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.

Below is a list of some of the conditions that can cause right-sided lower back pain.

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.

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.

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 radiculopathy (typically on one side of the body).

Most herniated discs don't require surgery, but about 10% don't improve with non-operative treatment. Physical therapy is often prescribed for disc herniations. A six-week course of therapy is typical.

Bone Spurs and Arthritis

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.

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.

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.

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.

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 a type of nerve pain called radiculopathy.

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.

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.

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.

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-, bone-, or nerve-related problems affecting the spine. These include herniated discs, facet joint bone spurs, spinal arthritis, ankylosing spondylitis, scoliosis, spinal cysts or tumors, and cauda equina syndrome. Other illnesses like kidney stones and gallstones 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.