Hard stomach

Hard stomach

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A hard stomach may have obvious functional causes, such as strong abdominal muscle training or heavy use of the abdominal muscles. It can also occur in women, for example, during menstrual bleeding or during pregnancy. And there are many cases in which a hard stomach appears without a cause being recognizable at first glance. The symptoms (with or without abdominal pain) can also go back to serious illnesses and it must always be borne in mind that an acute abdomen, which is a serious emergency, also has a hard stomach. The emergency services should be contacted here immediately.

Hard stomach - short overview

Basically, in view of the possible serious causes of the symptoms, medical clarification is necessary and in some cases, immediate emergency medical care may even be required. To quickly classify the complaint picture, the most important facts are briefly summarized here:

  • definition: Hard stomach is the colloquial term for a bloated stomach with a hard abdominal wall and a feeling of tension.
  • causes: Bowel obstruction, peritonitis, acute pancreatitis, breakthrough of the gall bladder, testicular, ovarian Stiehl rotation (ovarian torsion), an aortic aneurysm, pinched inguinal hernia, appendicitis, diverticulitis, pelvic inflammatory disease (ovarian and tubal inflammation), food intolerances, food allergies, indigestion, irritable bowel syndrome, as well as intense abdominal training and overeating and drinking.
  • When is the hard stomach an emergency? If there are accompanying symptoms such as excessive sweating, pallor, rapid heartbeat, vomiting blood, blood in the stool, fever, low blood pressure, nausea and vomiting or acute abdominal pain.
  • diagnosis: After a thorough medical history and physical examination with palpation and listening to the abdomen, imaging methods (such as sonography or computer tomography), endoscopic examinations (e.g. gastroscopy, colonoscopy), blood tests, urine and stool samples and other diagnostic methods can be used. In an emergency, a laparotomy (surgical opening of the abdomen) or laparoscopy (endoscopic intervention in the abdominal cavity) may be required for an acute abdomen.
  • treatment: Align with the respective causes; can range from simple dietary changes to drug treatments to major surgical interventions or emergency operations.
  • Naturopathy and holistic medicine: Supporting digestion, for example with Swedish herbs and other bitter substances; Medicinal plants such as caraway and fennel against flatulence; Healing earth for irritable bowel syndrome, abdominal massage and manual treatment, for example using osteopathy.

Important: Even with a heart attack, abdominal pain and extreme defensive tension in the abdominal wall can occur, which comes close to the symptoms of the hard belly. Accompanying symptoms such as chest pain, shortness of breath, tightness in the chest, circulatory problems and radiating pain in the left arm are to be seen here as warning signals!

Symptoms of a hard stomach

A hard stomach often occurs in combination with other symptoms that can provide important clues to the cause and may be a warning signal for a medical emergency. This is how the emergency services should be contacted if symptoms such as:

  • excessive sweating,
  • Paleness,
  • Racing heart,
  • Vomiting of blood,
  • Fever,
  • Blood in the stool,
  • low blood pressure,
  • Nausea and vomiting
  • or acute abdominal pain.

A hard stomach can also be associated with other symptoms, such as:

  • Pulling in the abdomen,
  • Rashes on the abdomen,
  • Flatulence,
  • Diarrhea,
  • Belching,
  • Feeling of fullness
  • and cramps.

Many of those affected also have daily and mechanical differences. For example, they complain of a hard stomach after eating or after sitting for a long time. Women also sometimes have a hard stomach after intercourse or during pregnancy.

Hard stomach - causes

If the severe symptoms mentioned at the outset appear, it can be an acute abdomen, which could result in circulatory failure or even a shock and which urgently needs immediate medical attention. An acute abdomen can result from various diseases, such as:

  • Bowel obstruction,
  • acute pancreatitis,
  • Breakthrough of the gallbladder,
  • Testicular torsion,
  • Ovarian rotation (ovarian torsion),
  • an aortic aneurysm,
  • pinched hernia,
  • Appendicitis,
  • Diverticulitis,
  • Adnexitis (inflammation of the ovaries and fallopian tubes).

Other possible causes of a hard stomach are:

  • intensive abdominal training,
  • Flatulence (e.g. due to food intolerance),
  • Indigestion,
  • Irritable bowel syndrome,
  • overeating and drinking.

Hard stomach - pregnancy

In addition to these acute and structural causes, there are also functional events that can trigger a hard stomach. In women, pregnancy can naturally lead to a hard stomach. If chronic fatigue, vomiting, nausea or mood changes occur, a pregnancy test should be carried out. A hard stomach can also appear during pregnancy, which does not necessarily indicate problems. However, a timely gynecological clarification is required in these cases.


First, a thorough medical history with questions about the occurrence of the symptoms, their intensity, accompanying symptoms, conspicuous relationships (e.g. with food intake) and known previous diseases should be carried out. A subsequent physical examination with palpation and eavesdropping in many cases already provides indications of possible causes for the hard stomach. Furthermore, depending on the suspicion, other examination methods can be used, such as imaging procedures (sonography, computer tomography), endoscopic examinations (e.g. gastroscopy, colonoscopy), blood tests, urine and stool samples, allergy tests and many more. However, an acute abdomen may require an immediate laparotomy (surgical opening of the abdomen) or laparoscopy (endoscopic intervention in the abdominal cavity) without a reliable diagnosis.

Hard stomach treatment

Depending on the respective causes of the complaints, various therapeutic measures are used, such as the supply of oxygen to a current abdomen, infusions for volume substitution, the administration of certain pain relievers, but also endoscopic interventions in the abdominal cavity or even an opening of the abdominal wall with subsequent surgery on the internal organs. At the same time, important medical parameters such as respiratory rate, heart rate, blood pressure or blood oxygen saturation are monitored.

Other causes of the hard stomach require less complex or no therapy at all. For example, in the case of indigestion and also food intolerance, simply changing the diet is often sufficient to permanently solve the problem. With an intensive abdominal muscle training as the cause, only a gentle phase is required for the recovery. In any case, it is therefore important to determine the causes as precisely as possible in order to determine the appropriate therapeutic measures.

Naturopathy and holistic medicine

Sufferers usually turn to naturopathy desperately when all organs and vessels in the region have been examined and labeled as intact - but the hard stomach remains. The serious illnesses mentioned have thus already been excluded. In this situation, naturopathy and holistic medicine offer quite a few options that are at least worth trying.

If irritable bowel syndrome is the cause of the symptoms, internal treatment with healing earth or the use of abdominal massages can provide relief. The latter often have a soothing effect on flatulence. Well-known home remedies for flatulence such as caraway and fennel or moist and hot body wraps can also help here.

If possible incorrect colonization of the intestinal flora has been determined on the basis of stool examinations, the natural intestinal flora can be rebuilt, if necessary, with an intestinal restoration in order to permanently counteract the hard stomach.

If the hard stomach is connected with the food intake, the so-called fletching (special technique when chewing) can be a useful measure: Here, the food is taken at fixed times and above all in peace and care is taken, with the special method in particular to chew thoroughly. There is also the option of using traditional remedies for indigestion, such as the so-called Swedish herbs and medicinal plants containing bitter substances.

In osteopathy, the movement and tension of the organs are also included. There are different approaches within this specialist discipline: some osteopaths follow the movement of the organs through breathing, others according to the former embryological movements. It is by no means just about movement disorders, but also about a lack of tension or overall unfavorable tension in the abdomen. The origins of the nerves on the spine are also examined - which is why the osteopathic initial examination can ask about back pain, for example. Then, through targeted manual treatment, an attempt is made to counteract the identified functional causes of the hard belly. (tf, jvs, fp)

Also read:
Home remedies for flatulence

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters


  • Professional association of German internists e.V .: abdominal pain: symptoms (access: 20.09.2019),
  • E. Dirks, J. Nothwang: Gastrointestinal emergencies: acute abdomen; in; Emergency & Rescue Medicine, October 2000, Volume 3, Issue 6, pages 381-389,
  • R. E. Schernthaner, C. Loewe: Vascular causes of a clinically unclear acute abdomen; in: Der Radiologe, Febraury 2019, Volume 59, Issue 2, pages 133–138,
  • Stefan Hecht, Matthias Meissnitzer, Rosemarie Forstne: Acute abdomen of women: gynecological causes; in: The Radiologist, February 2019, Volume 59, Issue 2, pages 126–132,
  • Reintam Blaser, A .; Malbrain, M.L.N.G .; Regli, A .: Abdominal pressure and gastrointestinal function: an inseparable couple ?; in: Anaesthesiology Intensive Therapy, 2017, 49 (2), page 146-158. , PubMed

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