Pain in the right side with movement

As a pain syndrome of any localization – pain in the right side during movement, that is, occurring during walking, running and even when changing the position of the body in space (when turning or bending the body) – has specific causes.

Causes right flank pain on movement

In clinical medicine, pain in the right side, felt by patients at rest or only during movement, is associated with the abdominal organs located on the right: in the hypochondrium (right upper quadrant of the abdomen), slightly lower - in the right lateral zone, in the right iliac region (limited by the wing of the right ilium and the pubic bone of the pelvis). The liver and the colon surrounding it are located in these areas; gallbladder; head of the pancreas; loops of the ileum; vermiform appendage of the cecum - appendix; right kidney and ureter; in women - uterine appendages (ovary and fallopian tube). The most likely causes of pain in the right side during movement, as well as risk factors for their occurrence, are associated with the condition of these organs.

An experienced clinician can determine the source of right flank pain by history alone in 80-90% of cases. Achieving this goal requires a thorough understanding of the pathogenesis of many abdominal diseases that cause pain and the pathways by which it is transmitted. [ 1 ]

Sharp pain in the right side when moving - in the form of colic - can be a consequence of exacerbation of chronic inflammation of the appendix, gall bladder (cholecystitis, especially in the presence of stones), as well as movement of a stone in the kidney in the presence of nephrolithiasis. For more details, see - Renal colic [ 2 ]

When walking, pain in the iliac region on the right, similar to an attack of appendicitis, may occur due to inflammation of the lymph nodes of the intestinal mesentery - mesadenitis (mesenteric lymphadenitis). Mesenteric adenitis can be divided into two groups: non-specific (or primary) and secondary. Primary mesenteric adenitis is a lymphadenopathy, mainly right-sided, without a pronounced acute inflammatory process. Secondary mesenteric adenitis is associated with a detectable intra-abdominal inflammatory process. [ 3 ]

Pain in the right side can also be caused by:

• hepatomegaly – enlargement of the liver after viral hepatitis or due to steatosis of the liver (fatty hepatosis); [ 4 ]
• Intestinal obstruction is a rare complication of gallstone disease, accounting for only 2% of all cases of intestinal obstruction. [ 5 ], [ 6 ]
• simultaneous increase in the size of the liver and spleen - hepatosplenomegaly, which can develop after monocytic angina, intestinal schistosomiasis, [ 7 ] and also in the presence of cytomegalovirus infection;
• pathologies of the ileocecal valve separating the ileum from the colon, in particular, chronic yersiniosis ileitis [ 8 ] or fatty infiltration of the ileocecal valve;
• Meckel's diverticulum inflammation of the ileum is a rare and difficult to diagnose pathology, which consists of a protrusion of the embryonic remnant of the yolk-intestinal duct; [ 9 ]
• right-sided inguinal hernia;
• the presence of adhesions in the peritoneal cavity;
• tension or twisting of the cyst or tumor stalk of the right ovary;
• right-sided chronic adnexitis (inflammatory process of the uterine appendages); [ 10 ]
• ectopic pregnancy. [ 11 ]

Doctors pay attention to pain during movement and physical activity with prolapse of abdominal organs and intestinal structures - congenital or acquired disorder of their fixation with a change in anatomical position, which is called enteroptosis, splanchoptosis or visceroptosis. Thus, prolapse of the right kidney - nephroptosis - may be accompanied by periodic pain; [ 12 ] Nephroptosis is more common in women with a ratio of 5-10: 1. In addition, it is more common on the right side (in 70% of cases). Interestingly, almost 64% of patients with fibromuscular dysplasia of the renal artery also have ipsilateral nephroptosis. [ 13 ] Right-sided hepatoptosis (shifting of the right kidney downwards); prolapse of the right part of the colon (right-sided coloptosis). [ 14 ]

It should be noted that healthy people who maintain physical fitness by jogging in the morning may also have pain in the right side. In such cases, the cause of the pain is considered physiological; why this happens is explained in detail in the article - Pain in the side when running.

Pathogenesis

The mechanism of development, that is, the pathogenesis of visceral and somatic pain of varying intensity, which can be felt in the right side during movement, as well as at rest, is discussed in detail in the publications:

• Pain in the right side
• Pain in the side when walking
• Pain on the right side under the ribs
• Pain in the liver

For information on how abdominal pain occurs, see the article – Visceral pain.

Diagnostics right flank pain on movement

Any pain, including in the right side when moving, is a symptom, for the purpose of identifying the specific cause of which a diagnosis of abdominal pain is carried out, which includes collecting anamnesis and assessing accompanying symptoms; conducting an examination of the abdomen, examination of the kidneys, etc., including all necessary tests (blood, urine, feces).

Instrumental diagnostics are mandatory:

• Ultrasound of the abdominal cavity;
• Ultrasound of the kidneys and ureters;
• X-ray of the intestine (standing and lying down);

Differential diagnosis

The ability to make a correct diagnosis is provided by differential diagnostics – differentiation of clinical symptoms with the involvement of specialized specialists (surgeon, gastroenterologist, hepatologist, nephrologist, gynecologist).

Treatment right flank pain on movement

When it comes to pain, symptomatic treatment is aimed at relieving it. To relieve pain, antispasmodics are taken orally: Meverin (Mebeverin, Duspatolin), [ 15 ] No-shpa (Drotaverin, Spazmol), Galidor (Benzicdan), etc.

Antispasmodics are generally safe medications. In a meta-analysis by Ford et al., about 14% of adult patients prescribed antispasmodics experienced adverse events compared to 9% assigned to placebo, with common side effects including dry mouth, dizziness, and blurred vision. No serious side effects were reported in any of the studies. [ 16 ] Another meta-analysis of mebeverine trials for IBS also found that this drug was well tolerated with no significant side effects. [ 17 ]

More information in the materials:

• Stomach pain pills
• Kidney Pain Pills
• Treatment of visceral pain

How to treat sharp pain, read in the publication - Colic in the right side.

Symptomatic treatment is combined with etiologic treatment of diseases and conditions accompanied by this symptom. Thus, mesenteric lymphadenitis requires antibiotics, liver steatosis requires hepatoprotective drugs and herbal treatment; if the cause of pain in the right side when moving is the kidney, then the identified disease of this organ is treated.

Enteroptosis is treated in a completely different way, using physiotherapeutic treatment; read the publication - Intestinal prolapse. And methods of treating adhesions are discussed in the material - Intestinal and pelvic adhesions.

In some situations – with inflammation of the appendix, inguinal hernia, torsion of the ovarian cyst, ectopic pregnancy – surgical treatment is necessary, and the operation is performed urgently.

Complications and consequences

Of course, such a symptom as pain can have complications – intensification and chronicity. However, diseases that cause pain have consequences. Kidney prolapse can lead to increased renal vein pressure, hydro- or pyelonephritis; inflammation of the appendix – to its abscess and perforation (with the development of peritonitis). With an inguinal hernia, the risk of developing intestinal obstruction is not excluded, and an ectopic pregnancy is fraught with the loss of one tube and a decrease in reproductive capacity.

Prevention

It is impossible to prevent the occurrence of a symptom such as pain in the right side when moving. And many conditions in which this symptom occurs do not have preventive measures, for example, ectopic pregnancy and torsion of the ovarian cyst stalk, enlargement or prolapse of the liver, colonoptosis, etc.

Forecast

From a medical point of view, the prognosis can be positive only with successful etiological treatment of pathologies that manifest themselves as right-sided pain in the side when moving.