptic ulcer, gallstones, IBS and constipation.
| Cause | What it feels like | Clue that points to it (source) |
|---|---|---|
| Acid reflux | Burning in the middle of the chest, sour taste, cough or hoarseness | Worse after eating, lying down or bending (NHS) |
| Gastritis | Upper abdominal pain, indigestion, bloating, nausea | Linked to H. pylori, ibuprofen or aspirin, heavy alcohol (NHS) |
| Peptic ulcer | Burning pain in the upper tummy | Often worse at night; NHS lists H. pylori and anti-inflammatory painkillers as main causes |
| Gallstones | Severe constant pain in the centre of the tummy or under the right ribs | Lasts over 30 minutes, up to several hours, with nausea (NHS); evening or night after a large meal (NIDDK) |
| IBS | Cramps with bloating, diarrhoea or constipation | Worse after eating, better after passing stool (NHS) |
| Constipation | Stomach ache, bloating, feeling sick | Fewer than 3 stools in the last week, or hard, lumpy stool (NHS) |
Reflux is common in India. A 2016 community study in BMC Gastroenterology, run in Trivandrum district, Kerala, found reflux disease in 22.2 percent of 1,072 adults, with higher odds in urban residents, people with a BMI of 30 or more, and pan masala chewers, who had twice the odds of the rest.
Gastritis and ulcers share causes. The NHS lists Helicobacter pylori infection, anti-inflammatory painkillers, heavy alcohol and severe stress for gastritis, says untreated gastritis can turn into an ulcer, and says an untreated ulcer can bleed, cause anaemia or perforate. Night pain that returns week after week needs a test, not another antacid.
What can you do tonight to ease the pain?
Sit up, take an antacid or alginate, drink water, and stop any ibuprofen or aspirin; those four steps cover the common causes safely until morning. The NHS says reflux symptoms get worse lying down, and that antacids and alginates ease symptoms in the short term when taken with food or soon after eating. Pharmacies in India sell both over the counter.
- For reflux or gastritis pain: sit propped up, take an antacid or alginate, and do not lie flat again for 3 to 4 hours after eating, the NHS interval.
- For cramps and wind: the NHS IBS page lists hyoscine butylbromide (Buscopan) and peppermint oil as pharmacy options for bloating, cramps and wind.
- For constipation: the NHS says most laxatives from a pharmacist work within 3 days and are for short-term use; drink plenty of fluid and keep walking during the day.
- For pain under the right ribs that has lasted more than 30 minutes: the NHS says to contact urgent care, because gallstone pain of that length needs an assessment, not home treatment.
- Do not take ibuprofen or aspirin for the pain. The NHS lists both as causes of gastritis and names anti-inflammatory painkillers as a main cause of ulcers; paracetamol is the alternative the NHS gallstones page suggests.
Antacids are a stopgap. The NHS says they do not cure the problem and should not be used regularly for long periods. If the same pain wakes you several nights running, the next step is a doctor.
Which night-time stomach pains need a hospital now?
A few patterns of night pain are emergencies, and the two most dangerous are appendicitis and a heart attack that feels like indigestion. The NHS stomach ache page lists the signs that mean an ambulance.
Go to the nearest emergency department, or call 112 for an ambulance, if the pain came on very suddenly or is severe, if it hurts to touch your tummy, if you vomit blood or material like ground coffee, if your stool is bloody or black and sticky, if you cannot pass urine, stool or wind, if you have chest pain or cannot breathe, or if you have diabetes and are vomiting.
Appendicitis has a specific course. The NHS says it usually starts with pain around the navel that later moves to the lower right side and gets worse; moving, coughing or pressing makes it hurt more, and nausea, loss of appetite and a high temperature often come with it. Pain that settles in the lower right and keeps worsening needs an assessment the same night.
A heart attack can start as what feels like indigestion. The NHS says the chest pain may feel like crushing or squeezing, may spread to the arm, neck or jaw, and may come with a burning chest, bloating, sweating, breathlessness or nausea. Tight or spreading chest pain is a 112 call, not an antacid.
For gallstones, the NHS lists sudden severe pain, pain spreading to the back with vomiting, a very high temperature, and yellow skin or eyes as reasons to go to hospital at once.
What should you change so the pain stops coming back?
Finish dinner 3 to 4 hours before bed, raise the head of the bed, eat smaller meals, and cut your triggers; these changes work for reflux, gastritis and IBS, which cause most repeat night pain. The NHS says not to eat within 3 or 4 hours of bed and to raise the head of the bed by around 10 to 20 cm with blocks, not extra pillows, which press on the belly and make reflux worse.
The NHS lists the common triggers, and the Kerala study adds one Indian habit:
- Coffee, tea, cola and energy drinks; the NHS IBS page caps caffeinated drinks at 3 cups a day.
- Alcohol, smoking and, in the Kerala study, pan masala chewing.
- Fatty, fried, spicy, acidic and fizzy foods, chocolate and tomatoes.
- Large meals; the NHS advises smaller, more frequent ones.
- Excess weight; the Kerala study found the odds of reflux rose with BMI.
- Stress, which the NHS lists as a trigger for reflux and IBS flares.
For IBS and constipation the NHS adds regular meals, around 1.5 litres of fluid a day, oats and linseeds for soluble fibre, less cabbage, cauliflower, beans and onions if bloating is the problem, and a daily walk. A two-week food diary shows which of these matters for you, and a dietician can turn it into a plan that fits an Indian kitchen.
Which tests and which doctor will find the cause?
A general physician can treat most reflux and constipation, but pain that keeps returning, pain under the right ribs, or any red flag needs a gastroenterologist and one or two tests. The NHS says to see a doctor for heartburn most days, food sticking in the throat, frequent vomiting, unexplained weight loss, or IBS symptoms lasting more than 4 weeks.
The tests follow the suspected cause:
- Gastritis and ulcers: the NHS says a doctor may order a breath, stool or blood test for H. pylori, and a gastroscopy, a thin camera passed through the mouth, if symptoms persist. In India this is billed as an upper GI endoscopy; see endoscopy cost for prices near you.
- Gallstones: the NHS says the usual tests are an ultrasound scan and a blood test. An abdominal ultrasound is painless and available in most district hospitals.
- Reflux that does not settle: the NHS says a doctor may prescribe a proton pump inhibitor such as omeprazole for 4 or 8 weeks, with a gastroscopy and bacteria test if that fails.
Treatment is short once the cause is found. The NHS says ulcer treatment, antibiotics for H. pylori plus an acid-reducing medicine, usually lasts 1 week to 2 months. Gallstones that cause attacks are treated by removing the gallbladder. A government hospital's medicine OPD orders these tests at little or no cost, and a listed Ayushman Bharat hospital covers the surgery for cardholders. This guide is general information from the sources listed below, not medical advice; a registered doctor makes decisions with you.
