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Pain in the right side when moving
Last reviewed: 23.04.2024
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As a pain syndrome of any localization - pain in the right side during movement, that is, that occurs during walking, running, and even when the body position changes in space (when turning or tilting the body) - it has specific reasons.
Causes of the pain in the right side when moving
In clinical medicine, pains in the right side, felt by patients at rest or only when moving, are associated with abdominal organs located on the right: in the hypochondrium (right upper quadrant of the abdomen), slightly lower - in the right side zone, in the right iliac region ( limited by the wing of the right ilium and the pubic bone of the pelvis). In these sections are the liver and the colon enveloping it; gall bladder; pancreatic head; ileum loops; caecum appendage - appendix; right kidney and ureter; in women - appendages of the uterus (ovary and fallopian tube). It is with the state of these organs that the most probable causes of pain in the right side are associated with movement, as well as risk factors for their appearance.
An experienced clinician can determine the source of pain in the right side only by studying the history in 80-90% of cases. To achieve this goal, a deep understanding of the pathogenesis of many diseases of the abdominal cavity that cause pain and the ways in which it is transmitted is required. [1]
A sharp pain in the right side during movement - 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 calculi), as well as the movement of a stone in the kidney in the presence of kidney stone disease. See details - Renal colic. [2]
When walking, appendicitis-like pain in the iliac region on the right can occur due to inflammation of the lymph nodes of the mesentery of the intestine - mesadenitis (mesenteric lymphadenitis). The mesenteric adenitis can be divided into two groups: non-specific (or primary) and secondary. Primary mesenteric adenitis is lymphadenopathy, mainly right-sided, without a pronounced acute inflammatory process. Secondary mesenteric adenitis is associated with a detectable intra-abdominal inflammatory process. [3]
Also, pain in the right side can manifest:
- hepatomegaly - an increase in the liver after a viral hepatitis or due to steatosis of the liver (fatty hepatosis); [4]
- intestinal obstruction is a rare complication of gallstone disease, which accounts 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 tonsillitis, intestinal schistosomiasis, [7] as well as in the presence of cytomegalovirus infection;
- pathology of the ileocecal valve separating the ileum from the colon, in particular chronic yersiniosis ileitis [8] or fatty infiltration of the ileocecal valve;
- inflammation of the Meckel ileum diverticulum is a rare and difficult to diagnose pathology, which consists in protruding the embryonic residue of the vitelline intestinal duct; [9]
- right inguinal hernia;
- the presence of adhesions in the peritoneal cavity;
- tension or twisting of the legs of a cyst or tumor 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 exertion when the abdominal organs and structures of the intestine are lowered - a congenital or acquired violation of their fixation with a change in the anatomical position, which is called enteroptosis, splanchoptosis or visceroptosis. So, omission 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 (mixing the right kidney down); prolapse of the right part of the colon (right-sided coloptosis). [14]
It should be noted that in healthy people who keep fit by morning jogging, it can also hurt 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 development mechanism, that is, the pathogenesis of visceral and somatic pains of various intensities, which can be felt in the right side during movement, as well as at rest, is discussed in detail in the publications:
How does the pain associated with abdominal organs, see the material - Visceral pain .
Diagnostics of the pain in the right side when moving
Any pain, including in the right side during movement, is a symptom, to determine the specific cause of which a diagnosis of abdominal pain is carried out , which includes taking an anamnesis and evaluating the accompanying symptoms; holding abdomen examinations , of the kidneys , etc., including all the necessary tests (blood, urine, feces).
Be sure to carry out instrumental diagnostics:
- Ultrasound of the abdomen ;
- Ultrasound of the kidneys and ureters ;
- X-ray of the intestine (in a standing and lying position);
Differential diagnosis
The opportunity to make a correct diagnosis is given by differential diagnostics - differentiation of clinical symptoms with the involvement of narrow specialists (surgeon, gastroenterologist, hepatologist, nephrologist, gynecologist).
Treatment of the pain in the right side when moving
When it comes to pain, symptomatic treatment is aimed at stopping it. To relieve pain inside, antispasmodics are taken: Meverin (Mebeverin, Duspatolin), [15]No-shpu (Drotaverin, Spazmol), Halidor (Benzicdan), etc.
Antispasmodics are generally safe medications. In a meta-analysis by Ford et al., About 14% of adult patients who were prescribed antispasmodics experienced adverse events compared with 9% prescribed for placebo, with common side effects such as dry mouth, dizziness, and blurred vision. None of the studies reported any serious side effects. [16]Another meta-analysis of mebeverin tests for IBS also showed that these drugs are well tolerated without significant side effects. [17]
More information in the materials:
How sharp pain is treated, read the publication - Colic in the right side .
Symptomatic treatment is combined with the etiological treatment of diseases and conditions accompanied by this symptom. So, with mesenteric lymphadenitis, antibiotics are needed, with liver steatosis, hepatoprotective drugs and herbal treatments are used; if the cause of pain in the right side during movement 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 . A treatment of adhesions is discussed in the material - Adhesions of the intestine and pelvis .
In some situations - with inflammation of the appendix, inguinal hernia, torsion of the legs 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, the consequences are diseases that lead to the appearance of pain. Prolapse of the kidney can lead to an increase in renal vein pressure, hydro- or pyelonephritis; inflammation of the appendix - to its abscess and perforation (with the development of peritonitis). With 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 ability.
Prevention
It is impossible to prevent the appearance of a symptom, which is pain in the right side when moving. And many conditions do not have preventive measures in which this symptom occurs, for example, an ectopic pregnancy and torsion of the legs of an ovarian cyst, 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 pains in the side when moving.