Right lower quadrant pain in children

What is right lower quadrant pain?

Pain in the tummy (abdomen) is a common problem in children. The right side of the lower part of the tummy (below the tummy button) is called the right lower quadrant of the abdomen. The main issue when pain is in this area is whether or not the diagnosis is acute appendicitis, but there are many other possible causes.

When pain comes on suddenly it is called 'acute'. Acute right lower quadrant pain may be caused by (see links for further details):

• Acute appendicitis.

• Gastroenteritis.

• Urinary tract infection.

• Groin (inguinal) hernia.

• Torsion of the testis.

• Mesenteric adenitis.

• Obstruction of the bowel (intestinal obstruction), eg, intussusception, or volvulus.

When pain comes on more gradually and is more persistent (chronic) or comes and goes (recurrent), the possible causes of right lower quadrant pain include:

• Constipation.

• Abdominal migraine (recurrent episodes of abdominal pain without the typical migraine headache. The pain is more often in the centre of the abdomen, in the area around the tummy button).

• Irritable bowel syndrome (more common in adults).

• Inflammatory bowel disease.

• Coeliac disease.

In children common causes of right lower quadrant (RLQ) pain include:

Constipation

• Very common in children.

• Means passing hard stools (faeces), with difficulty, less often than normal.

• May cause RLQ pain but more commonly causes pain on the left, over the last part of the colon (descending colon).

See separate leaflet called Constipation in Children for more information.

Gastroenteritis and food poisoning

• Cause diarrhoea.

• May also cause the child to be sick (vomit) and have crampy tummy (abdominal) pains.

• Pain may be anywhere in the tummy.

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

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

Lactose intolerance

• Leads to bloating, tummy pain, wind and watery stools after drinking milk.

• Lactose intolerance can sometimes occur for a while after gastroenteritis. The condition gets better when the infection is over and the gut lining heals.

• Some people are born with a tendency to develop it.

See separate leaflet called Lactose Intolerance for more information.

Mesenteric adenitis

• In children with infections such as colds, glands within the tummy commonly become inflamed giving them tummy ache.

• The child may have other symptoms of a cold, such as a runny nose or a sore throat.

See separate leaflet called Mesenteric Adenitis for more information.

Appendicitis

• In older children, symptoms will be similar to those in adults (see separate leaflet on right lower quadrant pain).

• Babies may get watery diarrhoea and vomiting.

• Preschool children may just have vague tummy pains and go off their food.

See separate leaflet called Appendicitis for more information.

Torsion of the testicle

• Occurs when a testicle (testis) twists around in the scrotum.

• It occurs in boys and young men, typically teenage boys.

• It is unusual over the age of 25 years.

• Severe pain that develops quickly.

• It can affect either side.

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

Coeliac disease

• Coeliac disease is caused by a reaction of the gut to gluten. Gluten is found in many foods.

• It can cause poor growth

• Stools may be pale, smelly and difficult to flush away.

• Pain doesn't always occur but can be anywhere in the tummy. It tends to come and go.

See separate leaflet called Coeliac Disease for more information.