Pain in the right side of the chest or abdomen, that is, in the flank, can have various causes. Its intensity, characteristics, and accompanying symptoms offer valuable clues about its severity and the need to see a doctor.
Pain in the right side can be caused by multiple diseases, so “accurate diagnosis is a major challenge for the doctor,” says Jonatan Miguel-Carrera, a member of the Emergency and Urgent Care Working Group of the Spanish Society of General and Family Physicians ( SEMG ).
The first step is to define what is meant by the right side. The word “side,” which comes from the Latin ” costatus ” (having ribs), refers, according to the dictionary of the Royal Spanish Academy, to “each of the two lateral parts of the human body located between the chest, back, armpits, and flanks.” It therefore implies “anatomical regions of the thorax and abdomen ,” explains Miguel-Carrera.
The causes of pain in these areas of the body can range from “minor to extremely serious, or even life-threatening .” Therefore, according to the family doctor, “a proper evaluation by a physician is of paramount importance.”
Types of chest and abdominal pain on the right side
Depending on the characteristics of the pain in the right side, the doctor can assess its possible origin and severity.
Pleuritic pain
It increases with respiratory movements and is generally due to pleuropulmonary pathology. “It is typical of, among other things, pneumothorax, which is the presence of air between the two layers of the pleura, and dyspnea (difficulty breathing ) is a very common accompanying symptom,” explains Miguel-Carrera. Pleuritic pain can also be present in pneumonia; in this case, it is generally accompanied by fever, cough, and sputum production. It can also appear in pulmonary thromboembolism, which is the blockage of a blood vessel that carries blood from the heart to the lungs. “This condition is sometimes associated with cough, fatigue, dizziness, syncope, and a slightly elevated body temperature,” clarifies the SEMG physician, who emphasizes that “these types of pathologies should always be evaluated by a doctor” and, if they are associated with alarming symptoms such as respiratory distress, dizziness, or syncope, “they will be considered a medical emergency requiring urgent attention (call 112).”
Mechanical pain
It’s typical of trauma; it changes with movement and improves with rest. Depending on the mechanism and energy of the impact, treatment could be delayed or urgent. “However, we must point out that rib fractures from minor trauma are not uncommon in elderly people or those with risk factors for osteoporosis, ” notes Miguel-Carrera.
Visceral pain
It is a more diffuse pain, not aggravated by movement, sometimes associated with nausea and vomiting. “Since the liver and gallbladder are located in the upper abdomen, behind the last ribs, we could find pathologies specific to these organs in this area, such as cholecystitis, biliary colic, cholangitis, or acute hepatitis ,” explains the SEMG expert.
Pain in the lower and posterior region of the right side
It is a pain located in the kidneys. “ Renal colic is a frequent reason for consultation ; it is a pain caused by a kidney stone passing from the kidney into the urinary tract,” explains Miguel-Carrera. This pain is sharp, stabbing, paroxysmal, radiates to the groin, is not affected by movement, and is generally associated with nausea and paleness. Acute pyelonephritis, a bacterial infection frequently associated with fever and chills, also affects the kidneys . Both suspected renal colic and suspected pyelonephritis are considered medical emergencies.
Neuropathic pain
It is burning, often with a very sharp component . It causes hyperalgesia (increased sensation of pain) and allodynia (pain in response to stimuli that would not normally cause pain). “It is characteristic of pathologies such as herpes zoster, which is an infection caused by the reactivation of the varicella-zoster virus; in this case, the pain usually precedes the appearance of the rash with vesicles by 2-3 days,” explains the family doctor. “If herpes zoster is suspected, you should seek medical attention urgently, as the benefit of treatment depends on the time elapsed since the onset of symptoms ,” advises Miguel-Carrera.
Ischemic chest pain
Although it doesn’t strictly affect the right side, the SEMG expert considers it pertinent to mention ischemic chest pain due to its severity. “It usually affects the central area of the chest, the left side of the thorax, or the epigastric region,” he notes. It can radiate to the neck, left shoulder, jaw, and sometimes even to both shoulders and wrists , which is why it can sometimes be very difficult for the patient to describe. “It’s an oppressive, squeezing pain, sometimes associated with nausea, sweating, paleness, or shortness of breath.” It is typical of heart conditions such as angina or a heart attack. “The presence of pain with these characteristics is considered a medical emergency, and anyone experiencing it should seek urgent medical attention, generally through the emergency medical services coordination center (Telephone 112),” Carrera assures.
Other possible causes
Salvador Casado , a family doctor at the Collado Villalba Health Center in Madrid, adds other possible causes of pain in the right side:
Adrenal gland tumors .
Kidney tumors.
Large intestine tumors.
Ovarian tumors or cysts .
Appendicitis .
Abdominal wall pain.
Flatulence or gas .
Diagnosis
To determine what the problem is, Francisco Camarelles, a member of the Spanish Society of Family and Community Medicine (Semfyc), points out that doctors always ask three things to find out the origin of the ailments:
How long has the pain been going on?
What other accompanying symptoms?
What does the patient attribute the pain to?
“In the case of rib pain, it is necessary to ask if there is a cough, fever, if the patient has been hit in the area, if there is a feeling of shortness of breath or if there are skin lesions,” he summarizes.
Casado adds that “ it is acceptable for the patient to use some pain reliever at home or apply gentle heat , depending on whether the discomfort is similar to other discomforts or not very intense. In most cases, the discomfort will subside on its own.”
Warning signs that indicate a need to go to the emergency room
“Intense pain is a reason to seek urgent medical attention,” Carrera emphasizes. But there are also other symptoms that, when associated with pain, could also indicate the severity of the condition, such as the following:
Fever .
Expectoration:
Pleuritic pain .
Nausea and vomiting.
“ The presence of other symptoms associated with pain, such as hemoptysis (blood in the sputum), shortness of breath, tachypnea (rapid and shallow breathing), dizziness, syncope (loss of consciousness) or the suspicion of ischemic pain, could be considered medical emergencies and it would be advisable to call the health emergency coordination center (Telephone 112),” recommends the family doctor from the SEMG.
