Lower right abdominal pain has a wide range of causes, from trapped gas that resolves on its own to appendicitis that needs emergency surgery. The lower right quadrant houses your appendix, the beginning of your large intestine (called the cecum), parts of your small intestine, and your right ureter. In women, the right ovary and fallopian tube sit here too. Any of these structures can be the source of your pain, and the character of the pain, how it started, and what other symptoms you have are the biggest clues to what’s going on.
Appendicitis: The Most Urgent Possibility
Appendicitis is the first thing most people (and most doctors) think of with lower right abdominal pain, and for good reason. Roughly 16% of people will develop appendicitis at some point in their lives. The classic pattern starts as a vague ache around your belly button, then over 12 to 24 hours migrates to a specific spot in the lower right abdomen. That spot, called McBurney’s point, sits about a third of the way from your hip bone to your navel.
What makes appendicitis pain distinctive is how it behaves. It tends to get steadily worse rather than coming and going. Pressing on the area and then releasing causes a sharp spike of pain, which doctors call rebound tenderness. You may also notice that your abdominal muscles tense up involuntarily when the area is touched. Fever, nausea, vomiting, and loss of appetite typically accompany the pain. If you’re experiencing this pattern, especially pain that started vaguely and is now localizing and intensifying, treat it as an emergency.
Trapped Gas and Digestive Cramping
Gas trapped in your intestines can produce surprisingly intense pain in the lower right abdomen, sometimes convincing enough to mimic appendicitis. The key differences: gas pain tends to come in waves or cramps rather than building steadily, it often improves after passing gas or having a bowel movement, and it isn’t accompanied by fever or worsening tenderness when you press on the area. You might also feel bloated or notice gurgling sounds.
Constipation can cause similar cramping, particularly in the cecum where stool first enters the large intestine. If you haven’t had a bowel movement in a few days and the pain is dull and crampy rather than sharp and escalating, a digestive issue is more likely than something surgical.
Kidney Stones and Urinary Tract Issues
A kidney stone doesn’t usually cause pain while it sits in the kidney. The trouble starts when it drops into the ureter, the narrow tube connecting your kidney to your bladder. Once there, it can block urine flow, causing the kidney to swell and the ureter to spasm. This produces severe, sharp pain in the side and back below the ribs that radiates down into the lower abdomen and groin.
Stone pain has a distinct personality: it comes in intense waves, shifts location as the stone moves, and rarely lets you sit still. Most people with a kidney stone pace or writhe trying to find a comfortable position, which is different from appendicitis, where movement makes the pain worse. You may also notice pink, red, or brown urine, a burning sensation when you urinate, or a constant urge to go with only small amounts coming out.
Causes Specific to Women
Women have additional anatomy in the lower right quadrant that opens up several possibilities men don’t face.
Ovarian Cysts
A cyst on the right ovary can cause a dull, achy pain that worsens during your period or with certain movements. Most ovarian cysts are harmless and resolve on their own within a few menstrual cycles. However, if a cyst ruptures, the pain shifts suddenly to sharp and stabbing, sometimes described as feeling like a knife. A ruptured cyst can also cause internal bleeding, so sudden severe pain on one side warrants urgent evaluation.
Ectopic Pregnancy
If you’re of reproductive age and have lower right abdominal pain along with a missed period and vaginal bleeding, an ectopic pregnancy is a serious possibility. This happens when a fertilized egg implants in the right fallopian tube instead of the uterus. It’s a medical emergency because the tube can rupture, causing life-threatening internal bleeding. Nausea and vomiting often accompany the pain.
Pelvic Inflammatory Disease
An infection of the reproductive organs can cause lower abdominal pain alongside abnormal vaginal discharge, fever, bleeding between periods, and pain during sex. Pelvic inflammatory disease typically develops from sexually transmitted infections and requires antibiotic treatment to prevent long-term complications.
Causes More Common in Men
Inguinal hernias are far more common in men and frequently cause pain in the lower right abdomen. The hallmark sign is a visible or palpable bulge in the groin area, sometimes extending into the scrotum. The discomfort tends to feel heavy or burning, and it characteristically worsens when you strain, lift, cough, or stand for extended periods, then improves when you lie down.
Most inguinal hernias aren’t emergencies, but they become one if the hernia gets stuck or its blood supply is cut off. Warning signs of a strangulated hernia include a bulge that suddenly gets larger or no longer pushes back in, severe pain or tenderness at the site, fever, nausea, vomiting, and bloating. This requires immediate surgery.
Chronic and Less Common Causes
Not all lower right abdominal pain is acute. If yours has been coming and going for weeks or months, a few conditions are worth considering.
Crohn’s disease most commonly affects the end of the small intestine, which sits in the lower right quadrant. Recurring pain in this area along with diarrhea, weight loss, fatigue, or blood in your stool could point to an inflammatory bowel condition, especially if you’re in your teens through thirties.
Right-sided diverticulitis, where small pouches in the wall of the large intestine become inflamed, can look very similar to appendicitis. It tends to affect people between ages 20 and 40, and compared to appendicitis, the pain is usually located slightly higher and more to the side, lasts longer before you seek care, and is less likely to come with fever or vomiting. This distinction is nearly impossible to make without imaging.
How Doctors Figure Out the Cause
When you show up with lower right abdominal pain, the evaluation typically starts with a physical exam and blood work. After that, imaging is the main tool for reaching a diagnosis. For patients under 30 who aren’t overweight, ultrasound is often the first choice because it avoids radiation exposure. For most other adults, a CT scan is preferred because it gives a clearer picture, especially when there’s more body fat between the skin and the organs. For women where a gynecological cause is suspected, ultrasound is the go-to test regardless of age, since it can evaluate the ovaries and fallopian tubes directly. Pregnant patients always start with ultrasound, with MRI as a backup if the results are unclear.
Signs That Need Emergency Attention
Severe lower right abdominal pain on its own is reason enough to go to the emergency room. Beyond severity, watch for pain that started mild but keeps getting worse, pain that doesn’t go away or keeps returning, fever or chills, vomiting blood, blood in your urine or stool, yellowing of your skin or eyes, or pain that spreads up toward your chest, neck, or shoulder. Unexplained weight loss alongside persistent pain also warrants prompt evaluation. If you’re genuinely unsure whether your pain is gas or something more serious, err on the side of getting checked out. The conditions that cause lower right abdominal pain range from completely benign to time-sensitive emergencies, and the difference isn’t always obvious from the outside.