Pain in the Lower Right Abdomen: When to be Concerned

Pain is often a symptom of an underlying health problem and one area of the body that can experience great pain is the lower right abdomen. But when do you need to be concerned about an abdominal pain?

Abdominal pain. Image Credit: Miss Ty / Shutterstock

What is in the lower right abdomen?

Before anything else, it is important to review the body’s anatomy. What are the organs located in the abdomen, and what diseases are often seen in these areas?

The abdomen has four quadrants – upper right, lower right, upper left, and the lower left. In addition to these, there are three areas in the middle abdomen, namely, the epigastric, umbilical, and hypogastric area.

In each area, there are specific organs or parts of the gastrointestinal system. For instance, the right upper part of the abdomen is where the liver, gall bladder, right kidney, and pancreas are located. In the left upper quadrant, the stomach, left kidney, and spleen are situated. The lower left quadrant is where the small intestine, colon, ureter, and major veins or arteries to the veins are located. Lastly, the lower right abdominal area is the site of the appendix, ascending colon, and part of the female reproductive organs.

Right lower abdominal pain

There are many conditions that can cause lower right abdominal pain. But one of the most common causes is appendicitis. Other causes include:

• Colitis or inflammation of the colon (large bowel)
• Diverticulitis or inflammation of an outpouching of the colon
• Inflammatory bowel disease, IBD
• Irritable bowel syndrome, IBS
• Diseases of the female reproductive organs such as:
  • Ectopic pregnancy or pregnancy occurring outside the uterus
  • Fibroids (tumors of the uterine wall muscle) of the uterus
  • Ovarian tumor or mass, with or without twisting
  • Pelvic inflammatory disease, PID

These are differentiated by a careful history, looking for specific signs on physical examination, and diagnostic radiography, ultrasound, and/or CT scanning of the abdomen. Symptoms like fever, migration of pain from near the navel to lower down on the right side, and the presence of rigidity and rebound tenderness of the abdominal wall should alert the physician to the possibility of appendicitis.

This must be confirmed by imaging studies as above. If the CT scan results are normal, the disease is likely to be localized in the female reproductive organs, the colon or the urinary tract, and specific examinations and tests must then be performed.

Pain in the lower right quadrant should be taken seriously if it is severe and accompanied by the following symptoms:

• Fever, chest pain, or a feeling of extreme faintness
• Severe vomiting immediately after eating
• Breathing problems
• Irregular pulse rate
• Dark or blackish stools
• Vomiting blood
• Mild pain persisting after two days
• Pain worsening, or accompanied by unexplained weight loss
• Pain with bloating over more than two days, or diarrhea for more than five days
• Pain with fever or associated urinary problems

It’s important to know about appendicitis as one of the most common causes of right lower quadrant abdominal pain.

What is appendicitis?

People who suffer from lower right abdominal pain may have a condition called appendicitis, or inflammation of the appendix. Appendicitis is a medical emergency and if it’s not treated immediately, it can be life-threatening. An inflamed appendix may burst or rupture, causing perforation and spilling of infective material into the abdominal cavity.

Causes of appendicitis

The appendix can be inflamed due to many causes, and more than one cause may be present in any given case. Some common reasons for inflammation of the appendix include:

• Blockage of the opening in the appendix
• Inflammatory bowel disease
• Hypertrophied (overgrown) tissue in the wall of the appendix (usually caused by an infection of the digestive tract)
• Trauma to the abdominal area
• the presence of hard stools, growths or parasites that can block the lumen of the appendix

The cause of appendicitis is unclear in many cases. It is true, nevertheless, that one of the most common causes is the obstruction of the appendix.

Appendicitis may be mild if treatment is initiated promptly. If pus builds up in the appendix due to inflammation, it may burst, flooding the abdominal area or cavity with the infected matter.

This usually happens after 36 hours from the onset of infection in the appendix. It may result in peritonitis (inflammation of the lining of the abdominal cavity) which is a potentially life-threatening complication, demanding prompt medical treatment.

When should you be concerned about right lower abdominal pain?

Appendicitis is a medical emergency. The common symptoms include a dull pain near the umbilical area or navel that becomes sharp, loss of appetite, constipation or diarrhea with gas, inability to pass gas, nausea or vomiting, and fever.

Other symptoms may appear, such as painful urination and a feeling that having a bowel movement will relieve discomfort and pain. Appendicitis can be mistaken for other conditions, such as gassy pains.

However, appendicitis may be suggested if the pain begins near the navel and moves to the right lower quadrant, becomes worse upon moving, walking or sneezing, becomes more intense over a few hours, occurs abruptly and may even wake you up from sleep, if the pain is the first symptom to occur, and if it very severe, often described as a pain worse than you’ve never felt before.

If you feel any of these symptoms, you must seek medical attention immediately.

How is appendicitis treated?

The only treatment for appendicitis is the surgical removal of the inflamed appendix. Pain medications can help relieve pain, but not for long. As long as the appendix is inflamed, the pain will persist. Worse, the appendix can rupture and cause infection in the whole abdominal cavity.

Appendectomy is a procedure involving the removal of the appendix. The procedure can be done through two methods – laparoscopic surgery and laparotomy. In laparoscopic surgery, surgeons use small incisions and specialized tools to remove the appendix. Since it’s less invasive than the traditional surgery, it has fewer complications and a shorter hospital stay.

On the other hand, laparotomy involves the removal of the appendix through a single incision over the abdominal wall in the right lower right quadrant. This is more invasive and may require a longer time for the patient to recover.

Usually, antibiotics are intravenously given to reduce the risk of peritonitis. The typical length of stay is between three and five days. The removal of the appendix has not been shown to have any effect on the digestive system, whether in the short or long term.

Further Reading

• All Abdominal Pain Content
• What is Abdominal Pain?
• What Causes Abdominal Pain?
• Chronic Functional Abdominal Pain (CFAP)
• Functional Abdominal Pain Syndrome (FAPS)

Written by

Angela Betsaida B. Laguipo

Angela is a nurse by profession and a writer by heart. She graduated with honors (Cum Laude) for her Bachelor of Nursing degree at the University of Baguio, Philippines. She is currently completing her Master's Degree where she specialized in Maternal and Child Nursing and worked as a clinical instructor and educator in the School of Nursing at the University of Baguio.