Stomach Knots – ‘Tied Up’ Feeling in Stomach, Abdomen

What are knots in the stomach?

People commonly describe feelings of strong anxiety or fear as having “knots in the stomach” or “butterflies in the stomach”. However, these common phrases are very nebulous because they fail to identify what exactly is wrong and where. During periods of heightened emotions, one may experience a strange discomfort in the abdominal area.

As the strong emotions subside, the strange abdominal discomfort also resolves. This “knots in the stomach” feeling caused by strong emotions is not really considered a medical condition. Sometimes, however, the strange uneasiness in the abdomen may also be accompanied by a dull ache or pain in the abdomen.

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When the feeling of having knots in the stomach is not associated with any psychological trigger (such as anxiety, nervousness, and fear), then it could be a symptom of some underlying disorder. Since people commonly (and erroneously) refer to the whole of the abdominal area as the stomach, a “stomach” problem may have its origin in any part of the abdomen.

In most cases, disorders of the stomach or the gastrointestinal tract may be responsible for the uneasy feeling of having knots in the stomach. However, the feeling of having knots in the stomach may also arise due to a problem outside the digestive tract or even the abdomen.

For these reasons, it is always advisable to consult a medical doctor to investigate a persistent feeling of knots in the stomach. Proper treatment can only be given when the cause of this uneasy feeling can be determined.

Causes of Stomach Knots

The feeling of having knots in the stomach is a symptom that can manifest in a variety of conditions. This uneasy feeling may also be accompanied by other signs and symptoms such as nausea, vomiting, heartburn, and abdominal bloating.

Since the feeling of stomach knots is too vague to help in the proper diagnosis of the cause, the other accompanying signs and symptoms need to be studied in order to find clues about the exact underlying cause.

Sometimes, one may even be advised to undergo medical investigations such as magnetic resonance imaging (commonly abbreviated as MRI) or upper gastrointestinal endoscopy in order to determine the root cause of stomach knots.

Psychological factors

The most probable reasons for knots in the stomach are psychological factors such as anxiety, fear, depression and other mental health issues. These causes should be ruled out first before considering other potential causes. Strong emotional states can affect the flow of blood in the body’s core and the periphery.

For example, the fight-or-flight response triggered by fear and mediated by hormones such as adrenalin, can cause sudden changes in the blood flow within the digestive tract. The activity of the gut nervous system is also affected by strong emotional mental states such as anxiety. Therefore, these psychological states can cause “butterflies or knots in the stomach” by modulating some physiological processes in the gut.


A stomach upset is also commonly referred to as indigestion. There are many reasons for indigestion, including dietary causes such as overeating. Acute cases of indigestion can usually be relieved easily by antacids or similar medications. However, persistent or recurring indigestion warrants further investigation to rule out more serious underlying issues in the stomach or the gut.

Diseases of the stomach

The feeling of knots in the stomach is a feature of many different stomach diseases. In most cases, a dull ache or discomfort in the stomach is mistaken for a feeling of knots in the stomach. Inflammation of the stomach (technically referred to as gastritis) is a common cause of stomach knots. The presence of ulcers in the stomach may also cause the feeling of stomach knots. Delayed gastric emptying is a relatively less common, yet possible cause of stomach knots.

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Peptic ulcers

Stomach knots can also be caused by the presence of peptic ulcers (open sores) in the walls of the stomach and the duodenum. In some cases, the open sores may also occur in the esophagus. The causes of peptic ulcers and gastritis are usually the same. The feeling of knots in the stomach in gastritis or peptic ulcer disease is commonly accompanied by some degree of pain.

Gastroesophageal reflux disease

Gastroesophageal reflux disease (commonly abbreviated as GERD) refers to a condition in which there is a chronic acid reflux from the stomach into the esophagus and throat. Acid reflux is a common problem that can cause a feeling of knots in the stomach.

Another acid-related problem that may cause stomach knots is Zollinger-Ellison syndrome. This condition is characterized by an overproduction of acid in the stomach. However, Zollinger-Ellison syndrome is not as common as acid reflux.

Problems with gallbladder and pancreas

The gallbladder and pancreas are key components of the digestive system. Both these organs lie near the stomach and the duodenum. A common problem of the gallbladder is the formation of gallstones, which may cause obstruction to the flow of bile.

A common problem of the pancreas is pancreatitis (or inflammation of the pancreas), which is often due to excessive consumption of alcohol. Both gallstones and pancreatitis typically cause pain. However, in mild cases or early stages of the condition, the sensation of knots in the stomach may be present.

Hunger or overeating

Sometimes, people may mistake hunger pangs for a feeling of knots in the stomach. Similarly, abdominal bloating and indigestion caused by overeating may also be described by some as having stomach knots. The sensation of stomach knots in both these conditions is temporary, and subsides with eating (after feeling hungry) or gastric emptying (after a bout of overeating).

Alcohol and medicines

The lining of the stomach wall can get irritated upon intake of alcohol and certain medicines (such as non-steroidal anti-inflammatory drugs and certain antibiotics). Irritation of the stomach wall can result in discomforting sensations, such as stomach knots, burning and pain.


Stomach knots can also be felt in various diarrheal conditions. One of the common causes of diarrhea and stomach knots is gastroenteritis. Nausea, vomiting, and abdominal cramps are characteristic signs and symptoms of gastroenteritis.

The most common cause of gastroenteritis is infection with pathogenic bacteria or viruses. The pathogenic microbes (and their toxins) responsible for gastroenteritis can spread through contaminated food, water, and fomites (inanimate objects).

Other causes

Stomach knots may also occur in conditions such as heart attack, liver diseases, kidney diseases, bowel disorders, and strain or injury to the abdominal wall.

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