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 of abdominal viscera that lies on left side of abdominal cavity. Occasionally diseases of organs that lies within right side or midline chest wall can also cause upper right side abdominal pain. A good example of this is infection of the lower right lung or lower end of esophagus, which may also give rise to right side abdominal pain. Similarly, right side abdominal pain is observed with diseases of small and large intestine that lies on right side of abdomen.
The Right Side Abdominal Pain Is Caused By Diseases Involving Following Organs-
- Skin covering the right abdomen
- Right kidney
- Right ureter
- Right adrenal gland
- Ascending colon
- Right transverse 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-
- Biliary Colic or gall bladder stone
- Renal Colic or kidney/ureter stone
- Mesenteric Lymphadenopathy
- Trapped wind
- Mid-cycle pain
Appendicitis- Inflammation of the appendix is one of the most common causes of right sided lower abdominal pain.1
Symptoms of Appendicitis-
Pain- Severe right lower abdominal pain is observed when appendix is inflamed. Rupture of appendix causes excruciating sharp, piercing and stabbing pain in lower right abdomen that is often referred to umbilicus. The pain usually starts in the lower right side of the abdomen then radiates towards the umbilicus and mid abdomen. The pain is constant in nature and gets worse upon movement or pressure.
Guarding and Rigidity of Abdominal Wall- The muscles of abdominal wall goes in severe contraction. Such muscle contraction that result to protect underlying organ is known as guarding. The guarding or severe muscle contraction causes rigid abdomen.
Loose bowel movements- Most often in children.
Treatment for Appendicitis-
NSAIDS– Mild to moderate ride side abdominal pain caused due to appendicitis is treated during investigation studies with non-steroidal anti-inflammatory medications. Most frequently motrin, naproxen and celebrex are prescribed as NSAIDs.
Opioids- Severe pain is treated with opioids. Opioids are prescribed as pills if patient is not suffering with nausea and vomiting. In most cases intravenous opioid treatment is given for patient who are suffering with nausea and vomiting.
Surgery- Ruptured appendix is removed as soon as possible by performing emergency surgery.
Biliary Colic- This is a medical term for colic pain in the right upper abdomen which is sudden in onset. Biliary colic pain is caused by obstruction of biliary duct or tube by gall stone.2 Gall bladder vigorously contract to push bile through the bile duct in to small intestine. The severe contraction of gall bladder and bile duct causes intense sudden squeezing pain. The biliary colic pain commonly occurs in individual who had bile duct obstruction because of gall stone. Pain is observed within a few minutes to an hour after consuming a meal.
Symptoms of Biliary Colic-
Colic Pain- Pain is localized over right side of abdomen. The pain is often acute, constant and dull in nature. Pain is always felt on right side of the upper abdomen. The pain is peristaltic in nature, i.e. it comes in waves with episodes of increased intensity.
Referred Pain- The pain radiates from the right abdomen to the right lateral side and below the right shoulder blade.
Nausea and Vomiting- Nausea and vomiting may be present.
Rich Fatty Foods- Such food triggers this type of pain.
Investigations to Diagnose Biliary Colic-
Imaging studies- Imaging study helps to evaluate presence of gall stone in gall bladder and bile duct.
Blood Examination- Blood examination helps to evaluate presence of infection.
White blood cell count- increase
Treatment For Biliary Colic
NSAIDS (nonsteroidal anti-inflammatory medications are prescribed for pain.
Antispasmodic Agent- Scopolamine relaxes bile duct. Medication is known as antispasmodic.
Lithotripsy- Surgery is performed to break the stone with lithotripsy (ultrasound)
Removal of Gall Bladder and Stone- In case there are several stones in gall bladder then surgery is performed to remove gall bladder and stone.
Kidney Stones (Renal Colic)- Renal colic is a pain felt over right side of abdomen and right side of spine on back. Renal colic is caused by obstruction of ureter by a small stone.3 The diameter of stone can be 1 mm to 10 mm. The ureter muscle tries to push the stone that is stuck within ureter lumen forward into urinary bladder. The urine that is discharged by kidney also pushes the stone. The stone blocks the urinary flow through ureter. The contractions of ureter become vigorous and creates a squeezing sharp pain. Such pain is known as renal colic. The ureter stone is also known as renal calculus. The pain from kidney stones is similar to biliary colic.
Symptoms of Renal Colic or Kidney/Ureter Stone-
- Colic Pain- Sudden, acute pain felt over right side abdomen and right loin. Loin is the anatomical area on right side of spine that lies just on back of right kidney.
- Radiating Pain- The pain radiates to the lower right abdomen and groin. The pain is felt as sharp squeezing cramp.
- Restlessness- Individual become restless and try to find most comfortable position by tossing and turning.
Investigations to Diagnose Renal Colic
Ultrasound- Ultrasound helps to diagnose ureter or kidney stone
X-ray of the abdomen- X-ray in most cases does not provide any significant information. X-ray is used to rule out fracture of ribs that often causes similar pain.
CT scan and MRI- Helps to diagnose kidney and ureter stone.
Blood Examination- Blood examination helps to evaluate presence of infection. The white blood cell count is increased if renal colic is associated with infection of ureter and kidney.
Treatment for Urinary Colic or Kidney/Ureter Stone- If the size of the stone is small, then it often passes out into urinary bladder with no further treatment required. If the size of the stone is large, i.e., greater than 7 mm, then surgical procedures is necessary.
Following Surgical procedure are performed to remove kidney stone in patient suffering with renal colic.
Treatment for Renal Colic or Kidney/Ureter Stone-
Extracorporeal Shock Wave Therapy-The most frequent treatment given is extracorporeal shock wave lithotripsy. The treatment involves transmission of ultrasound shock waves through the skin to the ureteral stone. The ultrasound probe is places over the skin that lies on top of stone that is lodge in ureter. The ultrasound waves are passed through the skin and eventually causes breakage of stone into smaller pieces. Procedure is performed under sedation. The broken stones are removed with the urine outside the human body.
Ureteroscopy-Alternative treatment involves passage of Ureteroscope into the ureter. Ureteroscope is a tubular long camera. The ureteroscope is passed through the external opening of urinary passage known as urethra. The ureteroscope is then advanced in to urinary bladder. The camera is used to find the opening of ureter into urinary bladder. The camera then passed into ureter. Tip of camera is placed in ureter in front of stone. The procedure is performed under x-ray image guidance. The stone is either removed with the tiny basket or broken by ultrasound.
Percutaneous Nephrolithotomy- The skin incision is taken over the kidney and stone is surgically removed.
Constipation As A Cause for Right Side Abdominal Pain- Also known as dyschezia is a condition where it becomes difficult to pass or have bowel movements and can cause right side abdominal pain. Constipation causes vigorous bowel contraction to move impacted feces forward. The contraction against impacted stool causes severe colic pain. Occasional feces get discharged out through anus during painful bowel contraction.
Symptoms of Constipation
- Abdominal Colic Pain
- Difficult or Infrequent Bowel Movements
- Abdominal Distension or Swelling in the Abdomen
- Rarely Vomiting.
Investigations to Diagnose Constipation-
- Blood Tests
- Barium studies and
Treatment of Constipation-
- Plenty of fluid intake, especially water.
- Dietary changes with increased fiber intake.
- Laxatives or enemas may also be given to treat constipation.
Right Side Abdominal Pain Caused Due to Mesenteric Lymphadenitis- The abdominal organs are enclosed within a peritoneum. Peritoneum is thin layer of serous membrane formed by connective tissue. The folds of peritoneum within abdominal cavity are known as mesentery. There are several lymph nodes spread within the mesentery. The inflammation of these lymph nodes is known as mesenteric lymphadenitis.4 The inflammation often spreads to surrounding mesentery and peritoneum.
Symptoms of Mesenteric Lymphadenitis-
Lower right-sided abdominal pain
Radiating pain felt over umbilicus and opposite side of abdomen.
Tenderness- Abdominal examination increases pain. In most cases rebound pain is observed. Rebound pain is severe in intensity and stays for prolonged period of time.
- Nausea and Vomiting
Guarding and Rigidity of Abdominal Wall- The inflammation of mesentery causes muscles contraction of surrounding muscles. The contraction causes stiff muscles and condition is known as abdominal guarding. Such guarding because of severe muscle contraction causes rigid abdomen.
Investigations- Medical history, lab studies, and imaging studies.
Treatment for Mesenteric Lymphadenitis-
- Antibiotics are given for infection.
Trapped Wind in Bowel Can Cause Right Side Abdominal Pain- The wind or gas frequently stays for long period of time in abdominal viscera. The wind gets trapped in stomach, small or large intestine and such trapped wind is also known as flatus. The trapped wind in ascending or transverse colon causes moderate to severe pain in right side of abdomen. In most cases wind is removed from stomach by reverse peristalsis as a burp or from lower bowel as flatulence. Thus, flatulence is removal of gas or flatus from abdominal viscera. Trapped wind causes distension of abdomen.5 Such distension causes abdominal pain
Symptoms of Trapped Wind-
- Pain- Pain is mostly localized over right side of the abdomen. Pain is more like discomfort and makes one feel like needing to go to toilet to pass feces.
- Abdominal Bloating- Individual suffering with trapped wind feels abdomen is swollen and bloated.
- Distension of Abdomen- Examination suggest abdomen is distended on one side when compared with opposite belly.
- Frequent burp- Frequent burp is observed when gas is swallowed while eating or chewing gum. The gas is mostly trapped in stomach.
- Frequent passing of smelly flatus
- Fever- Occasionally food poisoning causes trapped wind and fever. Contaminated food by viruses or bacteria causes fever and created wind in intestine. In such cases fever is treated with NSAIDs and antibiotics or antiviral medications.
Treatment for Trapped Wind-
Conservative Treatment for Trapped Wind Causing Right Side Abdominal Pain-
- High Fiber Diet- Vegetables, beans, sprouts, and bran
- Avoid Dairy Product
- Reduce or Avoid Carbohydrate and Fatty Food.
- Avoid Carbonated Drinks Like Soda and Soft Drinks
- Drink Lots of Water
Treatment To Decrease Volume of Gas in Bowel-
- Mylanta Gas Minis
- Prevent Excess Gas Formation- Take activated charcoal pills before and after lunch as well as dinner.
- Actidose- Aqua,
- Antispasmodics- Antispasmodics relaxes the bowel muscles and helps to relieve pain. Antispasmodics is also known as anti-cholenergic drug.
- Buscopan relaxes the bowel muscles and helps to relieve pain.
- Antibiotics- Infection is treated with antibiotics or antiviral medications.
- Mid-Cycle Pain- Also known as Mittelschmerz and ovulation pain. Mid cycle pain is felt mostly on one side by women midway through their menstrual cycle.
Symptoms of Mid Cycle Pain-
- Lower abdomen mostly on one side
- Pain is dull, sharp and burning in character
- Pain often feels like cramp
- Pain may or may not be associated with vaginal bleeding or discharge
- Pain subsides on its own within a few hours and sometimes within 2 to 3 days.
Treatment for Mid Cycle Pain-
- NSAIDS- Motrin, naproxen
- Contraceptive Medications
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.
Chronic Appendicits- Its Differential Diagnosis and Treatment.
StatPearls Publishing; 2019-.2018 Nov 15.
URETERIC CALCULI- Diagnosis, Behaviour and Appearances, wraith Seven Case Histories By VALENTINE A. J. SWAIN, F.R.C.S.
Course of acute nonspecific mesenteric lymphadenitis- single-center experience.
Eur J Pediatr. 2018 Feb;177(2)-243-246.
The role of intestinal gas in functional abdominal pain.
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