Upper right abdominal pain – what’s causing it?

Have you noticed right sided abdominal pain? While it’s usually nothing to worry about, ask yourself these key questions to find out if it’s down to digestion, or something more serious.

What is your right upper abdomen? 

What can cause upper right abdominal pain?  

What else could it be?

When to see a doctor

How is RUQ pain diagnosed?

Whether it’s a dull cramp or a sharp, stabbing sensation, pain in your upper right abdomen can feel worrying. Read on to work out what might be the cause – and when to see your doctor. 


Having right side upper abdominal pain can be uncomfortable and worrying, as well as disrupting everyday life.  

Many conditions that can lead to right side upper abdominal pain are usually more common in women. 

“In the US, 25 million people have gallstones and 65% to 75% of those are women. Although gallstones may not cause any symptoms themselves, they can lead to pain and complications.  Acute cholecystitis (inflammation of the gallbladder) is 3 times more common in women than in men up to the age of 50,” says Dr Ann Nainan, family doctor and Healthily expert. 

Read on to find out why you might be getting upper right abdominal pain and when to see your doctor. 


## What is your right upper abdomen? 

Your abdomen is a pretty big place so when thinking about causes of pain doctors often divide it into 4 smaller areas – 1 of which is your right upper quadrant (RUQ). This area includes:

- your __gallbladder__ – a small, pouch-like organ which stores bile, a fluid that helps you digest fatty foods 
- part of your __pancreas__ – this organ helps you with digestion and lies across the top of your abdomen 
- most of your __liver__ – this major organ has hundreds of functions, including filtering your blood 
- your __bile ducts__ – these tubes pass bile from your liver and gallbladder 
- your right __kidney__ – it’s located just below your rib cage at the back of your abdomen behind the other organs


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## What can cause upper right abdominal pain?  

### Biliary colic 

#### What is it?

- __pain caused by gallstones__ – what happens is a gallstone gets stuck in one of your bile ducts causing sudden, severe abdominal pain 
- [gallstones](https://www.livehealthily.com/health-library/conditions/gallstones) are __small stones, usually made of cholesterol__, that form in your gallbladder – most of the time they don’t cause trouble or need treatment 
- you might notice the symptoms of biliary colic after you’ve eaten a __large, fatty meal__ 
- __biliary colic may not happen often__ – after having an episode, it could be weeks or months before it happens again 

#### Who’s at risk?

__Biliary colic affects more women than men__ because female hormones play a part in the development of gallstones. 

Estrogen increases cholesterol in your bile, while progesterone slows down the emptying of your gallbladder – __both of which make gallstones more likely to develop__.

#### How does it feel? 

- you might get __severe cramping or upper stomach pain that comes and goes in waves__, lasting from 1 to 5 hours – though sometimes it can last just a few minutes 
- you may feel the __pain just under your ribs on your right-hand side__. The pain may spread from here to your side or shoulder blade. You can also feel biliary colic pain in the centre of your abdomen 
- you might also __get nausea, vomiting and pain__ in your right shoulder or back 

#### How is it treated? 

You’ll normally be treated with painkillers and you might be given advice about following a healthy diet to help control pain. But if you’re in a lot of discomfort and often, you may need to have surgery to remove your gallbladder.

### Acute cholecystitis 

#### What is it?

- this is __inflammation of your gallbladder__ and again, it’s usually a complication of gallstones – but unlike biliary colic, cholecystitis needs immediate treatment in the hospital
- acute cholecystitis happens when there’s a __prolonged blockage of your gallbladder__, usually caused by gallstones 

#### Who’s at risk?

Women are 3 times more likely to get cholecystitis than men up to age 50 – after that it’s about 1.5 times more common in women than in men 

#### How does it feel? 

- you __may get a sudden, sharp upper abdominal pain__ in your right-hand side. The pain can spread to your right shoulder and the part of your abdomen that’s affected usually feels very tender. Unlike biliary colic, with cholecystitis the pain is also likely to be persistent and may not go away in a few hours. 
- Deep breathing can make the pain worse. __You may go off food, feel sick or vomit.__ You might also have a high temperature and feel generally unwell.

#### How women say cholecystitis feels

Julie says: “The pain radiating from my abdomen was worse than childbirth. [The pain] was so piercing I had to loosen my bra to breathe, and as I put the children to bed I had to grip a pillow to distract myself from the agony. I spent the night vomiting and in unrelenting pain.” 

#### How is it treated?
You’ll usually need to be treated in hospital with rest, intravenous fluids and [antibiotics](https://www.livehealthily.com/health-library/drugs/antibiotics-penicillins) – so if you’re worried you might have cholecystitis get checked out by your doctor straight away. 

Read more about other symptoms of [cholecystitis(https://www.livehealthily.com/health-library/conditions/acute-cholecystitis), how it’s diagnosed and treated, and how to prevent it.

### Liver problems 

#### What are they?

- although your liver doesn’t actually contain any nerves (so you can’t actually feel pain in your liver), the layer of tissue surrounding your liver does. So __any condition that causes your liver to become inflamed or swollen__ can cause a dull, aching or stabbing pain in your upper stomach.
- __this includes liver infections like hepatitis A or B__, [liver cancer](https://www.livehealthily.com/health-library/conditions/cancer-of-the-liver) or a liver abscess 
- [__alcoholic liver disease](https://www.livehealthily.com/health-library/conditions/liver-disease-alcoholic) and non-alcoholic liver disease can also cause abdominal pain__ in the upper right side, but most types of liver disease don’t cause any symptoms in the early stages

#### Who’s at risk?

You’re at greater risk of having a liver condition if you are: 
- [obese](https://www.livehealthily.com/health-library/conditions/obesity)
- have an undiagnosed [hepatitis infection](https://www.livehealthily.com/health-library/conditions/hepatitis) 
- [misuse alcohol](https://www.livehealthily.com/self-care/alcohol-misuse)

#### How liver problems are treated

- always see a doctor if you think your liver may be causing your pain
- conditions like hepatitis or a [liver abscess](https://www.livehealthily.com/health-library/conditions/liver-abscess) can be treated, but it’s important to act fast because they can permanently scar your liver if you don’t get them treated

### Preeclampsia

#### What is it?

This is a condition that affects around 1 in 25 pregnancies in the US, usually from around 20 weeks of pregnancy or soon after your baby is born. 

[Preeclampsia](https://www.livehealthily.com/health-library/conditions/pre-eclampsia) can affect your heart and other organs such as your liver, lungs and kidneys, plus can affect the supply of blood to your placenta. 

#### Who’s at risk?

The risk factors include having [__high blood pressure__](https://www.livehealthily.com/health-library/conditions/blood-pressure-high), having had __preeclampsia in a previous pregnancy__, having a __family history of preeclampsia__, being __over the age of 40__ and __obesity__.

#### How does it feel?

- signs include __pain in your upper right abdomen__, usually just under your ribs 
- it can be easy to confuse this pain with [heartburn](https://www.livehealthily.com/health-library/conditions/gastroesophageal-reflux-disease), [indigestion](https://www.livehealthily.com/health-library/conditions/indigestion), gallbladder problems, [flu](https://www.livehealthily.com/health-library/conditions/flu), or pain from your baby kicking

#### How it’s treated

- if you get this kind of abdominal pain during pregnancy you should __call your doctor or go to the emergency room immediately__
- __treatment depends on the stage of your pregnancy and how severe your preeclampsia is__ – if your baby isn’t fully developed yet and you have mild preeclampsia, it’s possible this can be managed at home with regular check-ups with your doctor and, possibly, blood pressure-lowering medication. If your case is more severe, you might need to stay in the hospital for monitoring and treatment. 
- __it’s possible your baby will need to be delivered early__, usually at around 37 to 38 weeks, but this can sometimes be earlier if you become more unwell.

## What else could it be?

Other causes of pain in the right upper abdomen, which can also affect other areas of the abdomen include:
- [shingles](https://www.livehealthily.com/health-library/conditions/shingles)
- muscle pain
- nerve pain from a spinal problem
- referred pain from a problem somewhere else in the abdomen

Although more often associated with pain in other areas of your abdomen or other places on your body, some conditions can also sometimes cause pain to be felt in the upper right abdomen, including:
- [kidney stones](https://www.livehealthily.com/health-library/conditions/kidney-stones)
- [kidney infection (pyelonephritis)](https://www.livehealthily.com/health-library/conditions/kidney-infection)
- [indigestion](https://www.livehealthily.com/health-library/conditions/indigestion)
- [gastritis](https://www.livehealthily.com/health-library/conditions/gastritis)
- [diverticular disease](https://www.livehealthily.com/health-library/conditions/diverticular-disease-and-diverticulitis)
- [stomach ulcer](https://www.livehealthily.com/health-library/conditions/peptic-ulcer)
- [pneumonia](https://www.livehealthily.com/health-library/conditions/pneumonia)
- [a blood clot](https://www.livehealthily.com/health-library/conditions/thrombosis) in the lungs (pulmonary embolism)
- [a heart attack](https://www.livehealthily.com/health-library/conditions/heart-attack)
- [aortic dissection](https://www.livehealthily.com/health-library/conditions/thoracic-aortic-aneurysm-unruptured)

It’s important to note there are other conditions, not listed here, that can cause abdominal pain and may be felt in the upper right abdomen.


## When to see a doctor

If you’re getting any kind of pain in your upper right abdomen, make an appointment with your doctor. 

Make sure you see your doctor straight away if you:
- have blood in your poop 
- have black or sticky poop 
- your poo has changed consistency (it is runny or you are constipated) and it isn’t going back to normal 
- your skin looks yellow
- you are losing weight without trying

You should go straight to the emergency room if you have abdominal pain and you:
- are pregnant 
- are vomiting blood 
- can't pee or poop
- can't breathe
- have chest pain
- are diabetic and vomiting
- your pain is very severe
- you have a high temperature with shaking (rigors)


## How is RUQ pain diagnosed?

“Diagnosis of right upper quadrant pain (RUQ) depends on the type of pain you’re experiencing, how severe it is and any other symptoms you’re getting,” says Dr Ann. You can expect your doctor to: 

- ask about your medical history and symptoms – read more about the kind of questions your doctor could ask in [what’s causing your stomach pain?](https://www.livehealthily.com/health-library/symptoms/4-types-of-abdominal-pain-and-what-you-can-do)
- do a physical exam
- depending on your symptoms and exam, your doctor might arrange some tests, including blood tests, a scan, for example an ultrasound, or an endoscopy which is a camera that can look into your stomach and bowels.


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References

 Christina Quaine

Jo Wheatley

Dr Ann Nainan

Article information

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