Pain in the lower right abdomen has several possible causes, ranging from trapped gas to conditions that need emergency treatment. The most common concern people have when they feel this pain is appendicitis, but the list of possibilities also includes kidney stones, ovarian cysts, hernias, and digestive conditions. What matters most is the pattern: how the pain started, how it’s changing, and what other symptoms come with it.
Appendicitis: The Most Common Concern
Appendicitis is the first thing most people worry about, and for good reason. It’s the most common surgical emergency involving the abdomen. The classic pattern starts with vague, hard-to-pinpoint pain around the belly button or upper abdomen. Over the next several hours, that pain migrates downward and to the right, settling into a focused, sharper ache in the lower right quadrant.
This migration pattern happens because the initial inflammation irritates nerve pathways deep inside the abdomen that your brain can’t precisely locate. As the inflammation spreads to the abdominal wall lining, the pain sharpens and locks into position at a spot roughly one-third of the way from the hip bone to the belly button. That’s the point of maximum tenderness, not actually where the appendix sits. Nausea and vomiting often follow the onset of pain, not the other way around. A low-grade fever is common. The pain typically worsens with coughing, sneezing, or any jarring movement.
The whole progression from vague belly pain to intense right-sided pain usually unfolds over 12 to 24 hours. If the pain has been constant for several hours, is getting worse, and movement makes it sharper, that combination warrants urgent evaluation.
Trapped Gas or Indigestion
Gas pain can feel surprisingly intense and can settle in the lower right abdomen, mimicking more serious problems. The key difference is how it behaves. Gas pain tends to come in waves or cramps rather than building steadily. It often improves after you pass gas or burp. Walking around and gentle movement typically help release trapped gas, which is the opposite of appendicitis, where any movement makes things worse.
If your pain comes and goes, doesn’t worsen with coughing or sneezing, and eases after a bowel movement or passing gas, you’re most likely dealing with something digestive and benign.
Kidney Stones
A kidney stone that moves from the kidney into the thin tube connecting the kidney to the bladder (the ureter) can cause severe pain in the lower abdomen and flank. The pain often radiates from the back around to the front and down toward the groin. It comes in intense waves as the ureter contracts to push the stone through.
The distinguishing features are the wave-like intensity, restlessness (people with kidney stones can’t find a comfortable position, unlike appendicitis patients who prefer to stay still), and urinary symptoms. Blood in the urine, even if it just looks slightly pink, is a strong signal. You may also feel an urgent need to urinate more frequently or experience a burning sensation.
Ovarian Cysts and Torsion
For women and people with ovaries, a cyst on the right ovary is a common cause of lower right abdominal pain. Small ovarian cysts form routinely during the menstrual cycle and usually resolve on their own without symptoms. But when a cyst grows large enough to twist the ovary (called torsion) or ruptures, the pain can be sudden and severe.
Ovarian torsion typically causes sharp pain that comes on abruptly, often with nausea and vomiting. Because the twisting cuts off blood flow to the ovary, this is a time-sensitive emergency. A ruptured cyst can also cause sudden, intense pain, sometimes with lightheadedness if there’s internal bleeding. Cold or clammy skin, rapid breathing, or feeling faint alongside pelvic pain are signs that need immediate attention.
Ectopic Pregnancy
In women of reproductive age, lower right abdominal pain combined with vaginal bleeding and a missed period raises concern for an ectopic pregnancy, where a fertilized egg implants outside the uterus, most often in a fallopian tube. This is a medical emergency. Severe pelvic pain, vaginal bleeding, extreme lightheadedness or fainting, and shoulder pain (a sign of internal bleeding irritating the diaphragm) all warrant calling emergency services immediately.
Inguinal Hernia
A hernia in the groin area can produce an aching or burning sensation in the lower abdomen, usually near the pubic bone on one side. The hallmark is a visible or palpable bulge that becomes more noticeable when you stand up, cough, or strain. You can often feel it by pressing your hand over the area. The discomfort tends to worsen with bending, lifting, or prolonged standing. In men, the bulging tissue sometimes descends into the scrotum, causing pain and swelling there.
Most hernias aren’t emergencies, but they can become one. If the protruding tissue gets trapped in the abdominal wall and can’t be pushed back in, it’s called an incarcerated hernia. If the trapped tissue loses its blood supply, it becomes strangulated. Warning signs include sudden worsening pain, nausea and vomiting, fever, the bulge changing color to red or purple, and inability to pass gas or have a bowel movement. A strangulated hernia requires emergency surgery.
Crohn’s Disease and Chronic Inflammation
If your lower right abdominal pain keeps coming back over weeks or months, especially alongside diarrhea, Crohn’s disease is worth considering. About two-thirds of Crohn’s cases involve the terminal ileum, the very last segment of the small intestine, which sits in the lower right abdomen. This overlap in location means Crohn’s flares can closely mimic appendicitis.
The difference is the timeline. Crohn’s pain tends to be recurring and may come with chronic diarrhea (sometimes bloody), weight loss, and fatigue over months. It can also cause partial bowel obstruction symptoms like cramping and bloating after eating. An acute flare in someone who hasn’t been diagnosed yet can look like appendicitis, and sometimes the distinction is only made during imaging or surgery.
How Doctors Figure Out the Cause
When you go in for lower right abdominal pain, the physical exam focuses on how you respond to pressure. Your provider will press on the painful area and note whether the pain sharpens when they release the pressure (a sign of inflammation in the abdominal lining). They may also check whether extending your right hip backward or rotating it increases your pain, both of which suggest the inflammation is near specific muscles deep in the pelvis.
For imaging, ultrasound is the preferred first step for children, pregnant women, and younger women where ovarian causes need to be ruled out. CT scans are the most accurate tool for diagnosing appendicitis in adults and are often used when ultrasound results are unclear. MRI is an alternative with similar accuracy that avoids radiation exposure, making it especially useful during pregnancy.
Signs That Need Urgent Attention
Lower right abdominal pain that started suddenly and is severe warrants prompt evaluation. The same goes for pain that started mild but has been steadily worsening over several hours. Vital sign changes like a rapid heart rate, rapid breathing, or low blood pressure signal that something serious may be happening. Fever combined with abdominal pain raises concern for infection or perforation.
If you’ve been evaluated and sent home, the general guidance is to return if the pain worsens, you develop new vomiting or fever, or if the pain persists beyond 8 to 12 hours. Older adults deserve extra caution because they tend to report less severe symptoms even with serious underlying conditions.