Right-sided abdominal pain: causes, red flags and when to get it checked

Abdominal pain is described by its location because different organs lie in each region. The right side is a common site for two surgical problems, appendicitis and gallbladder disease, so their patterns are worth knowing. Many other causes are less urgent but still need identifying.

• Constipation, trapped wind and irritable bowel syndrome: cramping, relieved by passing wind or stool, with no fever.

• Gastroenteritis: cramps with diarrhoea and vomiting, usually settling within days.

• Urinary tract infection and kidney stones: pain on passing urine, or severe colicky flank pain with blood in the urine.

• Appendicitis: central pain moving to the lower right within hours, with nausea, loss of appetite, low fever and pain on coughing or walking.

• Gallstones and cholecystitis: upper right pain after fatty meals, lasting hours; with fever and persistent pain in cholecystitis.

• In women: ovarian cyst, endometriosis, pelvic inflammatory disease, and ectopic pregnancy.

• Crohn disease affecting the terminal ileum, with long-standing pain, diarrhoea and weight loss; hernias; shingles before the rash.

• Liver conditions such as hepatitis or a liver abscess, and cancers of the bowel or appendix, which are less common.

Pain that is constant and worsening, fever, vomiting, a rigid or very tender abdomen, pain that worsens with movement or coughing, yellowing of the skin, blood in stool or urine, a possible pregnancy with severe one-sided pain and bleeding, or a swollen hard abdomen are red flags.

• Call 999: severe abdominal pain with collapse, a rigid abdomen, vomiting blood or heavy vaginal bleeding with pain and dizziness.

• A&E or same-day GP: pain moving to the lower right with fever, vomiting or loss of appetite; severe one-sided pain with missed period.

• Same-day GP or NHS 111: pain with yellowing of skin, high fever or persistent vomiting.

• GP within days: recurrent right-sided cramps with bowel changes or weight loss.

The doctor asks when pain began, where it started and moved, its character, what eases or worsens it, nausea, bowel and urinary changes, fever, periods, sexual history, medicines and past surgery. They gently examine for tenderness, guarding, rebound and masses, and check for jaundice and hernias.

• Urine dipstick and pregnancy test where relevant.

• Blood tests: full blood count, CRP, liver tests and amylase.

• Abdominal ultrasound: for gallstones, appendix in some cases, and for the ovaries and kidneys.

• CT abdomen and pelvis: the most accurate scan for appendicitis and many other causes.

• Colonoscopy or calprotectin: for suspected bowel disease with persistent symptoms.

For mild, short-lived cramping, rest, warmth and fluids help, and gentle movement can ease trapped wind. Avoid eating heavily if pain is worsening and avoid painkillers that could mask a surgical problem while seeking assessment. If the pain is constant and escalating, do not wait.

The NHS route is a GP or urgent care, with A&E for severe pain and a surgical referral where needed. Private hospitals offer same-day ultrasound and CT, but emergency features need 999 or A&E.