What diseases does pain in the right side of the abdomen indicate?

Pain in the intestines on the right and left side of the lower abdomen can be caused by various reasons. This symptom is typical for people who have gastroenterological, gynecological and urological diseases. Pain in the intestines on the right and left side of the lower abdomen indicates pathologies in the pelvis. At the first complaint, the patient should contact a medical expert. At the private clinic “KDS Clinic”, specialists will conduct an initial examination, give advice and refer you for a diagnostic examination. We will help you determine the cause of the disease and select an individual treatment program.

Severe pain inside the abdomen is a clear sign of diseases that affect the large or small intestine. The process of spasms leads to the accumulation of lactic acid in the body, which irritates the nerve endings and causes pain.

Severe pain in the intestines is the result of poor nutrition, a side effect after taking medications, or an inflammatory process. Inflammatory processes in the intestines are accompanied by pain, nausea, bloating, colic and bad bowel movements.

Diseases of the biliary tract

Biliary colic may manifest itself as pain in the abdomen on the right. The pain is localized in the right hypochondrium and epigastrium (upper abdomen), sometimes radiating to the scapula 1, 2. It is worth noting that if biliary colic occurs, it is important to consult a doctor who will diagnose and prescribe treatment.

Biliary colic is one of the main manifestations of acute cholecystitis against the background of cholelithiasis1. The cause of cholecystolithiasis is gallstones from cholesterol crystals, salts and other substances that block the cystic duct of the gallbladder. This leads to increased pressure in the biliary tract and the occurrence of spasms. In addition, stones and crystals can irritate the lining of the bladder and bile ducts6, 17, 18.

The result is a pain syndrome that ranges from mild to severe. Sometimes it is accompanied by nausea and vomiting, but symptoms of intoxication (fever, weakness) are often absent6. The pain occurs suddenly and lasts from 15 minutes to several hours. The frequency of attacks also varies: from daily to once a year or even less often6.

For pain associated with spasm in diseases of the biliary tract, taking antispasmodic drugs can help1. For example, the active component of the drugs No-shpa® and No-shpa® forte, drotaverine, helps relax the smooth muscles of internal organs (including the biliary tract), helping to relieve pain7, 22.

Pain in the right hypochondrium can be associated not only with cholelithiasis, but also with other diseases of the biliary tract, for example, cholecystitis or papillitis1.

Causes of pain in the right hypochondrium

Pain in the right side of the abdomen does not always indicate any disease. At times they are caused by physiological changes that also happen to completely healthy people.

1. Stitches in the side after jogging
   or other physical activity. This is typical for unprepared people who are not used to playing sports. Physical activity is stressful for their body, and it reacts with a sharp release of adrenaline. The hormone provokes a spasm of the bile ducts, which stretch from the bile overflowing them. At the same time, the liver fills with blood, increases in size, and the organs press on each other, causing pinpoint pain and tingling.
2. Tingling in the right side
   after a heavy meal. On a full stomach you don’t want to move or move. Under the influence of adrenaline, the inferior vena cava expands and puts pressure on the liver, which is also under pressure from a full stomach. This is why you should not exercise immediately after eating.
3. Sharp pain in the right side
   , radiating to the back. This happens in women shortly before the start of menstruation. Hormonal imbalance causes spasm of the bile ducts, resulting in sharp pain that radiates to the back. It goes away on its own, but causes significant discomfort to the woman.
4. Pain in the right side during pregnancy
   . The uterus, stretched under the influence of the growing fetus, puts pressure on neighboring organs. Also, the hormone progesterone, secreted to relax smooth muscles and prevent miscarriage, provokes stagnation of bile (cholestasis in pregnant women). Many pregnant women experience pain in the right hypochondrium, which intensifies with movement. Therefore, women need to limit their loads and walk more at a slow pace.
5. Cramps in the lower abdomen (not menstrual)
   . Hepatic, renal, and intestinal colic are characterized by irradiation—reflection of the pain signal to another part of the body.

Pancreatic diseases

Pain usually occurs when this organ becomes inflamed and can be felt in several places. For example, when the head of the gland is affected, it is felt in the right hypochondrium, sometimes taking on a encircling character1. Some people are bothered by nagging and aching pain in the back1.

Pain from pancreatic disease may be worse when a person is lying down, but usually gets better when sitting because the tension on the pancreatic capsule is reduced1.

Pain due to diseases of the pancreas can be constant and painful. Their intensification can be provoked by the nature of the food and drinks taken: with alcoholic pancreatitis, complaints become more intense after eating spicy and sour foods, and with inflammation of the pancreas associated with damage to the ductal system - after eating fatty foods8.

Pancreatic pathology is also characterized by weakness, irritability, insomnia, and decreased performance. From the digestive tract, nausea, vomiting without a feeling of relief, bloating, alternating diarrhea and constipation may occur8.

Recently, the incidence of pancreatitis has been steadily increasing due to alcohol consumption8.

What to do if there is pain in the right side

For pain in the side, if the doctor cannot “by eye” determine the cause of the ailment, he sends the patient for an ultrasound of the abdominal cavity, ultrasound of the kidneys or ultrasound of the pelvis. Ultrasound waves with a frequency of over 20,000 Hz penetrate the skin into the abdominal cavity, where they are either absorbed by internal organs or reflected back. Special sensors (with abdominal ultrasound) analyze the reflected sound, and based on it, conclusions are drawn about the patient’s condition.

1. When tissues become inflamed, they soften and absorb ultrasound more than healthy areas.
2. Various lumps, tumors, and stones reflect radiation better, and it can be reliably stated that the cause of the pain is a stone or neoplasm.
3. Doppler ultrasound allows you to evaluate the speed of blood flow to exclude compression of the inferior vena cava.

Irritable bowel syndrome (IBS)

This condition is not associated with changes in the structure of organs and systems. However, pain with irritable bowel syndrome is almost always observed and is a common symptom overall. Women usually suffer from IBS more often than men. Pain (from moderate to severe) can cover the lower abdomen, including the right side, but is most often localized on the left9. IBS often develops against the background of psychoemotional disorders10.

Symptoms of the disease usually subside in the evening and do not bother patients at night. The pain in some cases spreads to the upper abdomen, radiating to the rectum and epigastric region9-11. An important role in the formation of complaints is played by impaired intestinal motility, accompanied by spasm. As part of complex therapy for IBS, antispasmodics (for example, No-shpu® and No-shpu® forte) can be used, which helps reduce pain7, 12, 22.

Treatment

Help before diagnosis

Mild pain in the right side associated with hypothermia or physical activity does not require drug treatment. Mostly they go away on their own after 1-3 days. If the pain syndrome bothers you for a long time or the intensity of the pain increases quickly, you should immediately seek medical help. For excruciating pain, the doctor uses analgesics at the prehospital stage.

Conservative therapy

To relieve pain, nonsteroidal anti-inflammatory drugs, narcotic analgesics, and antispasmodics are used in practical medicine. For quick pain relief, blockades are made with local anesthetics. These measures provide a temporary effect, so subsequently, to eliminate pain in the right side, etiotropic therapy is prescribed that affects the underlying disease. The following groups of medications are used in surgery and gastroenterology:

• Anti-inflammatory drugs.
  Inflammation is controlled not only by classic NSAIDs, but also by 5-aminosalicylic acid derivatives and corticosteroid hormones.
• Probiotics.
  Medicines are needed to restore microflora and normal intestinal function, which helps reduce pain and eliminate dyspeptic disorders.
• Infusion solutions.
  Necessary for correcting dehydration of the body, removing toxic breakdown products from the blood, maintaining normal hemodynamic parameters.
• Antibiotics.
  The drugs are prescribed for generalized forms of salmonellosis, for the prevention of purulent complications of inflammatory diseases of the digestive organs.
• Cytostatics.
  Taken for severe forms of Crohn's disease when hormonal therapy is ineffective. They are also included in chemotherapy regimens used for malignant neoplasia of the colon.

To improve the patient's condition, symptomatic therapy is carried out. Antidiarrheal or laxative drugs, drugs with pancreatic enzymes, and prokinetics are selected. In order to correct metabolic processes, vitamin and mineral complexes containing iron are indicated. During the recovery period of chronic diseases, courses of physiotherapy, drinking mineral waters, and sanatorium-resort treatment are recommended.

Surgery

Urgent surgical intervention is performed for acute appendicitis (laparoscopic or classic appendectomy), strangulated hernia (revision of abdominal organs and hernioplasty). When fistulas and abscesses form in those suffering from Crohn's disease, their opening and sanitation is indicated. If total damage to all layers of the intestinal wall develops, the operation of choice is resection of the intestinal section.

If an ectopic pregnancy is interrupted, urgent surgical care is required. The type of operation is selected taking into account the severity of complications and the woman’s desire to have children in the future. An organ-sparing tubotomy or radical tubectomy is performed. When an ovarian cyst ruptures, a wedge resection or oophorectomy is performed. Some forms of endometriosis require elective surgical treatment.

Urinary tract diseases

Pain on the right side may be caused by urolithiasis. If the right ureter is affected, there may be pain on the right in the abdomen and lower back1, 2. When the stone moves, the pain on the right can move to the lower abdomen, radiate to the genitals, and the inner thighs. If the stone is located in the lower third of the right ureter, the person is bothered by a constant painful urge to urinate2, 13. The pain is usually wave-like in nature, and for spasms in diseases of the urinary tract, the use of antispasmodics, for example No-shpa®, may be indicated or No-shpa® forte7, 13, 16, 22. The passage of stone or sand from the ureter is often manifested by pain and blood in the urine13.

What can hurt in the stomach on the right?

The causes of pain under the right rib can also be diseases in various organs:

1. Liver diseases
   : hepatitis (inflammation), hepatosis (metabolic disorders), cirrhosis (replacement of parenchymal cells with connective tissue), liver parasites, metastases as a result of malignant tumors of other organs.
2. Heart diseases
   (they cause circulatory disorders): myocarditis, endocarditis, coronary heart disease, abdominal myocardial infarction.
3. Gallbladder diseases
   : cholecystitis (inflammation), cancerous tumors.
4. Intestinal diseases: colitis (inflammation of the mucous membrane of the large intestine), Crohn's disease (severe damage to the entire gastrointestinal tract from the throat to the anus), diarrhea, diverticulosis (protrusion of the intestinal mucosa through the muscle wall), irritable bowel syndrome, intestinal infections.
5. Diseases of the right kidney
   : abscess (purulent inflammation), pyelonephritis (bacterial inflammation), cysts, kidney stones, echinococcosis (presence of helminths in the kidney), tuberculosis (drying) of the kidney, malignant tumor.
6. Diaphragmatitis (inflammation of the pleura covering the diaphragm).
7. Adrenal tumors.
8. Intercostal neuralgia (irritation of the intercostal nerves).
9. Formation of blood clots in the inferior vena cava.

Pain in the lower abdomen on the right side in women

On the right side of women are the right appendages of the uterus: fallopian tube and ovary. With inflammatory diseases of the pelvic organs, there may be pain in the lower abdomen on the right. Pain during the chronic process is aching, spreads to the lower back and suprapubic region, and is often combined with urinary disorders. Exacerbations may be accompanied by chills, nausea, sometimes vomiting, and discharge from the genital tract2, 14.

If the pain in the lower abdomen on the right begins suddenly and sharply, it may be a rupture or torsion of the cyst leg, or an ectopic pregnancy. The right lower abdomen hurts sharply, sometimes leading to fainting, the pain often radiates to the rectum. Patients try not to move so as not to increase the pain. Signs of intoxication and circulatory disorders may gradually appear: pallor, cold sticky sweat, nausea and vomiting, rapid heartbeat, and sometimes bloody discharge appears from the genital tract2, 14. Of course, if such symptoms appear, you must immediately seek medical help.

Pain in the right lower abdomen may periodically occur due to the connection with the menstrual cycle. Pain during menstruation can manifest itself as cramping or be aching and bursting. They often arise in the lower abdomen and then spread to the back, inner thighs, and rectum19-21.

Diagnostics

A gastroenterologist examines patients with complaints of pain in the right side; if necessary, other specialists are involved - a surgeon, a gynecologist, a nephrologist. During the physical examination, peritoneal symptoms, specific signs of appendicitis are checked, and deep palpation of the abdomen is performed. To establish a diagnosis, laboratory and instrumental methods are recommended:

• Sonography.
  Ultrasound of the abdominal organs is a screening method. Using ultrasound, inflammatory processes, space-occupying formations, and enlarged mesenteric lymph nodes are detected. Doppler ultrasound visualizes blood flow in the large vessels of the abdominal cavity.
• Radiography.
  A survey radiograph is not very informative; detailed visualization of the intestine is provided by irrigoscopy with double contrast. The method is suitable for detecting tumors, ulcerative defects, local narrowing or expansion of the intestine. Abdominal CT is widely used.
• Colonoscopy.
  Using endoscopic instruments, the mucous membrane of the colon is examined, and a biopsy sample is taken for chronic inflammation or suspected cellular atypia. If symptoms indicate damage to the small intestine, a modern method is used - video capsule endoscopy.
• Gynecological examination.
  Women undergo a standard bimanual examination and vaginal speculum examination. To exclude pathology of the appendages, an ultrasound of the pelvic organs is performed. For a more detailed examination, hysteroscopy, transvaginal sonography, and hysterography are prescribed.
• Laboratory methods.
  The list of mandatory studies includes clinical blood and urine tests, coprogram, and checking stool for helminth eggs. The expanded diagnostic complex includes biochemical blood tests with assessment of the content of acute-phase proteins, and stool culture.

Acute appendicitis

Perhaps this is the first pathology that a person thinks about when pain appears in the lower abdomen on the right. The pain in this case does not go away, arising near the navel, and eventually moves downwards1, 2, 15. The sensation may begin as dull, gradually becoming tugging, cutting, burning. A person’s health deteriorates and symptoms of digestive disorders occur: vomiting, bloating, constipation, and sometimes diarrhea15.

Acute appendicitis is treated surgically; if similar symptoms appear, you should immediately call an ambulance1.

Explanation: ultrasound diagnostic results and diseases in the images

If abdominal pain is accompanied by flatulence, ultrasound becomes ineffective.

If inflammation is suspected, the patient undergoes blood tests, and the level of platelets and eosinophils can be used to determine whether there is an inflammatory process in the body.

Abdominal pain on the right side in men

Dull abdominal pain in men most often occurs due to an inguinal or umbilical hernia. The reason is excessive physical activity. A bulge in the groin often develops in boys under 1 year of age due to weakness of the ligamentous apparatus, so babies should not be allowed to cry angrily for a long time. Umbilical and inguinal hernias are eliminated with plastic surgery (suturing the hernia opening or strengthening it with a special mesh). Without timely surgical intervention, strangulation of the hernia is highly likely. The pain increases, spreads to the entire abdomen, patients note frequent vomiting, stool retention and bloating. The surgery is performed on an emergency basis.

Pain in the lower back, radiating to the groin and leg, is characteristic of protrusion and herniation of the intervertebral disc. Patients often complain of weakness and numbness in the legs. Once the diagnosis is confirmed, the doctor will prescribe an effective course of anti-inflammatory drugs. If necessary, a therapeutic blockade or surgery is performed.

Diseases of the genitourinary system in men (cystitis, prostatitis, prostate adenoma) are manifested by pain in the lower abdomen, which subsides after defecation and urination. However, sometimes the pain is worse on the right or left.

With orchitis (inflammation of the testicle) and vesiculitis (an inflammatory process that develops in the seminal vesicles), the temperature suddenly rises, a sharp or dull pain radiates to the groin and perineum, and intensifies when walking down the stairs and physical activity. The damaged testicle swells. Inflammation of the testicles often complicates the course of sexually transmitted diseases and is fraught with infertility.

Varicocele (varicose veins of the spermatic cord) is diagnosed in every fourth man under the age of 30. The disease is often asymptomatic and is diagnosed during clinical examination of adolescents. Only in severe cases does aching pain occur on one side of the scrotum and in the groin. Pain increases with overheating, physical exertion and during sexual intercourse.

When testicular torsion occurs, a sharp pain suddenly occurs in the scrotum on one side, radiating to the groin, perineum and lower back. In young boys, the disease is accompanied by nausea and vomiting. Palpation reveals a higher position of the testicle in the scrotum. The pathology is eliminated urgently.

Important! If you suspect prostatitis, prostate adenoma or testicular disease, you should contact a urologist-andrologist.

How to relieve pain at home

• If you experience abdominal pain on the right side for the first time, you should not take analgesics on your own. Anesthesia may distort the clinical picture and make diagnosis difficult.
• If there are signs of an “acute abdomen” (pain, board-shaped abdomen, vomiting, stool retention, fever), cold (a heating pad with ice on the epicenter of pain), hunger, rest (the patient should be placed in a comfortable position) and calling emergency help are recommended.
• If the patient cannot wait until the ambulance arrives, it is permissible to give an antispasmodic tablet.