Lower Right Abdominal Pain

Lower right abdominal pain is one of the most common causes of patient visits to the emergency department. The lower right abdominal region is located below an imaginary horizontal line drawn under the lower right ribs and to the right of an imaginary vertical line running along the belly button.

Abdominal pain in this area is usually acute, and can be spontaneous or chronic. It can be a dull or sharp, localized or diffuse. Accompanying symptoms include nausea and vomiting, tenderness, constipation, diarrhea, loss of appetite, bloating and gas, and fever.

There are many structures in the lower right abdominal region in which pain can originate. The internal structures in this area include parts of the large intestine called the cecum, the appendix, and ascending colon, portions of the small intestine, the right ovary and the fallopian tube, and the right ureter. Any abnormality or disturbance of one or more of these structures can cause pain in the lower right abdomen.

Appendicitis

The most common cause of pain in the lower right portion of the abdomen is appendicitis, or an inflammation of the appendix. It occurs in about 10% of the population and it is most common between the ages of 10-30, although it may occur at any age.

The cause of appendicitis may be an infection or blockage, leading to inflammation and swelling. Symptoms usually begin as an aching pain around the belly button or in the middle of the upper abdomen, and then shifts to the lower right abdomen. This pain becomes sharper after several hours and is accompanied by tenderness or pain when exposed to pressure. When deep pressure is applied and released, a sharp pain or rebound tenderness is experienced. Accompanying symptoms include low-grade fever, nausea, vomiting, loss of appetite, and constipation or diarrhea.

If you experience these symptoms, seek immediate medical attention.

Ovulation Pain

Pain associated with ovulation or Mittelschmerz may occur either in the right or left side of the lower abdomen. This usually does not require medical attention. However, it is sometimes confused with the symptoms of appendicitis due to the location of pain.

Ovulation pain occurs about two weeks before the next menstrual period, when an egg is released from the ovary. This may be a dull, cramp-like pain or a sharp, sudden pain. This pain is not usually severe, but it may be accompanied by vaginal spotting or bleeding. It is often relieved by rest and pain relievers, but if it is accompanied by fever and nausea, infections such as appendicitis must be considered.

Right Kidney Stones

Small, crystal deposits can form inside the kidneys, especially when urine becomes too concentrated. Kidney stones can pass through any part of the urinary tract, from the kidney to the bladder. This can be very painful, although the stones do not cause permanent damage.

Symptoms include severe pain below the right ribs, including the side and back, which may spread to the lower right abdominal area and groin. The pain may come in waves and fluctuate in severity. Associated symptoms include pain when urinating, pinkish, reddish or brownish urine that may be cloudy and foul-smelling, nausea, vomiting, fever with chills, and frequent urination.

Sometimes pain may be relieved by drinking a lot of water and taking pain relievers. However, if the pain is severe then you may need to consult a doctor for possible removal of the stone.

Right Kidney Infection

Infection in the bladder or any part of the urinary tract can spread to the kidneys, causing inflammation and pain. It is characterized by lower abdominal pain, back pain, flank pain, or groin pain. There is a persistent urge to urinate, and this urination may be painful. Pus or blood may be seen in the urine. Fever is often present.

Kidney infection can lead to widespread infection or kidney damage if left untreated. Therefore, it is best to seek consultation for antibiotic treatment to prevent complications.

Right Ovarian Cysts

The ovary sometimes produces fluid filled sacs on the surface, which may grow large and produce discomfort. Although they are usually harmless and can resolve on their own, they may become enlarged and get twisted, producing lower abdominal pains. They can produce dull, aching, pelvic pain that is persistent or intermittent, and may radiate to the lower back and thigh. Pelvic pains may be experienced near the beginning or end of a menstrual period. Menstrual periods may be irregular. Lower abdominal pain may also be associated with heaviness or fullness of the abdomen, nausea, vomiting and pressure on the bladder or rectum.

Although most ovarian cysts resolve on their own, you should see a doctor if there is a sudden, severe lower abdominal or pelvic pain that is associated with fever or vomiting.

Constipation

Another common cause of lower right (or left) abdominal pain is constipation. This occurs when you are unable to regularly pass stools with ease, and instead, may pass hard stools less than 3 times a week. Straining, bloating, and pressure in the rectum accompany the pain. The pain usually disappears with bowel movement and may not be accompanied by additional symptoms. This is often relieved by modifying the diet and taking stool softeners or laxatives.

Ectopic Pregnancy

When a fertilized egg is implanted outside of the uterus, an ectopic pregnancy results. The fertilized egg may lodge in the right ovary, fallopian tube, or in the abdominal cavity, causing severe pain. If it occurs on the right side then it may be mistaken for appendicitis. However, it is often recognized because it is usually associated with a missed period, symptoms of early pregnancy, and vaginal bleeding.

Immediate medical consultation must be sought because a fallopian tube may rupture and cause heavy bleeding, which can be life threatening.

Here is a summary of the most common causes of lower right abdominal pain:

Cause

Character of Pain

Accompanying Symptoms

Treatment/Remedy

Appendicitis

Dull aching pain that becomes sharp, starts in the mid abdomen and shifts to the right lower region; tenderness, rebound tenderness

Fever, nausea, vomiting, loss of appetite, constipation/diarrhea

Surgical removal of appendix

Constipation

Dull abdominal pain when there is failure to pass stools

Straining, bloating and pressure in the rectum

Passage of stools relieve symptoms; use laxatives, modify diet

Ovulation Pain

Dull and cramp-like type of pain or sharp, sudden pain

Occurs 2 weeks before period, with or without vaginal spotting

Oral pain relievers, rest

Kidney Stones

Flank pain may be sharp, comes in waves, fluctuating, spreads to back and groin

Pain in urinating, pink, red or brown urine which may be cloudy and foul-smelling, nausea, vomiting, fever with chills, and frequent urination.

Mild - none or analgesics

Severe - surgery

Kidney Infection

lower abdominal pain, back pain, flank pain or groin pain

persistent urge to urinate, painful urination, pus or blood in the urine, fever

Antibiotic treatment

Ovarian Cysts

Dull, aching, pelvic pain that may also radiate to the lower back and thigh.

Irregular periods, heaviness, spotting, nausea, vomiting, pressure; sometimes none

Mild pain - none, or analgesics

Severe - possible surgery

Ectopic Pregnancy

Severe lower abdominal or pelvic pain

Missed period, signs of pregnancy, vaginal bleeding

Surgery

Less Common Causes

These are some less common causes of lower right abdominal pains:

  • Colon cancer - occurs in elderly patients and manifests as constipation or change in bowel habits, chronic abdominal pains, and remarkable weight loss.
  • Pelvic inflammatory disease - an infection involving the female reproductive organs, caused by sexually transmitted bacteria. Abdominal pain is accompanied by heavy vaginal discharge that is foul smelling, irregularities in menstruation, fever, low back pains, and pain during sex.
  • Endometriosis - a condition in which tissue from the uterus grows outside the uterus, such as on the right ovary, fallopian tube or bowels, causing severe pain that is experienced with menses.
  • Inflammatory bowel disease - a chronic inflammation of all or part of the digestive tract, including ulcerative colitis and Crohn's disease. These are painful and debilitating conditions that manifest as chronic diarrhea, weight loss, and sometimes can lead to life-threatening complications.
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