Lower Right Abdominal Pain

Causes, Diagnosis & Treatment Of Lower Right Abdominal Pain 

What Is Lower Right Abdominal Pain?

Lower right abdominal pain is defined as abdominal pain occurring to the right of an imaginary line drawn from above the pubic bone in the mid-line, up to the level of the belly button or umbilicus. Pain in this area is the most common reason for people going to accident and emergency departments across the world. 

The right side of the abdomen internally is different from the left side in at least three ways. There is the presence of the caecum, and the appendix on the right lower abdomen as well as a larger and steeper "right paracolic gutter" - the space surrounding the right half of the colon. These factors make the right lower abdomen more prone to having things go wrong with it than the left side.

Also within this region of the body lies other organs like the:

• Right Ureter or tube from the kidney
• The ascending colon
• Part of the urine bladder
• Some loop of small intestines
• Right Ovary
• Right Fallopian tube
• Part of the womb
• Upper part of the vagina and cervix to the mid line
  
• Muscles, ligaments, bones, connective tissues and skin over this region.

Damage or disease to these structures and organs can cause pain in the lower right abdomen.  

Infection far away in the upper part of the abdomen like from the gallbladder and liver can also track down to cause pain and symptoms in the lower right abdomen. A systematic approach to analysing the characteristics and associated symptoms of a lower right abdominal pain is the solution to understanding what might be causing such pain.. 

Common Causes of Lower Right Abdominal Pain

The following are common conditions that cause pain in the lower right abdomen and their individual symptoms. 

Appendicitis

Are you having pain in the lower right abdomen in the last few days? Did the pain start in your upper abdomen and then moved towards the lower right side? Has the pain become worse in the last day or so? Does it seems to get worse when you move or walk or stand straight? What's your appetite like? Feeling nauseated and not hungry... perhaps you have even skipped having dinner or breakfast? Are you feeling feverish? Does pressing your hand against your lower right abdomen cause this moderate to severe pain in you?

If you have a combination of two or more of the above symptoms, you might be suffering with acute appendicitis, and it is important that you seek urgent medical attention as soon as possible.

Appendicitis is undoubtedly one of the most common causes of lower right side stomach pain. It can occur in anyone and at any age, but:

• It is more common between ages 7 to 39
• It may start as a pain in the upper abdomen or around the belly button and then the pain moves to the right lower abdomen
• The pain tends to be worse on movement or standing straight
• The sufferer often prefers to stay still or bent over
  
• It is commonly associated with loss of appetite
• The sufferer feels they want to vomit (nausea) and in severe cases, there might be an episode of vomiting
• In younger people, there may be one or two episodes of loose stools or constipation
  
• Some people may feel feverish (feeling hot and cold and unwell in themselves)
• It doesn't last for more than a few days - it either gets worse or things settle down

Pain in the right lower abdomen which has been there for weeks or months will not be an appendicitis, and therefore this pain should also be investigated by a doctor. 

The best treatment option for appendicitis will be to have an operation to have the diseased appendix removed. The use of antibiotics alone only buys time. 

You can read more on appendicitis here.

Constipation

If you are constipated, you could develop lower right abdominal pain. This will not be difficult to diagnose as you may have noticed that you are not opening your bowel as frequently as you normally would, or that your stool has become harder to pass than usual.

If you have any of the following symptoms in association with a lower right abdominal pain, then constipation may be the cause of your abdominal pain:

• Passage of less than three stools in a week
• Stool has become hard and larger in last few days or weeks
• Excessive passing of wind with right lower abdominal pain
• Straining when going to the toilet

If you suspect that you are suffering with constipation, dietary and lifestyle changes like increasing your daily intake of clear fluids, eating more dietary fibre and using laxatives as prescribed by your healthcare provider will be the best way to go.

Urine Tract Infection

A urinary tract infection could be a cause of lower right side abdominal pain. This could be due to an infection affecting the right kidney, ureter or bladder. Though this condition more often causes a central lower abdominal pain, it could also lead to pain in the lower right side of the abdomen. Other symptoms of urinary tract infection include:

• Feeling feverish
• Reduced appetite
• Increased frequency of passing urine
• Pain or stinging sensation on passing urine.

If you suspect that your lower right side stomach pain may be due to a urine infection, it is important you see your doctor immediately for assessment and possible prescription of an antibiotic for you. Commonly used antibiotics that are more effective for the treatment of urine tract infection include trimethoprim 200mg twice a day for 3 to 7 days; nitrofurantoin 50 to 100mg up to four times a day for 3 to 7 days; co-amoxyclav 625mg three times a day for up to 7 days in more severe cases, or the use of ciprofloxacin. The choice of antibiotics is often governed by local policy and bacteria resistance pattern.

Mesenteric Lymphadenitis In Children

Mesenteric lymphadenitis is a very common cause of lower right side abdominal pain especially in children. It is often be confused with appendicitis but this condition is due to the inflammation of the lymph nodes or glands in the wall of the small bowel.

If your child is having a right lower abdominal pain, the abdominal pain due to a mesenteric lymphadenitis. Symptoms of this include:

• An episode of a cold including a runny nose, coughing or tonsillitis
  
• Pain in the right lower abdomen or anywhere around the umbilicus
• Pain which moves from one spot to another, as the bowel moves around inside the abdomen
• General sense of feeling unwell, other than from complaining of abdominal pain
• Often able to eat with a good appetite

If your child has a lower right abdominal ache, the best step is to take them to see the doctor. The doctor will examine the child to determine whether the cause of the abdominal pain is due to acute appendicitis or non-specific mesenteric lymphadenitis.

Irritable Bowel Syndrome

Irritable bowel syndrome or IBS can cause a lower right side abdominal pain, though it usually causes a left lower abdominal pain rather than pain on the right side. IBS is more common in young people between the ages of 13 to 30, and more common in women than in men.

The symptoms of irritable bowel syndrome include:

• Abdominal pain and discomfort lasting for more than 6 months
• Associated feeling of bloating, especially after eating certain types of food
• Passage of hard infrequent stools
• Passage of slime or mucus in the stool
  
• In some cases, passage of loose stools
  
• Symptoms made worse by eating

If you have any of the above symptoms, with ongoing weight loss, upper abdominal pain after eating, or passing blood in your stool, it is important you let your doctor know immediately.

Self-help measures including keeping a meal diary and eliminating foods which worsen symptoms is a good idea.

Other treatments include the use of special pain killers like amitriptyline, in conjunction with medications like mebeverine or buscopan. If constipation is the dominant feature then laxatives are recommended or loperamide if the problem is diarrhoea.

If you suffer from IBS, then expert care and support is required.

Ectopic Pregnancy

Are you a lady of child bearing age (between 13 to 65 years old) and are you sexually active? When last did you last have your period? Is it running a few days or perhaps weeks late? Could you be pregnant?

If you answer yes to the questions above and you have a lower right abdominal pain, it is very important that you get checked to exclude the presence of an ectopic pregnancy.

Ectopic pregnancy is the presence of pregnancy outside the womb. It is a very common cause of lower abdominal pain in women. If not diagnosed quickly and treated, it could be very serious and many women have lost their life due to this condition.

Symptoms of ectopic pregnancy include:

• Abdominal pain in the first 4 to 10 weeks of pregnancy (often before the women realises that she is pregnant)
• Pain on either the right lower or left lower abdomen
• Associated bleeding or spotting of blood
• Abdominal bloating or distention as the bleeding worsens
• Shoulder tip pain on lying down due to irritation from blood touching the diaphragm
• Dizziness and/or fainting and/or collapse

If you have any of the above symptoms and if there is a chance that you could be pregnant, it is very important that you get emergency medical attention. The best treatment option for ectopic pregnancy will depend on the site, size of the gestation sac, the progress and complications at the time of assessment.

Treatment options include:

• Active monitoring
• Use of powerful medication like methotrexate
• Surgery to remove or repair the affected fallopian tube

Ovarian Cyst Problem

Do you have a lower right side abdominal pain that started in last few hours or days? Does the pain spread to your lower back? Did you say the pain starts in your right hip and then moves to the upper thigh and down your leg?

Do you always have the pain there but does it also come in waves with periods of severe exacerbation?

When did you last have your period - are you in the middle of your menstrual cycle?

You may be suffering with ovarian cyst symptoms and if this is the case you will need to be assessed by your healthcare provider.

An ovarian cyst can become twisted, causing severe sudden onset of lower abdominal pain, colicky. Or it could become ruptured, causing a continuous lower abdominal pain spreading to the thigh or sometimes, you could bleed into the cyst, also leading to continuous pain, like in corpus leutum cyst. Treatment will depend on what has happened and the type of cyst.

Endometriosis 

Endometriosis is a very common cause of chronic abdominal or pelvic pain in women. It is estimated that pain in as much as 80 percent of ladies of child bearing age who suffer with a long standing abdominal pain may be due to endometriosis.

But what is endometriosis?

• Endometriosis is the presence of the material that lines the womb in any other part of the body, often in the Fallopian tubes, ovaries, general abdomen, in the bowels, or around the rectum or anus. This is abnormal
  
• It typically causes dull aching abdominal pain that seems to get worse around the time of menstruation or shortly there after
• There is often associated deep lying abdominal pain during intercourse
• There may also be pain around the back passage or anus - deep inside, during defecation
  

If you have a long standing lower right abdominal pain that seems to get worse around the time of your period, why not discuss with your doctor about the possibility of endometrosis?

Treatment will depend on site, severity and level of disruption to your life, and options for this include the use of simple pain killers, or mirena coil, or special kind of hormone medication, or even surgery.

Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease can cause a right lower abdominal pain in the form of a right salpingitis (infection in the right fallopian tube) or outright complete inflammation of the whole of the vagina, cervix, womb and tubes.

Could your lower right abdominal pain be due to pelvic infection? Do you have a right lower abdominal pain with:

• Unusual discharge from your vagina?
• Pain during intercourse?
• A fever?

Also, are you sexually active, with perhaps more than one sexual partner?

If you answer yes to most of the above, then it is likely that the cause of your lower right abdominal pain is due to a pelvic infection. It is a relatively easy condition to diagnose by doctors and treatment is readily available too, in form of antibiotics. Please speak with your doctor. Delay in treatment could lead to infertility and many other complications.

Crohn's Disease

Crohn’s disease is one of the inflammatory bowel diseases. It could cause a chronic or intermittent right side lower abdominal ache. The problem with Crohn’s disease is that it mimics so many other causes of abdominal pain. It is usually however a chronic problem, and other symptoms associated with Crohn's include:

• Passage of stools with mucus in it. In some cases, there might be blood in the stool too.
  
• Fatigue
  
• Anal itching
• Mouth ulcers
• Weight loss
• Fever and feeling unwell intermittently

Use of medications to control symptoms can be very successful, though in some cases, surgery may be required.

Hernias

A hernia is an out pouching of the bowel, or part of the bowel, through a weakness on the wall of the abdomen. You could also have other materials apart from the bowel inside a hernia.

There are common hernias, such as the groin hernias (inguinal and femoral hernia) where there is an obvious swelling with severe abdominal pain and vomiting.

Other types of hernias are less visible, causing intermittent abdominal pain, on the right or on the left lower abdomen. Such hernias include:

• Spigelian hernia
• Obturator hernia
• Sports hernia

If you suffer with a long standing lower right abdominal pain which is worse on movement, or on turning in the bed or during sports, why not discuss with your doctor the possibility of a hernia. Treatment is usually by surgery.

Psoas Abscess

Psoas muscle abscess is uncommon in the western world, and more a problem in regions where infections and tropical diseases like tuberculosis exist. Some infection for example, in the kidney could track down to the muscle on the floor of the lower right abdomen called the psoas muscle, leading to swelling and lower right abdominal pain. The sufferer may lose weight, develop poor appetite, have night sweats, and a mass may be felt in the lower right tummy.

Bowel Cancer

Before you panic about the "c-word", know that bowel cancer should not be the first thing to spring into your mind if you are having a lower abdominal pain.

Only worry about bowel cancer if:

• You are 40 years or more (younger if there is a family history of cancer)
• Have ongoing lower abdominal pain for several weeks
• Associated change in bowel habit - constipation and diarrhoea, plus or minus the presence of blood in your stool
  
• Decrease in appetite
• Unintended weight loss
• Feeling more tired than usual most of the time with a combination of a number of the above symptoms
  

If you've gone through all the other causes of lower right abdominal pain above, you will clearly notice that many of the symptoms mentioned for bowel cancer are also included in the symptoms for some other conditions. Do not be confused. If you have a combination of any of these symptoms described here under bowel cancer, it is important to discuss these with your doctor for a complete assessment and advice. 

References

9 Most Common Causes of Lower Right Abdominal Pain - EnkiVillage, http://www.enkivillage.com/lower-right-abdominal-pain.html (Accessed: September 2016)

Med-Heath.net, Lower Right Abdominal Pain, http://www.med-health.net/Lower-Right-Abdominal-Pain.html (Accessed: September 2016)

WebMD, Understanding Appendicitis, http://www.webmd.com/digestive-disorders/understanding-appendicitis-symptoms (Accessed: September 2016)

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Last Updated: 26th November 2012

Related Topics:

• Causes of Right Side Abdominal Pain
• Upper Right Side Abdominal Pain
  
• Left Side Abdominal Pain
• Lower Left Side Abdominal Pain
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