Right Lower Quadrant Pain - Common causes

Authored by Dr Jacqueline Payne, 08 Jul 2017

Patient is a certified member of
The Information Standard

Reviewed by:
Dr Helen Huins, 08 Jul 2017

The list of causes of right lower quadrant (RLQ) pain is almost endless but the following are some of the more common possibilities, not in order of how common they are.

All sorts of common and uncommon problems to do with your guts can give you pain in this area. For example:

Constipation

  • If your guts are full of poo (faeces) this can cause discomfort anywhere in your tummy.
  • You will normally be aware that you are not opening your bowels as often as usual.
  • Your poo will be hard and pellet-like.

See separate leaflet called Constipation in Adults for more information.

Gastroenteritis and food poisoning

  • Cause diarrhoea.
  • May also make you sick (vomit).
  • Pain may be anywhere in the abdomen (tummy).
  • Pain may ease for a while each time some diarrhoea is passed.

See separate leaflets called Gastroenteritis in Adults and Food Poisoning in Adults for more information.

Irritable bowel syndrome (IBS)

  • Very common.
  • Tends to cause crampy tummy (abdominal) pains.
  • Often causes bloating.
  • It comes and goes and may be associated with diarrhoea and/or constipation.

See separate leaflet called Irritable Bowel Syndrome for more information.

Appendicitis

  • Usually the pain starts in the middle of the tummy over an hour or so.
  • Typically it moves to the RLQ over the next few hours.
  • It tends to be sharper if you cough or move suddenly.
  • It may ease a bit if you pull your knees up to your chest.
  • You may also feel sick (nausea) and go off your food.
  • You may have a temperature (fever) and will feel generally unwell.
  • If the appendix bursts then pain can be severe and all over your tummy.

See separate leaflet called Appendicitis for more information.

Diverticulitis

  • This is an inflammation of a pouch or pouches which people who have diverticular disease have in their guts.
  • Usually pain from diverticular disease is in the left lower quadrant (LLQ) but it can be on the right or sometimes can be felt higher up.
  • It usually comes with a temperature and a change in bowel habit (opening your bowels more or less often than usual for you).

See separate leaflet called Diverticula (including Diverticulosis, Diverticular Disease and Diverticulitis) for more information.

Trapped inguinal or femoral hernia

  • A right inguinal or femoral hernia happens when a piece of bowel or other tissue from inside the tummy pushes through a weakness in the muscles of the tummy wall near the right groin.
  • It can happen on either side.
  • If whatever has pushed through gets stuck and can't slide back inside the tummy, it is trapped (incarcerated).
  • If it happens on the right-hand side, there will be a tender swelling in the right groin.
  • It causes pain in the groin and in the tummy, usually on the side of the hernia but it may cause pain over the whole tummy.
  • It is common to vomit.

See separate leaflet called Hernia for more information.

Kidney infection

  • A kidney infection can cause pain anywhere along your urinary tract. So this could be anywhere from the loin in your back, around the side and down to the RLQ.
  • You may notice that it hurts when you pass urine and that you need to pass urine more often.
  • You may have a temperature.

See separate leaflet called Kidney Infection (Pyelonephritis) for more information.

Mittelschmerz

  • Pain at the time that you release an egg (ovulation), which is usually about halfway between two periods.
  • Can be very severe and stop you short but usually eases over several minutes.
  • Will only be felt on one side but can be right or left.

Pelvic inflammatory disease

  • Pain is usually on both sides but may just be in the RLQ.
  • Pain is worse during sex.
  • There is abnormal bleeding, so bleeding not just at period time but in between periods and often after sex.
  • There is usually a vaginal discharge, which may be smelly.

See separate leaflet called Pelvic Inflammatory Disease for more information.

Twisted ovary

  • Twisted ovary (ovarian torsion) usually only occurs if a fluid-filled sac (cyst) has developed on the right ovary.
  • Pain can be constant or intermittent.
  • Symptoms can be similar to appendicitis.

See separate leaflet called Ovarian Cyst for more information.

Endometriosis

  • Sometimes endometriosis can cause constant lower tummy pain, though usually it is worse just before, during and for a short while after a period.
  • Pain is usually across the lower part of the tummy but it can be just on the right side.

See separate leaflet called Endometriosis for more information.

Ectopic pregnancy

You should always see a doctor urgently if you think you might be pregnant and are experiencing right lower quadrant pain. You could have an ectopic pregnancy.

See section on causes in pregnancy.

Any pain coming from the right side of the scrotum can cause pain in the right lower quadrant but usually the pain in the scrotum will be worse.

Torsion of the testicle

  • Torsion of the testicle (testis) causes severe pain in the scrotum and severe lower quadrant pain.
  • It most commonly affects teenage boys but young adult men can be affected.
  • It is unusual over the age of 25 years but can affect any man at any age.
  • The testicle is very tender.
  • You should seek urgent medical advice.

See separate leaflet called Torsion of the Testis for more information.

Epididymo-orchitis

  • Epididymo-orchitis is an inflammation of the testicle and/or the tubes surrounding it (epididymis).
  • It is caused by a germ (infection).
  • The affected side of the scrotum swells and goes very red and tender.

See separate leaflet called Epididymo-orchitis for more information.

Further reading and references

  • Cartwright SL, Knudson MP; Evaluation of acute abdominal pain in adults. Am Fam Physician. 2008 Apr 177(7):971-8.

  • Kim JS; Acute Abdominal Pain in Children. Pediatr Gastroenterol Hepatol Nutr. 2013 Dec16(4):219-224. Epub 2013 Dec 31.

  • Cartwright SL, Knudson MP; Diagnostic imaging of acute abdominal pain in adults. Am Fam Physician. 2015 Apr 191(7):452-9.

  • Manterola C, Vial M, Moraga J, et al; Analgesia in patients with acute abdominal pain. Cochrane Database Syst Rev. 2011 Jan 19(1):CD005660. doi: 10.1002/14651858.CD005660.pub3.

My question is, once diagnosed with Appendicolith, how long could it take before appendicitis develops? I have a 4 month history of kidney stones on and around both kidneys. I've had them blasted...

rebeccajeanine7
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