Right lower quadrant pain

Where is my right lower quadrant?

The right lower quadrant is a section of your abdomen (stomach).

Look down at your abdomen, and imagine that the area from the bottom of your ribs down to your pubic hair is divided into four quarters. The quarter on your right side below your belly button is your RLQ.

© By Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436

Abdominal Quadrant Regions

© OpenStax, CC BY 3.0, via Wikimedia Commons

What organs are in my right lower quadrant?

The right lower quadrant contains organs including:

• Small bowel (ileum).

• Caecum (the connection between your small and large bowel).

• Appendix.

• Colon (first part of your large bowel).

• Right ureter (at the back of the other organs).

• Right ovary and fallopian tube.

And don't forget the skin, muscles, and nerves of that area.

There are lots of causes of RLQ pain, some of the most common causes are:

• Constipation.

• Gastroenteritis and food poisoning.

• Irritable bowel syndrome (IBS).

• Appendicitis.

• Diverticulitis.

• Femoral hernia

• Endometriosis.

• Pelvic inflammatory disease (PID).

These common causes are discussed in detail below.

Constipation

• Constipation can cause discomfort anywhere in your abdomen.

• You will normally be aware that you are not opening your bowels as often as usual.

• Your poo will be hard and pellet-like.

Gastroenteritis and food poisoning

• Gastroenteritis and food poisoning can cause diarrhoea and pain anywhere in the abdomen.

• Pain may ease for a while each time some diarrhoea is passed.

Irritable bowel syndrome (IBS)

• IBS is very common and causes crampy pains and bloating.

• It comes and goes and may be associated with diarrhoea and/or constipation.

Appendicitis

• Appendicitis usually causes pain that starts in the middle of the abdomen then moves to the RLQ over the next few hours.

• Pain tends to be sharper if you cough or move suddenly and may ease a bit if you pull your knees up to your chest.

• If the appendix bursts then pain can be severe and all over your stomach.

Diverticulitis

• Diverticulitis usually causes pain 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).

Trapped inguinal or femoral hernia

• A right inguinal or femoral hernia can happen on either side of the abdomen.

• It causes pain in the groin and in the abdomen, usually on the side of the hernia but it may cause pain over the whole area.

• If it happens on the right-hand side, there will be a tender swelling in the right groin.

Ovulation pain (mittelschmerz)

• Mittelschmerz is pain when you release an egg (ovulation), which is usually about halfway between two periods.

• It can be very severe and make you stop what you are doing, but usually eases over several minutes.

• It will only be felt on one side, but can be right or left.

• You may get similar pain on the same or other side of your abdomen at the same point in another cycle.

Pelvic inflammatory disease

• Pelvic inflammatory disease causes pain that is usually on both sides of the abdomen but can be in the RLQ.

• Pain is usually worse during sex.

• You may also have abnormal bleeding, feel generally unwell and feverish, and have smelly vaginal discharge.

Endometriosis

• Endometriosis can sometimes cause constant lower abdominal pain, although usually it is worse just before, during and for a short while after a period.

• Pain is usually across the lower part of the abdomen but it can be just on the right side.

Twisted ovary

• Twisted ovary (ovarian torsion) usually only develops on the right ovary and causes pain that can be constant or intermittent.

• Symptoms can be similar to appendicitis.

Pregnancy- associated

Right lower quadrant pain in pregnancy can be caused by:

• Miscarriage: This usually causes cramping pain, like period pain, over both sides of the lower tummy and is often accompanied by bleeding, which can range from a small amount of dark blood to larger amounts of bright red blood with clots.

• Constipation: This is very common in pregnancy and gives you crampy lower tummy (lower abdominal) pains accompanied by opening your bowels less often and passing hard, pellet-like stools.

• Pelvic ligament pain: This usually starts at around 14 weeks and is due to the growing womb pulling on the structures which hold it in place. It usually causes a stabbing pain down one or both sides of the tummy.

• Urine infection: This is common in pregnancy. The usual symptoms are of pain when you pass urine and passing urine more often. You may also get tummy pain and a high temperature (fever) and notice blood in your pee.

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

• In later pregnancy pelvic girdle pain, placental abruption and labour can all cause pain in the lower right quadrant. Your midwife will be able to advise you further.

Any pain coming from the right side of the scrotum can cause pain in the RLQ, 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, usually on one side.

• The testicle is very tender.

• You should seek urgent medical advice.

Epididymo-orchitis

• Epididymo-orchitis is an inflammation of the testicle and/or the tubes surrounding it (epididymis).

• The affected side of the scrotum swells and goes very red and tender.

• Inflammatory bowel disease (IBD): Types of IBD such as Crohn's disease and ulcerative colitis cause the lining of the gut to become inflamed, and can cause pain in the RLQ.

• Kidney stones: A stone that passes into the ureter draining urine from your right kidney may cause pain that starts in your right loin and spreads to your groin and RLQ, or into your testicle or penis if you are a man.

• Shingles: A sharp or burning pain may be felt in the stomach before a rash develops.

• Abdominal aortic aneurysm: This can cause pain before it bursts. The pain is usually felt in your back or the side of your stomach but it can occasionally be felt in the right (or left) lower quadrant.

• Muscular pulls and sprains: This can cause pain when you use the pulled or strained muscle.

• Colon cancer: This can affect any part of the large bowel (colon), but it more commonly affects the last part (descending colon) which is on the left-hand side.

• Referred pain: Pain from your spine or back may be felt around the front.

If you have a pain which doesn't settle, you will probably need to see a health professional to help you figure out the cause.

Your doctor will usually be able to diagnose the cause of your RLQ pain by talking to you and examining you.

They will feel your abdomen in the area you have the pain, but may also need to examine other parts too, such as the rest of your abdomen. You may also be asked to provide a sample of urine, to rule out kidney problems.

You may also need blood tests to:

• Check the function of your liver and kidneys.

• Rule out any inflammation or infection in your body.

• Look for anaemia.

• Check your blood sugar level.

Further tests

If your doctor is still unsure of the cause of pain, they may recommend further tests such as:

• Colonoscopy - this is when a small camera (a scope) is used to check your large bowel.

• Computerised tomography (CT) scan - this is used to look for diverticula in the bowel, and also to look at your kidneys.

• Ultrasound scan - this is particularly used to look at your ovaries and tubes if you are a woman.

• X-ray - this is used to look at your gut and kidneys.

• Sigmoidoscopy - this is when a camera is used to check the lower part of your large bowel.

• Magnetic resonance imaging (MRI) scan - this scan allows detailed assessment of abdominal contents.

If it is thought you have appendicitis, an ectopic pregnancy (women) or a torsion of your testicle (testis) - men, you may only have one or two of these tests before having emergency surgery to treat your problem.

Most people will not need all of these tests, and some people may not need any.

The treatment for RLQ pain depends on the cause. Treatments for a few of the causes are briefly discussed below.

• Constipation can be treated with medicines, but often changes to your diet are needed to prevent it happening again.

• Gastroenteritis usually doesn't need any treatment, other than drinking plenty of fluid to compensate for all that is being lost. Occasionally when germs (bacteria) which can be treated with antibiotics are causing the infection, an antibiotic may help.

• Appendicitis may be treated with an operation (an appendicectomy).

• Ectopic pregnancy is usually treated by an operation but medical treatment is now more common. This avoids the need for surgery and means the tube is less likely to be permanently damaged.

• Shingles. The pain and rash settle on their own in time, but some people may be advised to take an antiviral tablet to reduce the risk of long-term nerve pain from the shingles.

• Kidney infections are treated with antibiotics. Mild infections can be treated with antibiotics at home. If you are very unwell you may need admission to hospital for antibiotics and fluids through a drip (intravenously).

• Kidney stones. Small kidney stones pass on their own eventually, in which case you will need to drink plenty of fluids and take strong painkillers. Larger kidney stones may need one of a number of procedures done to break them up or remove them altogether.

The outlook depends entirely on the cause of the pain. Some conditions settle very quickly on their own (for example, gastroenteritis), or with the help of antibiotics (for example, a kidney infection).

Others can be cured with surgery, such as appendicitis or torsion of the testicle (testis). Some are long-term conditions, for which there is no cure although there are treatments, such those used for people who have Crohn's disease.

Your doctor should be able to give you an idea of the outlook (prognosis) once a diagnosis has become clear.

Is right lower quadrant pain always serious?

No. Many cases are caused by temporary digestive issues, muscle strain, or mild infections. However, because serious conditions can present in a similar way, it’s important not to ignore persistent or worsening pain.

Can kidney infection cause right lower quadrant pain?

Kidney infections usually cause pain in the back or side, but the pain can spread to the lower abdomen, including the right lower quadrant. However, pain only in the lower right abdomen is less common and usually comes with back or side pain too.