Right Side Abdominal Pain
Causes, Diagnosis And Treatment

Understanding Common Causes Of Right Side Stomach Pain Or Ache In The Right Side Of The Tummy

A right sided abdominal pain, is pain occurring any where in the abdomen, to the right of an imaginary line drawn from the center of the chest through the umbilicus or belly button to the top of the genitalia.

Apart from acute appendicitis, gallstones or biliary colic, cholecystitis, hepatitis and many other liver diseases, the causes of right sided stomach pain can also cause pain on the left side.

In order to understand the possible cause of a 'right side stomach pain', it may be helpful to know the organs and structures that exist in this region of the body. Diseases, infections, or irritation of any of these organs will lead to a right side abdominal pain.

Also note that pain in the right side of the abdomen can be "referred" from an injury or disease originating from a nearby organ which may not necessarily be within the abdomen. An example of this is a right sided abdominal pain arising from a lower right lung infection.

Organs And Structures On The Right Side Of The Abdomen

Organs and structures in the right side of the abdomen include:

• Skin over the right abdomen
• Liver
• Gallbladder
• Pancreas
• Right kidney
• Right Ureter (the tube that drain urine from the kidney to be stored in the bladder
• Right adrenal gland
• Duodenum ( the very first part of the small intestines)
• Right part of the large intestines (also called ascending colon)
  
• The Appendix
• Right ovary in females
• Right Fallopian tube
  
• Muscles of the right abdominal wall
• The lower 9th to 12th ribs
  
• Blood vessels and nerves in the right side of the abdomen

Other structures not found in the abdomen that can cause right side abdominal pain include:

• The lower part of right lung
• Tumors from other sites

We shall now take you through a few of the various possible causes of right abdominal pain, giving a very brief gist of the important signs and symptoms that will help in recognizing and making a diagnosis of the possible cause of the pain.

If you have recent onset right side abdominal pain, it is worth considering if you are having any of the following listed causes of abdominal pain.

Common Causes Of Right Sided Abdominal Pain

Common causes of pain in the right side of the abdomen include:

Top 12 Causes of Right Sided Abdominal Pain

Many of the above listed conditions are very very rare. Here are the top twelve (12) common causes of right side abdominal pain and how to diagnose them:

1. Appendicitis

Right sided lower abdominal pain of a few days duration, associated with loss of appetite, nausea and occasionally vomiting, fever, feeling generally unwell in anyone between the ages of 9 and 39 is appendicitis, until proven otherwise.

This does not mean that appendicitis do not occur out side that age bracket. It is more common within the first three decade of life, and can occur at any age.

How to tell if the cause of your right sided pain is appendicitis?

• It is the most common cause of right side abdominal pain requiring operation.
  
• The pain typically starts up in the abdomen, or around the belly button called umbilicus. It then spreads or moves to the lower right abdomen within a day or two.
• In some individuals, the pain starts straight in the lower right abdomen. It gradually builds up in severity, initially niggling, then becomes a boring to sharp pain.
  
• The pain is typically always there, worsened by movement, and there is usually an associated loss of appetite, feeling of nausea and a few patient may actually vomit.
• There may be a brief episode of passage of loose stools, especially in children.
  

The main symptoms to watch out for to determine if it is appendicitis, is the combination of right sided lower abdominal pain, worse on pressing onto a spot about a hands breath from the right side of the umbilicus, with associated loss of appetite and feeling of nausea. There may be low level fever, or feeling hot and cold.

If you have any of the above symptoms, it is worth checking with your doctor to confirm if it is appendicitis that may be causing your right side abdominal pain.

Read more on appendicitis here. 

2. Biliary Colic

Biliary colic is the medical term used to describe pain in the right upper abdomen that comes on suddenly, often  within a few minutes to half an hour after eating. The pain is usually a severe continuous dull ache in the right side of the upper abdomen, but with periods of increased intensity, coming in waves.

It is often due to gallstones getting trapped in a narrow part of the gallbladder neck, or sometimes, just due to spasm of the gallbladder.

• The pain may spread from the right side of the upper abdomen to the side and to the back, under the right shoulder blade or scapular bone.
• The sufferer often paces around or curls up in bed, assuming various postures, looking for a position of comfort.

• There may be associated nausea or actual vomiting.

• The pain tends to last for about 20 to 30 minutes,  few hours or a whole day or two and then resolves.

• Food rich in fat like fries, stews, or heavy meals  are more likely to trigger attacks of biliary colic.

If you suffer with the above symptoms with associated fever, feeling hot and cold and perhaps shivering, with yellowness of the white area of your eyes (jaundice), this is often due to cholecystitis, which could potentially be serious if not treated in good time. It is important you consult your doctor immediately or go to your local Emergency Room or A&E.

You can read more about biliary colic here.

3. Kidney Stones

Right kidney stone pain often comes on as a sudden onset right loin or side pain.

• It is typically very severe in intensity (many patients describe this as the most severe pain they have ever felt, and even women who have had kids say it is worse than the pain of childbirth!).
  
• It spreads down the side to the lower right abdomen and groin, cramp-like, with associated nausea and vomiting.
  
• During attacks, the sufferer may be rolling around, trying to seek a position of comfort.

The pain is just like that of biliary colic but while biliary colic spreads from the front of the upper abdomen to the back, the pain from kidney stone (ureteric colic) spreads from the side of the abdomen and back downwards, towards the groin and in front.

Depending on the size of the stone, it is often passed down without any after effect.

Sometimes though, the stone could be too big (greater than 7mm) and will not pass down the ureters, causing obstruction. If the obstruction is not cleared in time, it could cause ballooning of the kidney and even an overwhelming kidney infection with potentially serious consequences. This could lead to a medical emergency that will need dealing with as soon as possible.

If you think you have kidney stone, then go to the hospital now. It is only after tests that doctors can be sure if there is an associated obstruction or not. Please read more on kidney stones here.

4. Constipation

Constipation is not just the passing of hard stools, it is also the infrequent passing of stools.

The average person opens his or her bowel three or more times per week. If you or child recently developed ongoing abdominal pain with reduced frequency of bowel motions or stools have recently become hard than normal, then constipation could be the cause of the abdominal pain.

This is even more common with children than with adults.

Constipation has been reported to be the cause of lower abdominal pain - right or left sided in as much as 43% of children in one study[1].

5. Mesenteric Lymphadenitis

Acute non-specific mesenteric lymphadenitis is as common as appendicitis as a cause of lower right side abdominal pain in children under the age of six [2].

It is caused by swelling of the lymph glands or lymph nodes on the wall of the small bowel in children following a viral infection.

Mesenteric lymphadenitis often comes as:

• Generalized abdominal pain in a child following a recent episode of cold or viral infection (within the previous two weeks or so).
• The pain may then be localized to the right lower abdomen, around where the appendix is, thus causing a right side abdominal pain.
  
• There may be associated vomiting very early in the illness.
• Fever is usually present but not always.
  
• The pain may be fleeting - moving around the abdomen.
• The child is usually able to play and eat when not in pain.
• Pain resolves on its own after a day or two.

Also called non-specific mesenteric lymphadenitis, this condition is usually self-limiting and causes no further complications. You can read more about Mesenteric Lymphadenitis here. 

6. Ovarian Cyst Issues

Ovarian torsion or ovarian cyst rupture are two of the common ovarian problems causing lower abdominal pain in children as well as adult females.

Pain from ovarian problem could occur in as young as a child under one year of age, up to 65 year old.  Older children, teenagers and younger women are more likely to have pain from ovarian problem. The symptoms of ovarian pain depends more on the type of issue involved.

In ovarian torsion, the ovary twists along its stalk to the Fallopian tube, much like an orange or apple could twist on its stalk, cutting off blood supply to the ovary. This can happen in infants as well as woman of any age, causing:

• Sudden onset lower right or left side abdominal pain, depending on whether this is happening in the right or left ovary respectively.
  
• The pain is usually severe.
• It spreads to the lower back and upper thigh on the side it is happening.
• There is often associated nausea and in most cases vomiting at the height of the pain.
• There may be a low grade fever.
• In very few cases, the patient may experience small vaginal bleeding or spotting.

Rarely, this could lead to loss of the ovary.

Rupture of Ovarian Cyst, on the other hand, usually occur more in women of reproductive age alone, and more on the right side. Symptoms of an ovarian cyst rupture typical presents as:

• Sudden onset right lower abdominal pain, in most cases, following sexual intercourse or strenuous exercise [3].
  
• The pain would be so severe that most women would seek medical help immediately.
• The pain is sharp and can be localized to a spot.
• Worsens with movement.
• With time, there could be bleeding into the abdominal cavity, causing irritation of the diaphragm and shoulder tip pain.
• Dizziness would result from significant blood loss.

If this sounds like you, you would need to go to the hospital immediately. Ruptured ovarian cyst  could be life-threatening.

7. Ectopic Pregnancy

Ectopic pregnancy refers to the implantation of a newly fertilized egg, anywhere outside the womb.

It tends to occur more in the Fallopian tubes (98%) than anywhere else [4]. If this happens on the right side, it could lead to right side abdominal pain.

The symptoms of ectopic pregnancy are:

• Lower abdominal pain in a woman of childbearing age.
• She may or may not realize that she is pregnant or even have a delayed menstruation.
  
• There may be associated vaginal bleeding or none at all.
• In severe cases of large internal bleeding into the abdominal cavity, shoulder tip pain may arise.
  
• Ectopic pregnancy is commonly diagnosis with the 6th to 8 week of pregnancy and rarely after 10 weeks.
  
• Diagnosis is by means of a positive blood test (Beta HCG) with an pregnancy ultrasound scan without a pregnancy seen within the uterus.
  

You can read more about ectopic pregnancy here.

8. Mittelschmerz or Midcycle Pain

Mittelschmerz, also called mid-cycle pain is pain associated with ovulation in many young women, especially within the first few years of starting their menses.

The pain typically:

• Occur in the middle of the menstrual cycle - for most women, this would be around two weeks after they had their "period" or last menses.
• Could be sharp in character and last a few hours or days.
• Is on the right lower abdomen, though less, often, could happen on the left too.
• There may be associated mild fever.
• In some teenagers, they would develop this pain about the same time every month or in alternate months.
• Use of simple pain killers like Tylenol (Paracetamol) or Naproxen if you do not have allergy to these medications is enough to control the pain.
  

You can read more about mid-cycle pain here.

9. Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease is an infection arising from the lower genital tract in a woman of childbearing age, spreading up through the cervix, to the uterus, Fallopian tubes and ovaries.

It could be localized to one tube (in which case it is referred to as salpingitis) or to the tube and ovary (referred to as salpingo-oophoritis). If this happens on the right side, it could lead to a right side abdominal pain.

The symptoms of right side pelvic inflammatory disease are:

• Lower right side abdominal pain in a woman of childbearing age.
• The pain is of gradual onset in nature.
• May be dull or sharp.
  
• Associated low grade fever.
• There may be abnormal vaginal discharge.
• Patient may complain on a deep-seated pain in the lower abdomen or pelvis during sexual intercourse.
• There may be associated ongoing nausea or vomiting.
• Some women may also complain of pain on passing urine or burning sensation on passing urine.
• There may be associated menstrual irregularities or even abnormal vaginal bleed.
• In severe cases, the women may feel unwell.

PID is indeed a very common cause of lower abdominal pain in sexually active women. It is almost always caused by sexually transmitted disease - chlamydia and gonorrhea especially [5].

If is a common cause of chronic illness and infertility, if not caught in time and treated.

If you suspect you may be having salpingitis or PID, please see your doctor soonest.

You can read more on PID here.

10. Bowel or Colon Cancer

Bowel or colon cancer often refers to cancer involving the large bowel or colon. Just over a third of all colon cancer involves the appendix, cecum, ascending colon and right side of the transverse colon.

The vast majority of colon cancer occurs on the left side of the colon.

Right sided colon cancers are notoriously very painful.

Symptoms of right sided colon cancer include:

• Worsening lower right side abdominal pain of several months duration.
  
• Associated bloating.
• There may be nausea.
• Decreased appetite.
• Unintended weight loss.
• There may be blood in your stool.

Bowel or colon cancer affects older people, usually 50 years and older, though can be seen in younger age groups too. Any one of the above symptoms could be seen in many disease conditions. It is when a number of these symptoms are occurring together in someone older than 40 years of age over several months, that a high suspicion of cancer of the bowel is entertained.

A urgent occult fecal blood test, colonoscopy and CT scan is needed to diagnose bowel cancer of any part of the colon.

Early stages of colon cancer are completely curable.

11. Endometriosis

Endometriosis is the presence of the tissue that lines the inner wall of the uterus outside the womb. It leads to the accumulation of menstrual blood where this tissue is found, causing chronic abdominal pain and infertility in some cases.

Endometriosis is more commonly seen in women in their late twenties to forties. It is a benign condition, meaning that it does not cause immediately life-threatening complication.

The symptoms of endometriosis include:

• Painful menstruation in a women who usually have no pain or difficulty with her menses.
• Lower abdominal pain around the time of menses.
• Deep-seated pelvic pain during and after sexual intercourse.
• Pain on defecation around the time of menstruation.
• Heavy menstrual bleed.

Endometriosis is treatable. You can read more about this condition here.

12. Diabetic Ketoacidosis

Diabetic Ketoacidosis is a complication of diabetes, often seen in type 1 diabetes.

It is a common cause of diffuse or right sided lower abdominal pain, typically in children.

Many kids have been taken to hospital with sudden onset severe lower right sided abdominal pain, thought to be appendicitis, only to find out that they have very high sugar levels in their blood or urine before being taken into the operating room for "appendicitis".

The children are often not even known to suffer with diabetes, and they are only diagnosed after coming to hospital in severe lower abdomen pain.

If you are having protracted lower right side abdominal pain that is difficult to diagnose and that has just refused to go away, feel free to book a paid consultation with one of our doctors for a one-on-one secured online assessment to see if the cause could be identified or what further tests that may need doing.

References

1. Constipation as cause of acute abdominal pain in children. Loening-Baucke V, Swidsinski A. Journal of Pediatrics. 2007;151(6):666.
2. Acute Non-specific Mesenteric Lymphadenitis. Hamilton Bailey's Physical Signs: Demonstrations of Physical Signs in Clinical Surgery, 19th Edition. By John S.P Lumley, Anil K. D'Cruz, Jamal J. Hoballah, Carol E.H. Scott-Connor.
3. Successful conservative management of ruptured ovarian cysts with hemoperitoneum in healthy women. Kim JH, Lee SM, Lee JH, Jo YR, Moon MH, Shin J, Kim BJ, Hwang KR, Lee TS, Bai KB, Jeon HW PLoS One. 2014;9(3):e91171. Epub 2014 .
4. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases.
   Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N. Human Reprod. 2002;17(12):3224.
5. Eschenbach D. Treatment of pelvic inflammatory disease. Clinical Infectious Diseases 2007;44:961–3.
   
   
   
   
   

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