The flanks are the abdominal area between the ribs and pelvic bone (ilium) on either side of the body. The right flank is essentially the right lumbar region – one of nine abdominal regions. It includes area of the body running around the sides of the abdomen to the back. The lower part of the flank area is where fat tends to accumulate (midsection) and is commonly referred to as “love handles” or “spare tire”. The flanks are also known by several other common terms including the loins, sides and left and right lumbar regions.

Meaning of Right Flank Pain

Flank pain is in most cases due to a problem in the kidney or ureters, irrespective of whether it occurs on the right or left flank. However, there are various other causes that may also be responsible for flank pain and this can vary from the right side and left side. Right flank pain indicates a problem with one or more of the organs lying in this area. These organs include :

  • Right kidney
  • Right ureter
  • Colon – ascending, hepatic flexure and descending colon
  • Right diaphragm

Organs which are at the border of the right flank or in neighboring regions can also also cause flank pain. This includes :

  • Gallbladder
  • Appendix
  • Right ovary (women)
  • Pancreas (head)
  • Urinary bladder

Other Signs and Symptoms

The various other symptoms that may be present depend on the cause of the right flank pain. Typically there are urinary disturbances since most causes of right flank pain are associated with the kidney and ureter. These symptoms include :

  • Frequent urination
  • Large volume urine (polyuria), small volume (oliguria) or no urine (anuria)
  • Burning upon urination
  • Blood in the urine (hematuria)

Disease affecting the liver and gallbladder that may cause right flank pain includes :

  • Jaundice
  • Weight loss
  • Nausea
  • Fatty stools
  • Diarrhea

Problems in the colon may present with :

  • Diarrhea or constipation
  • Excessive flatulence
  • Abdominal distention
  • Mucus or blood in the stool

No other symptoms

Often right flank pain arises with no other symptoms at the outset. This may be seen mainly with kidney and liver disorders. However, the other symptoms mentioned above develops gradually. Right flank pain with no other symptoms should not be ignored. It needs to be investigated further particularly if the pain is severe or worsening over time despite no other symptoms developing over time.

Causes of Right Flank Pain

Kidney

Diseases of the right kidney causes upper right flank pain, more towards the back as discussed under kidney pain location.

  • Pyelonephritis is an infection of the kidney which typically arises as a consequence of an ascending urinary tract infection. It is mainly bacterial in nature. Pyelonephritis is an acute infection that can have serious complications if not treated rapidly.
  • Kidney stones (renal calculi) are hard sediments that form in the kidney. Smaller stones pass down the ureter and may be expelled with little or no pain. Larger stones may stay lodged in the kidney or ureter and cause severe flank pain known as renal colic.
  • Hydronephrosis is an accumulation of urine in the kidney leading to kidney swelling. It occurs with any cause of urinary tract obstruction like a kidney stone, enlarged prostate (men), pregnancy (women) or tumor in or around the tract.
  • Kidney trauma may arise with any injury to the kidney. This can be associated with blunt force or sharp force trauma. It may arise with assault, a fall or car accidents. Bleeding within the kidney may arise (renal hemorrhage).
  • Polycystic kidney disease is the presence of multiple cysts within the kidney tissue. This may be associated with genetic abnormalities. It can eventually lead to kidney failure.
  • Renal cell carcinoma is a cancerous growth arising from the kidney cells. It is the most common type of kidney cancer. Sometimes less common types of cancers may arise in the kidney and ureter like transitional cell carcinoma. These are primary cancers meaning it starts in the kidney tissue. Sometimes cancer from elsewhere in the body can spread to the kidney (metastasis).
  • Renal vascular problems includes renal artery stenosis which is narrowing of the artery that carries blood to the kidney or renal vein thrombosis where a clot forms in the vein carrying blood out of the kidney.

Ureter

Many of the conditions that affect the kidney can extend to the ureter. Ureteral conditions may cause flank pain that runs down the flank towards the central part of the lower abdominal area (suprapubic region) where it joins the bladder.

  • Ureteral stones which are kidney stones that pass into the ureter and either stay lodged within the ureter or cause significant damage to the inner wall as it passes down the ureter.
  • Ureteritis is inflammation of the ureter most commonly as a result of an ascending urinary tract infection.
  • Ureteral cancer is a malignant tumor of the ureter which most often starts in the kidney, like transitional cell carcinoma.

Liver

Liver diseases that are isolated to the outer (lateral) part of the right lobe of the liver may be responsible for right flank pain as described under liver pain.

  • Hepatitis is inflammation of the liver associated with an infection particularly with the hepatitis virus (viral hepatitis) or alcohol abuse (alcoholic hepatitis) which is part of alcoholic liver disease (ALD). There are other causes of hepatitis but these two causes are the most common.
  • Fatty liver disease is the accumulation of fat within the liver tissue. It arises with obesity, diabetes mellitus, hypertension and hyperlipidemia (elevated blood lipids).
  • Pyogenic liver abscess is a collection of pus within the liver tissue. It develops as a complication of infections within the abdomen like an appendicitis or if microbes gain entry into the liver tissue following trauma that leads to open wounds. Sometimes it arises after surgery or certain diagnostic investigation.

Gallbladder pain may be due to :

  • Cholecystitis
  • Cholangitis
  • Gallstones
  • Gallbladder cancer

Large Intestine

Diseases of the large intestine which affects the cecum, ascending colon, hepatic flexure and first portion of the transverse colon may cause right flank pain.

  • Appendicitis is inflammation of the appendix, the outpouching from the cecum. It arises with an obstruction or infection of the appendix. Appendix pain is located at the right lower quadrant of the abdomen closer to the belly button.
  • Inflammatory bowel disease is a chronic inflammatory disorder of the gut that mainly affects the colon and rectum. There are two types – ulcerative colitis and Crohn’s disease.
  • Colonic obstruction is any partial or complete blockage of the colon which may arise with a tumor, twisting of the colon, external compression of the colon and impacted feces.
  • Ischemic bowel disease is a condition where the blood supply to the bowel wall is interrupted. This leads to damage of the bowel wall and eventually death of the tissue.

Other causes

  • Abdominal wall injury
  • Muscle strain
  • Intra-abdominal abscess
  • Peritonitis
  • Adrenal gland tumors
  • Shingles (herpes zoster)
  • Pleuritis
  • Lung infections
  • Pneumonia
  • Referred pain from the back


Article reviewed by Dr. Greg. Last updated on January 24, 2012