Lower Right Back Pain: Causes and Treatment

Lower right back pain can be caused by pain from bones, muscles, joints, intestinal issues, kidneys, reproductive organs, intestinal conditions, and several additional causes.

Conditions causing lower right back pain are divided into three different categories:

  • Mechanical and structural problems (e.g., sprains and strains)
  • Inflammatory conditions (e.g., arthritis)
  • Other medical conditions (e.g., kidney infection or endometriosis)

Many causes of lower right back pain respond well to home treatment. However, if the pain is severe, ongoing, or accompanied by other signs and symptoms, more serious conditions should be ruled out. Your healthcare provider can perform an exam and diagnostics to determine a course of treatment and hopefully relieve your pain.

A woman holding her back in pain at the beach
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Causes of Lower Right Back Pain

Causes of lower right back pain are either:

Mechanical and structural conditions: Muscles, ligaments, tendons, bones, discs, and your spine are all mechanical and structural body parts that may cause lower right back pain if injured.

Inflammatory conditions: Conditions that cause arthritis, such as ankylosing spondylitis, can cause lower back pain.

Other medical conditions: Different conditions that can cause pain in the lower right back include, but are not limited to, kidney stones or infections, endometriosis, inflammatory bowel disease, infections, and tumors.

It is also possible to have a combination of these conditions contributing to your lower right back pain.

It can be challenging to determine whether your lower right back pain is caused by muscle or organ pain. If you recently did heavy lifting, started a new exercise program, or injured the area, a muscle or ligament injury is more likely. If your pain is more localized, you didn't recently injure yourself, and your daily routine stayed consistent, then organ pain may be more likely.

Muscles and Ligaments

Most back pain in the right side of the lower back is caused by muscle or ligament injuries. Muscle and tissue injuries can happen suddenly, such as during a car accident or lifting something heavy, over time, or due to poor posture.

Muscle Strain

Muscle strains are the most common cause of lower back pain. This is because your lower back is used for many different movements, such as bending and twisting. When you overuse your back muscles or experience a sudden injury, it can cause lower back pain. 

Muscle strains in the lower back cause pain that does not usually radiate to your legs. Other symptoms can include:

  • Reduced range of motion
  • Stiffness and muscle spasm
  • Difficulty standing or sitting up straight

Treatment: Pain from muscle strain can be treated with non-steroidal anti-inflammatory medications (NSAIDs) and cold packs applied to the area for 15 minutes at a time. Although medical professionals used to recommend rest, the importance of keeping the muscles moving is now emphasized.

Ligament Injuries

A ligament injury in the lower back is called a lower back sprain. Sprains happen when you stretch or tear a ligament, one of the thick bands of tissue that connects bones to other bones, muscles, cartilage, and tendons. People often injure back ligaments during falls, sporting accidents, or car accidents. Poor posture can also damage your ligaments over time. 

The symptoms of a lower back ligament injury are similar to those of a lower back muscle strain.

Treatment: Similar to a muscle strain, NSAIDs and ice can help relieve pain and swelling. Ligament injuries may also benefit from physical therapy.

Spine and Joints

Conditions of the spine and joints in the back can also lead to lower back pain. Some of these conditions include:

Spinal Stenosis

Spinal stenosis occurs when the spaces between the spinal vertebra narrow, creating pressure on the spinal cord and nerve roots. When it occurs in the lumbar spine, it can cause lower back pain on one or both sides. 

Pain from spinal stenosis is often described as a burning ache or pain. It may radiate down the buttocks and into the leg.

Spinal stenosis pain is typically worse when standing or walking and is relieved by leaning forward. It can also cause numbness, tingling, weakness, or cramping in the feet and legs. Symptoms are more pronounced when standing or walking.

Treatment: A surgical procedure called a laminectomy is the treatment for spinal stenosis. The procedure involves removing bony spurs to open up the spinal column.

Sacroiliac Joint Disorders

The sacroiliac (SI) joint connects the pelvis to the sacrum, the triangular bone between the lower spine and tailbone. The locking or abnormal movement of these joints (due to trauma or other causes) can lead to back pain and referred pain.

Sacroiliac pain may also be caused by a form of arthritis called ankylosing spondylitis. This progressive inflammatory condition can cause parts of the spine to fuse together, resulting in spinal stiffness, pain, and immobility.

Treatment: Although there is no cure for ankylosing spondylitis, treatment options like physical therapy and pain relievers can help manage symptoms day to day.

Herniated Disc

A herniated disc occurs when the shock-absorbing cushion between two adjacent vertebrae (spinal bones) bulges or ruptures. In many cases, a soft, liquid-like substance inside the disc can leak out.

Should the substance come into contact with a nerve root, it can "short circuit" electrical signals and trigger symptoms of a type of nerve pain called radiculopathy (typically on one side of the body).

Symptoms of radiculopathy include pain, weakness, numbness, or a pins-and-needles sensation that runs down one leg. There may also be cramping and discomfort while walking.

Treatment: For about 90% of herniated discs, the pain goes away on its own within six months. Physical therapy is often prescribed for disc herniations, and a six-week course of therapy is typical. If conservative strategies aren't effective, surgery may be suggested.

Scoliosis

Scoliosis is the abnormal curvature of the spine that causes it to have an "S" or "C" shape. The abnormal curve can cause muscles to be tight and overstretched on one section of the spine and compressed on another.

Low back pain is common in adults with scoliosis and is often unilateral (occurring on only one side). Sciatica and muscle spasms are also common.

Treatment: Typically, the severity of the curvature guides the treatment plan. Some instances may simply be observed over time. Using a brace can slow or stop the curvature of the spine. More severe cases may require surgery.

Spinal Cysts and Tumors

Two potentially serious causes of back pain are spinal cysts and tumors. Cysts develop due to degenerative changes in the spine, while tumors can develop due to changes in cells.

A spinal cyst can press on a nerve root that goes to a different area of the body. This pressure can cause radiculopathy.

Spinal tumors, either cancerous or non-cancerous, can press on the spinal cord itself. Symptoms include back pain that radiates (spreads) to other areas, known as referred pain. There may also be muscle weakness, difficulty walking, decreased sensitivity to pain, and bowel or bladder incontinence.

Treatment: There are several treatment options, including physical therapy, pain-relieving injections, or surgical removal. In cancerous tumors, the cancer may also be treated with surgery, chemotherapy, or radiation.

Cauda Equina Syndrome

Cauda equina syndrome is a rare but serious condition that occurs when nerve roots in the lumbar spine are compressed, disrupting the function of the bladder, bowel, and legs. Causes include spinal trauma, tumors, infection, and spinal birth defects.

Symptoms of cauda equina syndrome may include severe low back pain, sciatica, leg numbness, an inability to urinate, bowel incontinence, sexual dysfunction, and the loss of reflexes in the legs.

Treatment: Immediate surgery is generally advised.

Bone

The bones themselves can also cause pain in the lower back. You might be experiencing this kind of pain because of a condition like bone spurs or because of a fracture.

Bone Spurs

Facet joints are interconnecting joints located at the back of the spine. Collectively, they give the spine its integrity by limiting spinal movement. Each spinal level has a right and left facet joint.

Bone spurs often develop at facet joints. These abnormal bone growths may be triggered by arthritis, previous trauma, or other causes.

When spurs develop on a right facet joint, they cause right-sided pain. Other symptoms include leg weakness, numbness, tingling, and electrical sensations that shoot down one leg.

Treatment: Bone spurs can be removed surgically if necessary. This relieves pressure on the nerves.

Fractures

A fracture of the spine can happen during an accident, such as a fall or a car crash. Many of these injuries require emergency medical attention. When your lumbar spine is fractured, you may experience:

  • Moderate to severe pain that gets worse when you move
  • Numbness, tingling, and weakness in the limbs
  • A change in posture
  • Difficulty walking
  • Bowel and bladder problems

Treatment: Compression fractures may not require treatment. However, other types of spinal fractures often require surgical intervention.

Ankylosing Spondylitis

A form of arthritis called ankylosing spondylitis is the main inflammatory condition that directly affects the lower back. This progressive condition can cause parts of the spine to fuse, resulting in spinal stiffness, pain, and immobility.

Treatment: Although there is no cure for ankylosing spondylitis, treatment options like physical therapy and pain relievers can help manage symptoms day to day.

Other Medical Conditions

Conditions affecting internal organs, such as the kidneys and appendix, can sometimes cause pain that radiates to the lower back.

Kidney Issues

Lower right back pain can be related to the kidneys. A kidney infection, known as pyelonephritis and kidney stones, can cause pain on either side of the lower back. If a kidney infection is the cause of your lower back pain, you will likely have additional symptoms such as a fever, chills, and pain or frequency with peeing.

Kidney stones are another common kidney-related cause of non-spine-related back pain. Even a tiny kidney stone can be painful as it passes through the urinary tract.

Due to the location of the kidneys, pain from kidney stones may be felt deep within the left or right side of the back, depending on which kidney is involved. The pain will typically be sharp. There may also be lower abdominal pain, pain with urination, and nausea or vomiting.

Treatment: A kidney infection requires antibiotics. If you believe you have a kidney infection, seek medical care, as the infection can spread and become serious quickly.

Kidney stones are often managed through pain relief and waiting for the stone to pass. If a kidney stone is too large to pass, it can be broken up into smaller fragments using a procedure called shock wave lithotripsy. Surgery may also be an option.

Gallstones

Gallstones can also cause right-sided back pain due to the location of the gall bladder just under the liver on the right side of the body.

In addition, gallstones can cause sudden and intense pain in the upper abdomen, beneath the breastbone, between the shoulder blades, and in the right shoulder. Nausea or vomiting are also common.

Treatment: Most gallstones are treated by removing the gallbladder. Non-surgical management, like medication or an endoscopy procedure, is usually less effective since it needs to be repeated during subsequent episodes.

Appendicitis

Appendicitis can sometimes cause back pain. The pain from an inflamed appendix typically begins near the belly button and then moves to the lower right side of the abdomen. It can occasionally also radiate to the right side of the back. 

Treatment: Surgery to remove the appendix is required to prevent potentially life-threatening complications like infection.

Irritable Bowel Disease

While irritable bowel disease (IBD) primarily affects the bowels, one symptom of the condition is lower back pain. Some individuals with IBD develop a condition called sacroiliitis, which is inflammation of the sacroiliac joints.

The sacroiliac joints connect the pelvis to the lower spine, and pain can be felt on one or both sides.

Treatment: Treatment for sacroiliitis overlaps with therapy for IBD and may include a type of medication known as biologics. In some cases, surgery may be necessary, and joint fusions may help relieve some of the pain.

Abdominal Aortic Aneurysm

Abdominal aortic aneurysms are often asymptomatic. However, one of their symptoms is low back and hip pain. Typically, there are other risk factors, such as high blood pressure, heart disease, or being a male 65 years and older.

Treatment: Abdominal aortic aneurysms require surgical intervention for treatment. If they rupture, they are a medical emergency.

Gynecological Conditions

Some conditions that only affect females can cause pain in the lower right side of the back. These include:

Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease occurs when the female reproductive organs become infected, usually by a sexually transmitted bacteria. PID can cause pain in the lower abdomen that radiates to your lower back, buttocks, and thighs. 

Treatment: Antibiotics are the most common treatment for PID.

Endometriosis

Endometriosis occurs when the tissue that usually lines the uterus grows outside of the uterus. When it grows near the lower back, it can cause pain. 

Endometrial tissue in the lower back can compress nerves and cause inflammation. If you have endometriosis, you may also experience symptoms such as:

  • Painful menstruation
  • Bleeding between periods
  • Chronic abdominal pain
  • Painful bowel movements
  • Pain during and/or after sexual intercourse
  • Gastrointestinal symptoms such as diarrhea and bloating
  • Infertility

Treatment: Pain-relieving agents like NSAIDs, hormonal treatments like birth control, and sometimes surgery are all used to alleviate pain caused by endometriosis.

Uterine Fibroids

A uterine fibroid is a benign (non-cancerous) growth that occurs on or inside the uterus. Fibroids most often cause pelvic discomfort, but when they press on the muscles and nerves in the lower back they can also lead to back pain. 

Pain from fibroids can be treated with over-the-counter medications. Fibroids that cause other problems like severe pain or heavy menstrual bleeding might require treatment with uterine fibroid embolization (UFE), a procedure that cuts off the blood supply to the fibroid causing it to shrink.

Treatment: Myomectomy (the removal of a fibroid) or hysterectomy (the removal of the uterus) are surgical options to treat fibroids.

Menstrual Disorders

Hormone-like substances your body releases during your menstrual cycle can affect the muscles in your lower back. This can lead to lower back pain during menstruation.

Menstrual disorders such as premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are also associated with lower back pain in females. 

Treatment: Painful periods can be treated with over-the-counter medications. Hormonal birth control can also help manage painful periods.

Ovarian Tumors or Cysts

Pain from an ovarian cyst or tumor will likely cause abdominal or pelvic pain. However, the pain may also be felt in the lower back. If the tumor or cyst is on the right ovary, the pain may be felt in the lower right back.

Treatment: Low back pain caused by an ovarian tumor or cyst depends on the underlying cause. If the pain is due to a cyst, your provider may choose to watch the cyst for some time or remove it.

If the pain is due to an ovarian tumor, treatment will depend on several factors and may include surgical removal and cancer therapies such as chemotherapy and radiation.

Pregnancy

Back pain is common during pregnancy. This kind of pain occurs due to certain changes that happen to your body when you're pregnant.

For example, hormones can cause your muscles to relax and your ligaments to loosen. As your pregnancy progresses, your center of gravity changes, causing your lower spine to move forward. This can put a strain on your back muscles, especially if you find yourself leaning backward to compensate. 

Treatment: Back pain from pregnancy usually resolves after delivery. Pain can often be managed with Tylenol (acetaminophen). Discuss safe medication use with your healthcare provider if you are pregnant.

Testicular Torsion

Testicular torsion happens when a testicle twists abnormally, blocking the blood supply. This condition causes sudden, severe pain in the groin that can radiate to the lower back. You may also experience:

  • Swelling in the scrotum
  • Nausea and vomiting

Treatment: Testicular torsion is an emergency. If you have any of these symptoms, seek medical care right away. Surgery can usually repair testicular torsion if it is caught quickly enough. In severe cases, testicular torsion results in surgical removal of the affected testicle.

Diagnosis

Diagnosing lower right back pain involves a physical exam and a review of your medical history. This may include a neurological exam to see if your reflexes are normal or to check for weaknesses or sensations that point to a nerve injury.

Based on the findings, your doctor may order imaging studies to look for abnormalities throughout your body. This may involve an X-ray of the spine or a computed tomography (CT) scan, in which multiple X-ray images are combined into a 3-D image. Magnetic resonance imaging (MRI) is another test that can better detect soft tissue damage.

A nerve conduction study, or electromyography, may also be ordered. This can show your doctor how well electrical signals are traveling through nerves.

Depending on your symptoms, additional bloodwork, imaging, or referral to a specialist may be necessary.

Treatment

Right-sided low back pain treatment differs depending on the underlying cause. If the cause is related to a systemic illness, efforts will be focused on resolving the underlying condition first.

Options for the treatment of lower back pain itself may include:

Red Flags for Lower Right Back Pain

There are several red flags for lower right back pain, including, but not limited to:

  • Pain that is sudden and severe
  • Pain associated with a significant injury (e.g., a fall or motor vehicle accident)
  • Pain that does not go away
  • Pain that wakes you up at night or keeps you awake
  • Difficulty walking or standing
  • Loss of bladder or bowel control
  • Loss of consciousness
  • Numbness or tingling in your pelvis or down your legs
  • Fever

These signs and symptoms point to the potential for more serious causes that require urgent treatment, such as cauda equina syndrome, appendicitis, or a kidney infection.

Summary

Muscle and ligament injuries, spine and joint problems, and bone conditions may cause right-sided lower back pain. It can also originate in internal organs such as the kidneys or the appendix. Certain conditions related to the female or male reproductive systems can also cause lower back pain. 

Diagnosing lower back pain may involve a physical exam, a medical history review, imaging tests, bloodwork, and nerve conduction studies if needed.

The treatment varies by the cause but may include prescription or over-the-counter painkillers, physical therapy, spinal manipulation, spinal steroid injections, and surgery.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Anne Asher, CPT
Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert.