Acute and Chronic Right Lower (RLQ) Abdominal Pain – Diagnosis

ACUTE Right Lower (RLQ) Abdominal (Stomach) Pain

Acute (sudden, newly appearing) right lower abdominal (RLQ= Right Lower Quadrant) pain, lasting from few seconds to few weeks, may arise from:

1. Appendicitis

Typical symptoms and signs of appendicitis:

  • Sudden moderate to severe pain starting around the navel, moving toward the right hip, getting worse in the following hours and with moving around
  • Nausea or vomiting
  • Low-grade fever (not always)
  • Rebound tenderness: pressuring and relieving pressure on any part of the abdomen triggers pain in RLQ.
  • Guarding – reflex tension of abdominal wall in RLQ when pressuring on a painful spot

Diagnosis of appendicitis can be often made from the history alone. In doubtful cases CT is required. Ultrasound is not reliable in diagnosis of appendicitis. Blood test usually shows elevated white blood cells.

2. Inguinal Hernia

Protruding of a part of the small intestine through the cleft in the muscle of abdominal wall may appear with RLQ pain and pain in the scrotum. Diagnosis is made by physical examination.

3. Volvulus

Volvulus (twisting along long axis) of the cecum (starting part of the large intestine) is rare and occurs mostly in small children as sudden right lower pain, nausea, vomiting and bloating.

Diagnosis is made by X-ray with contrast (barium swallow).

4. Pain, Related to Female Reproductive Organs

Ovulation (mid-cycle pain, Mittleschmerz) may sometimes appear with pain at about 14th day of the menstrual cycle.

Rotation of the right ovary (twisted Fallopian tube), ruptured ovarian cyst, ectopic pregnancy or miscarriage may resemble pain in appendicitis (see above).

5. Pain, Related to Male Reproductive Organs

Right testis torsion, spermatic cord and testicular veins disorders (varicocele, hydrocele) appear with pain, tenderness and swelling in the scrotum; pain may radiate in RLQ.

6. Pain, Related to Abdominal Muscles

Psoas abscess

7. Skin Related Disorders

Herpes zoster appears as burning pain and rash appearing over the course of one or more spinal nerves (extending from the spine toward the middle line of the abdominal wall.

CHRONIC Right Lower Abdominal Pain

Chronic (long term or recurring) pain in the lower right abdomen, lasting from few months to years may arise from:

1. Crohn’s Disease

Crohn’s disease usually affect young to middle aged adults and may appear with RLQ pain, nausea, low-grade fever, diarrhea, blood in the stool, skin rash, mouth ulcers and other symptoms. Diagnosis is made by colonoscopy and examination of the small or large intestinal mucosa (obtained during colonoscopy) under the microscope, blood and stool tests.

2. Carcinoid

Carcinoid is a rare, slowly growing tumor appearing mostly in older adults and can cause LRQ pain if it grows in the appendix or cecum. Other symptoms may include nausea, diarrhea and hot flashes. Diagnosis is made by blood tests for histamine or serotonin and CT of appendix.

3. Endometriosis

Endometriosis is an abnormal growth of uterine mucosa outside of the uterus. For diagnosis endoscopy of the abdominal cavity (laparoscopy) is needed.

4. Polycystic Ovarian Syndrome – PCOS

Symptoms of PCOS include RLQ or LLQ pain, irregular periods, hirsutism (increased body hair grow), increased blood pressure and more.  In diagnosis transvaginal ultrasound may help.

About Jan Modric (249 Articles)
Health writer

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  • Madison

    OK so here’s the deal i have been dealing with on again off again’s uti for a while i just urecentley discovered im preganet and i was having back pain and stomach pain and fatiuge, also naseaua but from morining too night i can’t keep anything down what so ever. my fever went up too 101.5 and since it was late and i wsas having serve pain. We went to the er they did basic blood work, urine, and a ultrasound and said it was a uti and sent me antibotics to go home with. But the pain is in my lower right abdomnal and it keeps getting worse also my fever went as high as 103.5, a lot worse pain and a different kind of pain then with the uti’s i have had. The pain is all in my rigt side and very tender when you push on it also i noticed when im on my right side sleeping i feel nausead easier then when im on my left side. I don’t waant to be a complainer i just feel like there is something else wrong. Please, would appericate the advice.

  • Dr. Chris

    Hi Madison

    UTIs are common in women and could account for many of the symptoms you are experiencing, in addition to the pregnancy contributing to this clinical presentation as well. However, the concern is that your infection may be progressing and could put your pregnancy in jeopardy. Even though you went to the ER, you should have still followed up with your family doctor and gynecologist. Please see these practitioners IMMEDIATELY. The ER is only there for emergency situations and the onus is on you to seek medical attention afterwards. Either way, since you are pregnancy, you will need constant antenatal assessment.

  • Jenny Ford

    Iam in my fifth year of papiloma serous carcinoma uterine cancer I had some bleeding headachs and bad nausia does this have anything to do with it ?

  • Hi Jenny. It is very difficult to answer that with any certainty. You do not state what treatment you are undergoing at the moment, if any. Neither do you clarify where exactly you are bleeding. Given the seriousness of your previous condition, and the host of other factors that could be present, we would strongly advise you to see your oncologist (cancer specialist) or family doctor as soon as possible. There is the possibility that these symptoms are unrelated to your uterine cancer but there is know way of knowing or answering your question for sure without a doctor examining you and assessing your case.Speak to your doctor ASAP.

  • Jenny Ford

    thank you for replying. I was scared and went to ER they did blood work and sent results to my oncologist He said I am cancer free. There was a quite a bit of blood I felt it trickle down through the folds like when I had periods. He said because I had been sick and vomiting I must have torn the tissue thin cervix. I have worried sometime, because the oncologist who removed my uteris and cancer said he could not find my left ovary, I am not even sure it was the right over that had been removed years ago due to a tumor. But there are no tumors in my abdomen now. Does the thought of Cancer ever leave?

  • Hi Jenny. Every cancer survivor responds differently and takes different experiences from the ordeal. It is only natural to always be concerned about cancer if you have been down that road once, or even if you had seen a close friend or family member go through it. So the thought and fear never leaves you. But always consider more common and less severe causes before jumping to the conclusion of cancer. Best of luck.

  • Julia Hall Stanger

    I had a hysterectomy so it is not that. Pain was so severe I went to ER Ct Scan, xrays OK. Have elevated neutrophils, low grade fever, diarrhea every day till noon. Lower right abdomen sore to the touch. hURts right now, docs won’t give pain pills because something “might be percolating”. Can hardly do anything. colonoscopy not until aug. 22nd. Any help will be appreciated.

  • Julia Hall Stanger

    I did have an extremely stressful encounter 7 weeks ago with a person who was baker acted.

  • Hi Julia. The colonoscopy is very important in identifying the cause. Many of the signs and symptoms you mention here can be due to a host of causes, like appendicitis, gastroenteritis and so on. But it may also not be arising from the digestive system. It is very difficult to say on your symptoms alone as these are common and often non-specific symptoms (abdominal pain, diarrhea, low grade fever). Remember that even diarrhea does not necessarily mean that the origin of the problem is in the digestive tract.

    Further investigation is therefore necessary. Unfortunately it is such a long wait till the colonosocopy. If you are not satisfied with your current doctor, you my want to seek a second opinion of another doctor, preferably out of the public health system. Do not hesitate to go to the ER should your symptoms worsen.

  • Alyssa

    Hello all,

    I am 23 year old female, I have gotten Mirena IUD August 2013. I have not had any issues regarding Mirena so I didn’t think this is causing my problem. I have been having sharp, stab-like pains in my lower right stomach/hip area. When it hurts it’s agonizing pain, I don’t want to move but sometimes walking around helps alleviate the pain and sometimes it worsens the pain. Sometimes the pain is for 15 seconds, sometimes 5+ minutes; it varies. I can feel a tightness in the pained area when the pain arrives but sometimes the tightness is replaced with painful bloating. All of this side pain is followed along with sharp lower back pains as well, until the pain in my right side goes away. I can no longer eat FULL meals like I once used to- which is so not me. I end up feeling sick and just stop eating. I’ve also noticed I’ve been making frequent stops to the bathroom- peeing a lot more. I’ve had harder time passing stools- straining and pushing too hard- (I can feel a massive load ready to push through for minutes at a time, but it ends up being a just a drop or 2… and it feels like ive been going for hours even though it’s for a few minutes and barely anything was excreted.) I work every week day from 730am-530pm (NORMAL BUSINESS HOURS /: ) so I really don’t want/ can’t afford to take a day off for an apt unless this is considered a life threatening emergency. I’m so scared I might have a gallbladder problem, appendicitis, Irritable Bowel Syndrom or a simple UTI. Please, any help would be appreciated. Thank you

  • Hi Alyssa. Unfortunately you require medical attention. It is unavoidable at this point. While it may be gynecological, there are also concerns about gallbladder disease, appendicitis, UTIs and kidney stones as you correctly mentioned. Delaying medical treatment can lead to complications which may be severe, possibly even life-threatening. There is no way we can diagnose your condition online although there does seem to be symptoms of a UTI or appendicitis specifically. We cannot stress enough that you are putting your health and possibly life at risk by not seeing a doctor ASAP. Even if it means going to the ER in the evening, you need to seek medical attention at this point.

  • Jess

    I’m not sure if you can help, I’ve have been having server pain on my lower right quadrient, I’ve had a small bowel mri scan came out clear, had colonoscopy, gastroscope, laparoscopy, ultrasound internal and external, one specilous assumed I had Crohn’s diease came out clear, my gyno discovered a tiny cyst on my left ovary but was surprised it wasn’t giving me any pain, I supposably have mild endo, I have pain smack dead centre between my belly button and my hip, it runs into my back and down into my hip, it feels like someone is stabbing me with a blunt knife, I can not walk most times, pain killers do not ease the pain, nor heat pack, tried birth control and that does help a very little, it does get worse when a ovulate but saying that out of 1 month I’ll have severe pain for 3 weeks and it dies of but out of no where I get sharp pain that forces me to stop what I’m doing and crunch, I have to put pressure on it even tho it still hurts but helps with the pain. Truthfully I do not know what else to do, I just wish it went away. And I hope it doesn’t effect in the future by having any children. The pain is worse than anything I have experience before, it is worse than tearing my ac joint in my shoulder. I need help on what else I could possible do to figure out what else could it be. And recently it is starting to effect my daily activities, because if I lift any thing that is slightly heavy it aggravates it, I can not handle sex now due to the pain. So I’m totally lost what else I could, and who I could see about it.

  • Hi Jess. An ovarian cyst and endometriosis can both account for many of the symptoms you are experiencing. Since you have been diagnosed with both these conditions you should be discussing the treatment options with your gynecologist. It is important to note that both these conditions can be difficult to treat and the focus of long term management is to minimize the severity of the symptoms and its impact on your daily life. Surgery may sometimes be necessary but your gynecologist will be able to advise you further as he/she knows your case better. The treatment may not immediately yield results but it is important to continue with it as prescribed.

  • Jess

    Thank you, yes the cyst was removed but it was very small giving no pain in my left ovary, all my pain I’m experiencing is on my right, I’ll definitly go back but I was just hoping there might be something else that they missed, thanks you

  • Hi Jess. You’re welcome. This current pain could be due to some other condition but with PCOS it is important to first exclude another cyst, even on the side that was previously unaffected. It is common for cysts to recur or for multiple cysts to occur on both sides. You would have to start with your gynecologist and then focus on other possible conditions.

  • Jess

    Hello, wouldn’t that be picked up by a mri? Because my gastro specialist said my ovaries are normal. With no cyst and my ovaries are at a nice size. Thank you for your help. I hope they can figure it out even tho it has taken them almost 4 years to do so.

  • Hi Jess. Yes it should but may not always be picked up if it’s small. Remember that PCOS goes beyond ovarian cysts despite its name. Raised androgen levels and an irregular menstrual cycle are the other key features of the condition. But we may be focusing a bit too much on PCOS. It could be some other condition. Your doctor will be able to advise your accordingly.

  • Sinda Willis

    I had both of my ovaries removed on October 21, 2014. My right ovary was fine but my left ovary was attached to the abdominal wall with the sigmoid colan was wrapped around it and it was full of scar tissue. I have been experiencing lower right abdominal pain for quite some time now. All of the tests have come back normal but I still have pain. Does anyone have any suggestions for me?

  • Hi Sinda. It is still relatively early after your surgery so you should be following up with the surgeon if the pain is persisting. The scar tissue that you reported could have been more extensive than just what was around your ovaries. If all of it was not removed then it is possible that this can cause ongoing pain. Your surgeon will be in the best position to advise your further as he/she is familiar with your case.

  • Sinda Willis

    Thank you for the great advice. I did talk to my surgeon and she told me it is “phantom pain” and I will have pain for the next four years. Does this seem right? I am lost and am thinking about a second opinion.

  • Hi Sinda. It’s possible but I would think that a second opinion may be a good idea. It will help put your mind at ease if indeed there is no problem.

  • Denise Feuerstein

    Hi Jess, I have the same pain, I had a hernia repair in October and think it has reoccurred. My symptoms now are same as yours. Do you find if you press in on that area it makes the pain go away? I had hernia repair on the left side and that healed well. But not the right. I’m 53 and exercised regularly. I care for 5 elderly adults in my home and transferred them a lot over my 30 plus years in nursing. I see my surgeon next week. But have you thought you my have a hernia. When they fixed the hernia they did remove a cyst on the right ovary. Read up on it and see if it applies to you, but we have the same symptoms. Hope you feel better.

  • Thank you for your input Denise. Hopefully this will help Jess with her current situation.

  • Teala

    Hey everyone
    This morning as I was taking a shower I started to develop light pain in my lower left abdominal area. I thought nothing of it until minutes later it developed into full lower abdominal pain, right sided back pain, and pain that wraps around my navel. Soon after that I began vomiting a lot and developed a low grade fever. Also my last bowel movement was recent. Any ideas ?

  • Tita13

    I have been having sharp burning pains on my RLQ. It comes and goes. Not sure what that means.

  • Hi Teala. Many conditions can present in this manner. Gallstones is one possible cause although you should have noticed symptoms after eating. Pancreatitis and appendicitis may cause these symptoms as well as do many other conditions. You should consult with your doctor who can then run further tests before reaching a diagnosis.

  • KLHN1986

    I have had RLQ pain on occasion but it hasn’t felt like this… the pain is different and it usually doesn’t persist like this. It woke me up early this morning, I was even dreaming about the pain. It really feels like I am being sliced on a superior to inferior plane (head to toe direction top to bottom). The pain is worst below the belly button, and then between the groin and midline region. So the worst pain is just below the belly button line and to the right. The pain begins just above the belly button and is at it’s worst at that specific localized spot below the belly button line and between the groin and midline. The pain continues down into my groin and halfway down my thigh. I do not have a fever. I do not have tingling or numbness. I had a normal BM this morning. I have not been tooting though I usually toot all day long. I am burping a lot and I never burp. I am 29. I have a “heart shaped uterus” it is not bicornuate. I had an ectopic pregnancy 6 years ago. I am on the nuvaring and started must rating a few days ago when I took it out. My BP is about 20 point higher than normal about 132/92… I weigh 164lbs and am 5’7″. The pain worsens when I breathe in. When the pain started it was only in the RLQ and has since spread upward and down into the thigh. There is some rigidity of the abdomen on the right, no knots or bulging or anything else remarkable with palpation

  • tosmaky

    I have lower rhq discomfort whenever I exercise which can move to the groin area. It all started with a little blood on the tissue paper that disappeared on its own. Several months later, I had a cramp and hfm disease before a week of diarrhea and bloating (took antibiotics and ppis to deal with it). Some days I will feel completely fine and okay. This had been going on since July/August. I have no idea what’s wrong with me but hoping it is not too serious.

  • Tatum

    I’m 18 years old. About 2 weeks ago, I woke up and I was bleeding very heavy and it was clumpy too. I had severe pain in my right abdonminal and right back pain. My period usually is at the end of the month, also. The bleeding stoped three days after the incident. Now, I am bleeding again. This morning I had hot flashes, then puked, then started bleeding out of my vagina, now I have right adonminal pain, lower right back pain, and bloating. Not sure if I should go to the doctors if its nothing serious… Oh, and I have been constipated the past 2 days too, and tired all the time.