Lower Back Pain on the Right Side: 9 Possible Causes

Written by Jamie Page
Physiotherapist, Salford University
Medically reviewed by Dr Gina Arena
Research Fellow, University of Western Australia
Reviewed on July 21, 2022

Man sitting on the couch holding his right side of the lower back in pain

Lower back pain on the right side is caused by muscle strain or a nerve problem originating in your spine (nonspecific or mechanical).[1] Other causes are due to conditions like kidney stones, infections, and appendicitis.

What are the symptoms of lower right back pain?

The symptoms of lower back pain can vary. They are usually localised and dull aching or can radiate to the legs, and it may feel like the legs are tingling.[2] On the other hand, organ problems tend to have different symptoms like loss of bladder and bowel control.

What causes lower right back pain?

Pain on the right side of the lower back is due to mechanical issues with the spine, muscles, tendons, and ligaments. Other times, it is from infection, inflammation, and irritation of your organs from the mid-back, abdominal, or pelvic area.

1. Back muscle or spinal issues

Lower back pain is one of the most common reasons why people see the doctor, and it often causes many people to take time off of their work. The causes can include:

  • Overstretching or tearing of the ligament from improper lifting

  • Decreased durability of the shock-absorbing spinal disc due to ageing and normal wear and tear

  • Muscle tightness due to prolonged periods of improper posture.

Depending on the reason, causes, and severity, the treatment will vary. Your physician will recommend conservative treatments in the beginning, like physical therapy and medications to reduce inflammation. If it is not relieved, then surgery amy be advised.

2. Spinal stenosis

As you age, deterioration of the vertebrae causes the spine to narrow, causing pressure on the nerves. This can happen with arthritis, spinal injuries, and fractures, potentially leading to spinal stenosis.

It can happen insidiously and causes pain in the lower back, described as a burning or tingling sensation that radiates to the buttocks and legs. If the right side area is affected, pain is located on the same side and spreads down to the lower limbs.

With this condition, physical therapy is the first-line treatment. A back brace and pain relief medications may also be prescribed. Surgery is done in some cases to create more space on the spinal canal and alleviate the pressure on your spinal cord or nerve roots.

3. Lumbar radiculopathy

Another term for lumbar radiculopathy is a pinched nerve in your lower back, more commonly known as sciatica.[3] It is usually because of a herniated disc or bone spurs. The usual complaints are pain and numbness from the back to the leg.

Physical therapy is an excellent treatment for this condition to increase core and lower limb strength, flexibility, and stability. These are important to either delay or hinder potential surgery. In some cases, massage therapy and acupuncture are helpful.

4. Intervertebral disc disease

Discs provide cushioning on your vertebrae and act as a shock absorber for the back. When it degenerates, the bones rub together and cause bone spurs to form, leading to more pressure on the spinal cord and nerve roots.

The initial symptom of degenerative disc disease is back pain, and if it gets worse, weakness or numbness. Some people experience incontinence, which occurs when the impingement is severe. In these circumstances, seek urgent care.

Treatments like physical therapy and pain relief medications are recommended. In severe cases, surgery is imperative to remove and replace the affected disc.

5. Kidney Problems

The kidneys are on both sides of the spine under the rib cage. Due to the different sizes of the lung and the presence of the stomach, the right kidney hangs a little lower than the left, making it more likely to cause pain in the back if it has issues.

Kidney Stones

Kidney stones are pebble-like and solid structures that accumulate and lodge into your ureter. These are generally from minerals and salts found in the urine and can cause pain in the lower abdomen, the groin, and the back.

Most of the time, kidney stone pain is intermittent and felt when it moves. Other symptoms are painful urination, urgency incontinence, difficulty emptying the bladder, and only producing a small amount of urine.[4] Appearance may look bloody secondary to the stones injuring the tissue of the ureter.

For treatment, the physician may suggest the following:

  • Medication to help relax the ureter to let the stone smoothly pass and be voided

  • Short wave lithotripsy, using ultrasound or X-ray guided shock waves to break the stones

  • Surgical procedures to pulverise or remove the stone.

Kidney Infection

Bacteria is the common cause of kidney infections, especially E.coli. As this is present in the digestive system, you will have a urinary tract infection if it is present in another organ, like the kidneys. Symptoms are pain, burning urination, urgent need to urinate, and urine appearing cloudy, dark, and foul-smelling.

In the natural course of kidney infections, symptoms include fever, chills, nausea, and vomiting.

If left untreated, permanent kidney damage is life-threatening, and it is best to go to a doctor to get the proper treatment.

6. Appendicitis

The appendix is a small tube attached to the large intestine, located at the lower right side of the abdomen. The inflammation can happen by underlying conditions of infection, fecaliths (stones made of up feces), and tumours.[5] These are common in people aged 10 to 30 years old.

Tenderness begins near the navel when the appendix swells, and pain can extend to the back and groin. It can worsen with movement and pressing the tender area near the right hip. Other symptoms include nausea and vomiting. If you are experiencing these symptoms, immediately contact the emergency services.

If left untreated, it can burst and infect surrounding areas of the abdomen and be a life-threatening situation. Therefore, conventional treatment like removing the appendix is called an appendectomy. Another method is laparoscopic surgery in uncomplicated cases, and it is possible to treat it with antibiotics, especially when an infection is involved.

7. Abdominal aortic aneurysm

The abdominal aorta is the largest blood vessel in the body and is located in the abdomen. If an aneurysm develops in this area, it could lead to bleeding complications and can be life-threatening.[6] When this bulges abnormally, it is vital to seek medical attention immediately.

The main symptom is severe abdominal pain, with lower back pain. If this bursts, you will feel dizziness, shortness of breath, and fainting. Treatment for the abdominal aortic aneurysm involves placing a catheter, where a tube or graft is placed at the aneurysm site to prevent rupture. In dire situations, surgery is needed to remove the affected aorta and is replaced with a graft.

8. Causes specific to women

- Endometriosis

Endometriosis is a chronic condition where tissues on the uterus lining, called the endometrial tissue, grow outside the uterus. If the tissues grow on other sites of the reproductive system like the ovaries, it can disrupt their function.

It can cause cramp-like pain from the front and side of the body to the back. Typically, treatments like hormonal therapy, such as low-dose birth control pills, is a method to cease its growth. In addition, laparoscopic surgery is done to remove the growth.

- Pregnancy: First trimester

It is common for women to experience low back pain throughout pregnancy. It can begin as early as conception because of the secretion of the hormone “relaxin”, which helps lose the ligaments, especially in your pelvis, to prepare for delivery.

Furthermore, it is essential to note that low back pain is also a symptom of miscarriage, especially if it is accompanied by cramping and spotting. From this, you have to talk with your doctor as soon as possible.

Mild discomfort is relieved with gentle stretches, warm baths, wearing low-heeled shoes, massage, and acetaminophen. Be reminded that if you are taking any medications, ask your obstetric physician if you can.

- Pregnancy: Second and third trimester

As your uterus expands for the growing baby, changes in your walking and posture become apparent and cause lower back pain. Depending on the location of the baby and your walking, the pain may be present only on the right side.

Another possibility of pain involves ligaments, which are fibrous connective tissues that help support your uterus, and in pregnancy, these can stretch. As this elongates, nerve fibres on the right side of the body cause intermittent sharp and stabbing pains.

Urinary tract infections can be painful and cause lower right side pain inthe back and can lead to complications if left unaddressed. Therefore, be mindful of symptoms such as burning urination, abdominal discomfort, and cloudy urine.

9. Causes in Men

Testicular torsion is when your spermatic cord in your scrotum, providing blood to your testes, is twisted. It can cause pain on the right side of the lower back, severely impeding the blood flow in your testicle.

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 or your scrotum, and nausea and vomiting. Therefore, surgery is imperative to untwist the spermatic cord to save the testicle.

Self-care for lower back pain on the left side

In many cases, home treatments and lifestyle modifications are solutions to lower back pain.

  • Apply ice or heat for 20 to 30 minutes, every 2 to 3 hours, to reduce pain and inflammation.

  • Take over-the-counter painkillers like ibuprofen (Advil, Mortin) or acetaminophen (Tylenol) with your doctor’s guidance.

  • Drink eight glasses of water every day, and reduce the intake of animal protein and salt. This can decrease the development of kidney stones or urinary tract infections.

  • Practice proper body mechanics in lifting, and to do this, bend your knees in a squat position and hold the load close to your body.

  • Spend a few minutes everyday stretching any tight muscles

When to call a doctor

When you feel intense pain that does not seem to go away in any position and you feel disrupted in your everyday tasks, consult your doctor to help you identify what is going on.

Is it a medical emergency?

In most cases, right side low back pain does not need emergency services. Meanwhile, it is best to see the doctor for these concerns:

  • When you are having difficulty peeing or defecating

  • Having severe and abrupt pain, weakness or loss of sensation in the lower body

  • Have a pain accompanied by a fever, clammy skin, a rapid heart rate, nausea, vomiting, and any other concerning symptoms.

Treatment in an emergency

Treatment for severe cases is dependent on how it happened. If it is not visible, imaging and screening are done:

  • Magnetic resonance imaging (to see the spinal cord, nerve roots, and other soft tissues)

  • X-ray (to look at your spine and other joints for signs of fracture and other concerns) and blood tests (infection).

If it is because of muscle or nerve problems, interventions are given, like epidural injections of corticosteroids.

If appendicitis is untreatable with antibiotics, removal of the appendix through surgery is permitted. For those with an abdominal aortic aneurysm, repairing the aorta or removing the damaged tissue may be done with open abdominal surgery or endovascular surgery.

If the abdominal aortic aneurysm is smaller than 5.5 centimetres in width, your health providers will be able to monitor it in the meantime. If it comes to the point that it bursts, procedures should be done as soon as possible to avoid a potentially life-threatening result.

The bottom line

In many cases, lower back pain on the right side of the low back is caused by a pulled muscle or other injuries to the back. It is also due to many different conditions:

  • Nerve compression in your spine

  • Disc degeneration

  • Kidney disease

  • An abdominal aortic aneurysm

  • Appendicitis

Do not ignore the symptoms, especially if they are severe and accompanied by other concerning symptoms. Be sure to talk with your doctor about it.

Written by Jamie Page
Physiotherapist, Salford University
Published on July 21, 2022
Medically reviewed by Dr Gina Arena
Research Fellow, University of Western Australia
Reviewed on July 21, 2022
Medical reviewers
Last medically reviewed on July 21, 2022
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