What Can Cause Pain on the Right Side of the Lower Back?

Back muscle or spinal issues

According to the National Institute of Neurological Disorders and Stroke (NINDS), back pain — especially lower back pain — is one of the most common reasons people see their doctor or miss work. Often times that pain is caused by mechanical problems, such as:

• overstretching or tearing of a ligament due to improper lifting
• degeneration of a shock-absorbing spinal disc due to aging or normal wear and tear
• muscle tightness due to improper posture

Treatment varies depending on the cause and severity of your condition. Your doctor may initially recommend conservative options like physical therapy or medications to reduce inflammation.

If conservative treatment methods don’t help, or if your condition is severe, your doctor may recommend surgery.

Spinal stenosis

When the spaces between your vertebrae start to narrow — usually caused by normal wear and tear with age — pressure can build on your spinal cord and nerve roots. These are the parts of your nerves that extend out from your spinal cord itself. Arthritis and spinal injuries, such as fractures, may also cause spinal stenosis.

Symptoms of spinal stenosis can begin slowly and typically include pain in your lower back, as well as a burning or tingling sensation that extends down through your buttocks and legs.

If your nerve roots on the right side of your spinal cord are affected, you’ll feel pain on the right side of your lower back, buttocks, and legs. In severe cases, weakness in your legs may occur.

Physical therapy is usually the first-line treatment. A back brace may also help manage symptoms. Pain relief medications may also help when symptoms flare up.

If surgery is required, the procedure aims to create more space within your spinal canal to relieve pressure on your spinal cord or nerve roots.

Lumbar radiculopathy

Radiculopathy is a condition that develops when a nerve root becomes pinched. When it develops in your lower back, it’s called lumbar radiculopathy, or more commonly, sciatica. It’s often caused by spinal stenosis, a herniated disc or bone spurs.

Symptoms usually include pain or numbness radiating from your lower back down one or both legs.

Treatment usually involves physical therapy. Exercises designed to improve core and lower body strength, flexibility, and stability can often delay or prevent surgery.

Massage therapy and acupuncture may also be helpful in some cases.

Intervertebral disc disease

Intervertebral disc disease refers to the breakdown or degeneration of your spinal discs that separate your vertebrae — the bones in your spine. The purpose of these rubbery discs is to provide cushioning between your vertebrae and to act as shock absorbers. These spinal discs help your back to move, bend, and twist comfortably.

When these cushions degenerate or wear away, your vertebrae can start to rub together. This can cause bone spurs to form, putting pressure on your spinal cord or nerve roots.

According to medical experts, the condition affects about 5 percent of the adult population per year in well-resourced countries.

Back pain is the primary symptom of degenerative disc disease. In severe cases, weakness or numbness in your legs can occur. Incontinence may also occur if the injury to the affected nerve is especially serious. If you experience these symptoms, seek medical attention right away.

Initial treatment may include physical therapy and pain relief medications. In serious cases, surgery may be necessary to remove and replace the affected disc.

Kidney problems

The kidneys are located on either side of your spine, under your rib cage. Your right kidney hangs a little lower than the left, making it even more likely to cause lower back pain if it’s infected, irritated, or inflamed.

Common kidney problems include kidney stones and kidney infection, which are covered in more detail below.

Kidney stones

Kidney stones are solid, pebble-like structures made up of excess minerals and salts normally found in urine.

When these stones lodge in your ureter, you may experience a sharp, cramping pain in your back, lower abdomen, and groin. The ureter is a tube that carries urine from your kidneys to your bladder.

With kidney stones, the pain comes and goes as the stone moves.

Other symptoms include urination that is painful or urgent. You may also have difficulty fully emptying your bladder, or you may only produce a small amount of urine when you urinate. Urine may also be bloody due to the sharp-edged stone cutting tissue as it travels down your ureter.

For treatment, your doctor may recommend:

• medication to help relax the ureter, so the stone can pass more easily
• shock wave lithotripsy (SWL), which uses ultrasound- or X-ray-guided shock waves to break up a stone
• surgical procedures to remove or pulverize a stone

Kidney infection

The most common cause of kidney infections is bacteria, such as E. coli, which lives in your bowel, traveling through your ureter, and into the bladder and kidneys. Symptoms are similar to those of other urinary tract infections, and may include:

• back and abdominal pain
• burning urination
• feeling an urgent need to urinate
• cloudy, dark, or foul-smelling urine

With a kidney infection, you’re likely to also feel sick, and may experience:

• fever
• chills
• nausea
• vomiting

Permanent kidney damage and a life threatening blood infection can result from an untreated kidney infection, so seek prompt medical attention if you suspect a kidney infection. Your doctor will prescribe antibiotics to fight off the bacteria.

Appendicitis

Your appendix is a small tube that attaches to your large intestine and sits in the lower right side of your body. In about 9 percent of Americans, the appendix becomes inflamed and infected. This is called appendicitis. It’s most common in people between 10 and 30 years old.

This infection causes the appendix to swell. You may have tenderness and fullness in your abdomen that begins near the navel and gradually extends to the right side. The pain often worsens with movement or by pressing the tender areas. Pain can also extend around to your back or groin.

Other symptoms include nausea and vomiting.

If you have any symptoms of appendicitis, get immediate medical help. If your appendix continues to swell, it may eventually burst and spread its infected contents throughout your abdomen, creating a life threatening situation.

Conventional treatment consists of surgical removal of the appendix. This is called an appendectomy, and it can be done via minimally invasive laparoscopic surgery in uncomplicated cases.

In some cases, it may be possible to treat appendicitis with antibiotics alone, meaning you may not need surgery. In one study, nearly three quarters of people who received antibiotics for their appendicitis did not require a later appendectomy.

Abdominal aortic aneurysm

The aorta is the largest blood vessel in your body. If the portion of your aorta in your abdomen bulges abnormally, it’s called an abdominal aortic aneurysm (AAA). The risk is that the bulge will burst, causing life threatening bleeding complications.

The main symptoms of an abdominal aortic aneurysm are severe abdominal pain, as well as lower back pain. If the aneurysm bursts, symptoms may include:

• dizziness
• shortness of breath
• fainting

Treatment for an abdominal aortic aneurysm may include a catheter procedure that places a tube or graft at the site of the aneurysm to strengthen that section of the aorta and prevent a rupture.

In more serious cases, surgery may be necessary to remove the affected portion of the aorta and replace it with a graft.

Causes in women

There are some causes unique to women.

Endometriosis

Endometriosis is a chronic condition where tissue that resembles the uterus lining, called endometrial tissue, grows outside the uterus. The Endometriosis Foundation of America says that it affects 1 in 10 females in the United States.

If the tissue grows on the right ovary or fallopian tube, it can irritate the ovary and surrounding tissue and cause a cramp-like pain that can radiate from the front and side of the body to the back.

Treatment typically includes hormonal therapy or laparoscopic surgery. Hormonal therapy, such as low-dose birth control pills, can help shrink growths. Surgery can also be used to remove the growths.

Pregnancy: First trimester

Low back pain, on either side of your spine, is common throughout pregnancy. It can begin early in pregnancy due to your body producing a hormone called relaxin that helps loosen the ligaments in your body in preparation for delivery.

Low back pain can also be a symptom of miscarriage, especially if it’s accompanied by cramping and spotting. Talk with your doctor if you experience back pain with cramping or spotting.

Mild discomfort can generally be eased with:

• gentle stretching
• warm baths
• wearing low-heeled shoes
• massage
• acetaminophen (Tylenol) — before taking this medication, ask your doctor if it’s appropriate to use during your pregnancy

Pregnancy: Second and third trimester

There are several things that can cause back pain in your second and third trimesters. As your uterus grows to accommodate your growing baby, your gait and posture can change, causing your lower back to ache. Depending on the location of your baby and your gait, the pain may be localized to the right side.

Round ligaments are another possible cause of pain. Round ligaments are fibrous connective tissues that help support your uterus. Pregnancy causes these ligaments to stretch.

As the ligaments stretch, nerve fibers, most commonly on the right side of the body, are pulled, causing periodic sharp, stabbing pains.

Urinary tract infections (UTIs) may also cause pain on the lower right side of your back. Contact your doctor if you’re pregnant and experiencing any symptoms of a UTI, including:

• burning urination
• abdominal discomfort
• cloudy urine

An untreated UTI in a pregnant person can lead to a kidney infection, which can seriously affect both the birthing parent and baby.

Causes in men

In men, testicular torsion can lead to lower back pain on the right side. This occurs when your spermatic cord, which lies in your scrotum and carries blood to your testes, becomes twisted. As a result, blood flow to your testicle is severely reduced or even cut off altogether.

Symptoms include:

• severe, sudden groin pain, that can radiate to the back, either on the left or right side, depending on which testicle is affected
• swelling of your scrotum
• nausea and vomiting

While rare, testicular torsion is considered a medical emergency. Without proper blood supply, the testicle can be irreversibly damaged. Doctors will have to surgically untwist the spermatic cord to save the testicle.

In many cases, lower back pain can be managed with simple, at-home treatments or lifestyle modifications. For instance you can:

• Apply ice or heat for 20 to 30 minutes, every 2 to 3 hours, to ease pain and inflammation.
• Take over-the-counter pain relief medication, such as ibuprofen (Advil, Mortin) or acetaminophen (Tylenol), with your doctor’s guidance.
• Drink at least eight 8-ounce glasses of water a day, and limit your intake of animal protein and salt to reduce your risk of kidney stones.
• When using the bathroom, wipe from front to back to prevent bacteria from your anal area entering your urinary tract and causing an infection.
• Practice proper lifting techniques. Lift objects by bending low with your knees in a squat position, and hold the load close to your chest.
• Spend a few minutes every day stretching any tight muscles.

Consult your doctor if you have back pain that’s intense, worrisome, or that doesn’t go away with self-care measures. It’s also important to call your doctor if your lower back pain is making it hard for you to go about your daily activities.

Most cases of lower back pain on the right side are not medical emergencies. However, don’t hesitate to get immediate medical help if you experience back pain that’s accompanied by any of the following symptoms:

• loss of bladder or bowel function
• sudden, severe pain
• weakness or loss of sensation in your lower body
• pain accompanied by fever, clammy skin, a rapid heart rate, nausea, vomiting, or any other concerning symptoms

The appropriate treatment for lower back pain emergencies depends on the cause. If the source of the pain isn’t obvious, you may need one or more of the following screenings to determine the right course of action:

• an MRI to check your spinal cord, nerve roots, and other soft tissue
• an X-ray to look at your spine and other joints for signs of fracture or other concerns
• blood tests to check for markers of inflammation

If nerve or muscle problems are the cause of lower back on the right, epidural injections of corticosteroids may be necessary if the pain and loss of mobility and function are severe.

If appendicitis is diagnosed and it can’t be managed by antibiotics, then emergency surgery to remove the appendix may be necessary.

If you’re diagnosed with an abdominal aortic aneurysm, you may need surgery, so your doctor can repair or remove the damaged tissue. Depending on the type of aneurysm and your overall health, this may be done with open abdominal surgery or endovascular surgery — a less invasive type of surgery.

If the abdominal aortic aneurysm is smaller than 5.5 centimeters in width, your doctor may decide to monitor it instead of performing surgery.

A burst abdominal aortic aneurysm is treated in the same way as an aneurysm before rupture, though the procedure must be done as soon as possible after rupture to avoid a potentially life threatening outcome.

In many cases, pain on the right side of the lower back is caused by a pulled muscle or other injury to your back. It’s also possible that it could be caused by an underlying condition, such as:

• nerve compression in your spine
• disc degeneration
• kidney disease
• an abdominal aortic aneurysm
• appendicitis

Because lower right side back pain can have many causes, it’s important not to ignore your symptoms, especially if your lower back pain is intense and comes on suddenly, or is accompanied by other concerning symptoms.

Be sure to talk with your doctor if you’re concerned about back pain, or if the pain is affecting your daily activities.

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