If an individual experiences pain anywhere on the right side of an imaginary line drawn from the central point of the chest, passing via the umbilicus and ending above the genitalia, then it is known as right side abdominal pain. The most common causes of right side abdominal pain are: gallstones or biliary colic, acute appendicitis, hepatitis, cholecystitis, and other diseases of the liver. Sometimes, causative factor of right sided abdominal pain may also cause left sided abdominal pain. This happens if the corresponding organ on the left side is also involved. Sometimes right sided abdominal pain may also be referred from any injury or disease which occurs at a nearby organ and which may not be exactly within the abdomen. A good example of this is infection of the lower right lung which may also give rise to right abdominal pain. Any problem with the organs and structures present on the right side of the abdomen also results in pain in the right abdomen.
The following organs/structures are found on the right side of the abdomen
- Skin covering the right abdomen
- Right kidney
- Right ureter
- Right adrenal gland
- Ascending colon
- Right ovary (in females)
- Right fallopian tube (in females)
- Muscles of the right abdominal wall
- Ribs 9 to 12.
- Blood vessels and nerves present on the right side of the abdomen
Other structures which are not located in the abdomen, but may give rise to right side abdominal pain include the lower region of right lung and tumors from various sites.
7 Most Common Causes of Right Side Abdominal Pain Are:
- Appendicitis: Inflammation of the appendix is one of the most common causes of right sided lower abdominal pain.
Symptoms: Loss of appetite, nausea, sometimes vomiting and fever. The pain usually starts in the abdomen or around the umbilicus, radiates towards the lower right abdomen. The pain is constant in nature and gets worse upon movement or pressure. Patient may also have loose bowel movements; although this is more commonly seen in children.
Investigations: Blood tests, urine tests and imaging studies like ultrasound, x-rays and CT scan.
Treatment: Surgery is done if the cause of the pain is appendicitis.
- Biliary Colic: This is a medical term for pain in the right upper abdomen which is sudden in onset. It commonly occurs within a few minutes to an hour after consuming a meal.
Symptoms: The pain is often acute, constant and dull in nature present in the right side of the upper abdomen. The pain is peristaltic in nature, i.e. it comes in waves with episodes of increased intensity. The pain radiates from the right abdomen to the right lateral side and below the right shoulder blade. Nausea and vomiting may be present. Rich fatty foods trigger this type of pain.
Investigations: Imaging studies such as ultrasound, X-ray of the abdomen, CT scan etc.
Treatment: Painkillers are given for pain and if an ultrasound confirms the presence of gallstones, then surgery is needed.
- Kidney Stones: Also medically termed as renal calculus. The pain from kidney stones is similar to biliary colic.
Symptoms: Sudden, acute pain occurring in the right loin or the right side. The pain radiates to the lower right abdomen and groin. It is cramp like in nature. Patient may also have nausea and vomiting. It is one of the most severe pains which a patient experiences and the patient tries to find the most comfortable position by tossing and turning.
Treatment: If the size of the stone is small, then it often passes out with no further treatment required. If the size of the stone is large, i.e., greater than 7mm, then surgical procedures such as ureteroscopy, extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy are done.
- Constipation: Also known as dyschezia is a condition where it becomes difficult to pass or have bowel movements. This results in pain in the abdomen and painful defecation.
Symptoms: Difficult or infrequent bowel movements, pain and swelling in the abdomen and sometimes vomiting.
Investigations: Blood tests, barium studies, colonoscopy.
Treatment: Plenty of fluid intake, especially water. Dietary changes with increased fiber intake. Laxatives or enemas may also be done.
- Mesenteric Lymphadenitis: This is inflammation of the lymph nodes which are present in the membrane which is attached to the intestines or bowel and to the abdominal wall. Infection in the intestines is the cause of mesenteric lymphadenitis.
Symptoms: Lower, right-sided abdominal pain which can radiate to other regions too. Tenderness, fever, diarrhea, nausea and vomiting may also be present.
Investigations: Medical history, lab studies and imaging studies.
Treatment: OTC pain killers are given for pain and antibiotics are given for infection.
- Trapped Wind: The pain is crampy in nature.
Treatment: Medicines like buscopan or mebeverine are given. If the pain is accompanied by diarrhea, then it means there is an infection, in which case antibiotics are given.
Mid-Cycle Pain: Also known as Mittelschmerz and ovulation pain is the pain felt by women midway though their menstrual cycle.
Symptoms: Pain is felt in the lower abdomen and pelvis. The pain is sudden in nature and subsides on its own within a few hours and sometimes 2 to 3 days.
Treatment: Usually no treatment is required. OTC analgesics can be given for pain. If there is severe pain, then oral contraceptives can be taken to prevent ovulation.
Other (Rare) Causes Of Right Sided Abdominal Pain Include:
- Ruptured Gall Bladder
- Cancer of the Gall Bladder
- Liver Abscess
- Fatty Liver Disease
- Cysts in the Liver
- Cancer of the Liver
- Fabry Disease
- Bowel Cancer
- Ileal Plasmacytoma
- Carcinoid Tumor
- Perinephric Abscess
- Cancer of the Right Kidney
- Urine Infection
- Epiploic Appendagitis
- Right Sided Colonic Diverticulitis
- Polycystic Ovarian Syndrome
- Irritable Bowel Syndrome (IBS)
- Ulcerative Colitis
- Sigmoid Volvulus
- Cecal Volvulus
- Celiac Disease
- Tietze's Syndrome
- Intestinal Worms
- Diabetic Ketoacidosis
- Aneurysm in the Iliac Artery
- Testicular Torsion
- Sports Hernia
- Spigelian Hernia
- Strangulated or Obstructed Inguinal Hernia
- Polycystic Kidney Disease
- Tuberculosis of the Bowel
- Osteogenic Sarcoma Of Iliac Bone (Rare)
- Crohn's Disease
- Ectopic Pregnancy
- Pulled Muscle
As seen above, there are many causes for right sided abdominal pain and the treatment of right side abdominal pain depends on the cause. Patient should never ignore persistent, severe abdominal pain and should visit the ER without further delay.