Pain associated with pathologies of the digestive system can be called the most unpleasant. The appearance of pain can indicate various pathological processes, and the pain can be dull, sharp, cutting or any other nature.
Only a doctor can identify the cause of discomfort and prescribe the correct therapy. Pain in the rectum and lower abdomen can appear due to various diseases - from prostatitis to intestinal oncology. The constant occurrence of unpleasant sensations requires immediate diagnosis.
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.
Determining the cause of pain by symptoms
The table was compiled by Victoria Druzhikina, a practicing therapist on the AskVracha website, and serves as the most reliable source of information when determining the cause of pain.
| Disease | Symptom | Drugs used |
| Acute cholecystitis | Acute, severe pain radiating downwards, nausea, vomiting, fever, loose stools. | Antispasmodics (Duspatalin, No-shpa, Papaverine); Antibiotics (Ciprofloxacin, Amikacin, Meropenem); Analgesics (Diclofenac, Ketorol); Antacids (Famotidine, Omeprazole, Rabeprazole). |
| Chronic cholecystitis | Most often dull, aching, paroxysmal pain, intensifying after fatty foods, rarely - pronounced, loose stools. | Antispasmodics (“Duspatalin”, “No-shpa”, “Papaverine”); Antibiotics (“Ciprofloxacin”, “Amikacin”, “Meropenem”); Analgesics (“Diclofenac”, “Ketorol”); Antacids (Famotidine, Omeprazole, Rabeprazole). |
| ZhKB | Sharp, cutting pain, nausea, vomiting, yellowing of the skin, loose stools" | Antispasmodics (“Duspatalin”, “No-shpa”, “Papaverine”); Antibiotics (“Ciprofloxacin”, “Amikacin”, “Meropenem”); Analgesics (“Diclofenac”, “Ketorol”); Antacids (Famotidine, Omeprazole, Rabeprazole), surgery |
| Hepatitis | The pain is strong, but dull, and may be nagging. Nausea, vomiting, fever, loose stools, weakness, sweating. | Specific antiviral therapy. |
| Cirrhosis of the liver | Dull, in the final stage severe pain, ascites (fluid in the abdominal cavity, looks like a bulging belly), yellow-brown tongue, weakness, nausea, vomiting, loose stools, heaviness in the right side. The protruding edge of the liver is often visible from under the ribs. In the final stage, the organ shrinks and stops protruding. | Hepatoprotectors (“Heptral”, “Ursosan”, “Ornithi”n, milk thistle extract); Proton pump inhibitors (Omeprazole, Rabeprazole, Esomeprazole); Anticholinergic drugs (Mebeverine, Trimebutine). |
| Appendicitis | Many faces - pains are sharp, dull, strong, weak, from the navel to the level of the sternum. Nausea, single vomiting. Fever. Loose stools. Mixing of pain from the epigastrium to the right iliac region after 3–4 hours from the onset (Kocher’s symptom). | Surgery |
| Enteritis, colitis | Pain along the intestines, rumbling in the abdomen, bloating, blood and mucus in the stool. The stool is irregular, liquid. | Antispasmodics (“No-shpa”, “Papaverine”); Antidiarrheal ("Smecta") |
| Bowel cancer | The pain is aching at first, then severe. Constipation, obstruction, weight loss. | Surgical treatment, chemotherapy, radiation |
| Nephroptosis | The pain is often associated with sudden movements, especially high jumps. Varying intensity, usually medium. | Kinesiology. Osteopathy. Surgical correction – kidney suturing |
| Osteochondrosis | The pain comes from the spine and intensifies with movement, inhalation, and coughing. At rest I subside or decrease. | NSAIDs (“Meloxicam”, “Xefocam”, “Diclofenac”, “Aertal”); Muscle relaxants (“Sirdalud”, “Mydocalm”); Chondroprotectors (“Teraflex”, “Dona”, “Arthra”); B vitamins (“Neurobion”, “Combilipen”, “Milgamma”). |
| Endometriosis | The pain is quite intense and is accompanied by cycle disruption and bleeding. | Surgery; Hormonal drugs. |
| Bruise, injury | Pain is associated with a fall, blow, etc., and is limited by this impact. Intensifies with pressure. Accompanied by the formation of a hematoma and bruise. | NSAIDs (Meloxicam, Xefocam, Diclofenac). |
| Myositis | Pain in the muscle, intensifies with pressure and movement. Quite noticeable, subsides when resting. | NSAIDs (“Meloxicam”, “Xefocam”, “Diclofenac”, “Aertal”); Muscle relaxants (“Sirdalud”, “Mydocalm”); |
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.
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.
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.
- When tissues become inflamed, they soften and absorb ultrasound more than healthy areas.
- 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.
- Doppler ultrasound allows you to evaluate the speed of blood flow to exclude compression of the inferior vena cava.
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:
- 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. - Heart diseases
(they cause circulatory disorders): myocarditis, endocarditis, coronary heart disease, abdominal myocardial infarction. - Gallbladder diseases
: cholecystitis (inflammation), cancerous tumors. - 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.
- 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. - Diaphragmatitis (inflammation of the pleura covering the diaphragm).
- Adrenal tumors.
- Intercostal neuralgia (irritation of the intercostal nerves).
- 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.
Pelvic organ prolapse
With age or during pregnancy and childbirth, the pelvic floor muscles may weaken, causing the uterus, vagina and bladder to move downwards. This is not a dangerous condition, but it leads to a feeling of discomfort and makes sexual intercourse painful. Special Kegel exercises help strengthen the pelvic floor muscles.
Varicose veins of the pelvic veins
Varicose veins can occur not only on the legs. Dilatation of the pelvic veins leads to pain, which intensifies when the woman sits or stands. When lying down, symptoms decrease or disappear. Varicose veins of the pelvic veins are treated surgically.
