Understanding New and Severe Abdominal Pain

You have identified that you are sensitive to a change in your position. This may lead your doctor to consider one or more of the diagnoses below:

The esophagus can occasionally cause pain that is heavy or aching, even though its usual symptom is heartburn (burning pain). Acid reflux should be considered as a possible diagnosis since your symptoms are worse when you lie flat. Acid can enter the esophagus more easily in this position.

Pancreatitis is less painful when you sit up or sit forward. When it is inflamed, your pancreas is very sensitive to the weight of surrounding structures. Your pancreas is located in the back of your abdomen. When you lean forward, you take the weight of overlying structures such as your stomach and intestines off of your pancreas.

Irritation of a protective sack that surrounds your heart (called the pericardium) can result in fluid accumulation around the heart. Pericarditis is least painful when you lean forward.

Several other problems -- an ulcer in the stomach or duodenum or gallstone disease -- can also be more painful when you lie down at night. For these conditions the increase in pain is not related to your position at all; rather, it is related to timing. The time that you lie down in the evening is two or three hours after the evening meal for most people. At this stage in your digestion, there is a large amount of digestive acid in your stomach and duodenum but not very much mucus. Acid can therefore become very irritating to any open sore (ulcer) located along the wall of these structures. Gallstones are most symptomatic at night because the gallbladder squeezes most forcefully several hours after a large meal.