Lower Right Back Pain: Causes and Treatment

Lower right back pain has many potential causes. Muscles, bones, discs, spinal nerves, internal organs, or underlying illness can directly or indirectly cause lower back pain.

Common causes of lower back pain on the right side only can be minor problems like a pulled muscle or a misaligned spine. Lower right back pain can also indicate more urgent conditions, like kidney stones or spinal stenosis. 

While dealing with any type of back pain is frustrating, pain in your lower right back is usually not serious and can be treated at home. Severe or ongoing pain should be evaluated by a healthcare professional.

This article explores the potential causes of lower right back pain. It also details when to seek medical help and how lower right back pain is diagnosed and treated.

Causes of Lower Right Back Pain

Most causes of lower back pain involve the bones and muscles that move the spinal column. Neurological causes can involve the lumbar nerve roots.

Although uncommon, other underlying health problems sometimes cause right-sided back pain. Even though you may feel pain in the lower back, the problem may actually be located elsewhere in your body.

Muscle and Tissue

Most back pain is caused by injury to the muscles or ligaments. These injuries can happen suddenly, such as during a car accident, or over time as a result of poor posture.

Muscle Strain

Muscle strains are the most common causes of lower back pain. This is because you use your lower back for a lot of 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/or muscle spasm
• Difficulty standing or sitting up straight

The pain from muscle strain can be treated with non-steroidal anti-inflammatory medications (NSAIDs) and using cold packs on the area for 15 minutes at a time. Although medical professionals used to recommend rest, now the importance of keeping the muscles moving is 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 is also similar to muscle strain, and may involve physical therapy as well.

Spine and Joint

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 and create 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 for spinal stenosis can include surgery called a laminectomy, which 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. Ankylosing spondylitis is a progressive, debilitating disease that can cause parts of the spine to fuse together. Symptoms include spinal stiffness, pain, and immobility.

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.

For about 90% of herniated discs, the pain goes away on its own within six months. Physical therapy is often prescribed for disc herniations. 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 of scoliosis depends on the severity of the curvature. 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 for spinal cysts and tumors vary from physical therapy and pain-relieving injections to 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. 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.

Facet joints are often where bone spurs develop. 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.

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
  

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

Internal Organs

Your internal organs such as your kidneys and appendix can sometimes cause pain that radiates to your lower back. Conditions that might cause this include:

Kidney Stones

Kidney stones are a common cause of non-spine-related back pain. Even a small 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.

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.

Most gallstones are treated with the removal of the gallbladder during surgery. Non-surgical management like medication or a procedure using endoscopy is unusual, and usually must be repeated with every instance of gallstones.

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. 

Surgery is required to prevent potentially life-threatening complications like infection.

Female-Related Pain

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. 

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 for endometriosis can include pain relieving agents like NSAIDs, hormonal treatments like birth control, and sometimes surgery.

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.

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

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 strain on your back muscles, especially if you find yourself leaning backwards to compensate. 

Back pain from pregnancy usually resolves after delivery. Pain can be managed safely with Tylenol (acetaminophen).

Male-Related Pain

Conditions that only affect males can also cause lower back pain.

Testicular Torsion

Testicular torsion happens when a testical twists in an abnormal way, blocking the supply of blood. 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

Testicular torsion is an emergency. If you have any of these symptoms, seek medical care right away. Surgery can repair testicular torsion.

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 in the spine. This may involve an X-ray of the spine or 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 detect soft tissue damage better.

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

Treatment

Right-sided low back pain treatment can differ based on the underlying cause. If the cause is related to a systemic illness, efforts will be focused on resolving the underlying condition first and foremost.

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

• Nonsteroidal anti-inflammatory drugs (NSAIDs) 
• Prescription opioid drugs
• Physical therapy
• Chiropractic or osteopathic manipulation
• Epidural steroid injections
• Surgery
  

Summary

Right-sided lower back pain may be caused by muscle and ligament injuries, spine and joint problems, or conditions of the bone. Lower back pain 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. 

The diagnosis of lower back pain involves a physical exam and a review of your medical history as well as imaging tests 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.