What Causes Pain on the Right Side of the Lower Back?

What Causes Pain on the Right Side of the Lower Back?

  • The causes of lower right back pain in seniors may vary. This type of lower back pain may arise due to injuries, kidney infections, inflammatory bowel diseases, and appendicitis(1-4).
  • Causes of pain on the right side of the lower back may also be gender-specific. For instance, females who have pelvic inflammatory diseases, uterine fibroids, and endometriosis may develop this condition(5-7).
  • Several treatments may help ease pain in this region of the body. Conventional methods, such as the use of nonsteroidal anti-inflammatory drugs, and complementary therapy, like massages, acupuncture and lower back stretches for pain relief, maybe combined(8).
  • For optimal results, seniors and their caregivers are encouraged to first speak with a doctor.

Lower back pain in seniors can be restricting physically, socially, and psychologically(9).

A 2017 study detailed that older adults with back pain experience a disruption of their sleep and exercise routines. Many asked for help as they did not know the best sleeping positions for lower back pain. They are also unable to execute their regular activities(10). 

Due to back pain, they cannot pursue their interests and are more prone to developing feelings of isolation, irritability, and sadness.

The study suggested that elderly people with back pain may feel a loss of hope towards pain relief or recovery and are fearful about their health worsening.

Health Report aims to help seniors understand the causes of their lower right back pain and whether this condition may affect their kidneys and other organs.

The article also covers who among the senior population is at risk of experiencing lower right back pain and how this condition may differ if the individual is male or female.

Recommended treatment options to help alleviate lower right back pain are also discussed in the article to help older adults return to the pain-free life they used to live.

Causes of Lower Right Back Pain

Back pain has several causes, ranging from a minor occurrence, such as lifting something heavy or doing a strenuous workout after a period of not having exercised, to more severe ones, like getting into an accident. 

Back pain on one side is common (11). However, seniors who experience this type of lower back pain should observe if the pain does not subside after a few weeks.

Possible causes of pain on the lower right side of the back may be categorized into general, female-specific, and male-specific causes.

General Causes 


Based on the low back pain fact sheet of the National Institute of Neurological Disorders and Stroke (NINDS), some of the causes of pain in the lower back are tears in the tendons or muscles (strains), muscle spasms, and overstretched or torn ligaments (sprains)(12).

Pain in this area may also be caused by a traumatic injury, such as a bad fall.

Other tissue-related injuries may result from being stuck in a seated position for prolonged periods, sitting in front of the computer and not being able to move around, or taking a sleeping position that could strain one side of the back(13).

Even minor injuries from sports or car accidents may result in damages to spinal structures, specifically to muscles, discs, or joints(14).

Usually, these types of injuries cause spinal pain. However, they may also lead to pain in one side of the back (either the right or left side).

Lumbar Spinal Stenosis

Some of the usual lumbar spinal stenosis symptoms include pain in the back and burning pain that radiates to the buttocks and down to the legs (sciatica).

According to a Johns Hopkins Medicine article, the most common cause of spinal stenosis is osteoarthritis, the gradual wear and tear of joints over time(15).

Osteoarthritis causes changes in people’s spines by age 50. Hence, most people who develop spinal stenosis symptoms are 50 years and above(16).

The report also mentions that women are more likely to develop spinal stenosis than men.

Herniated Disc

According to the American Academy of Orthopaedic Surgeons, herniated disc refers to a health condition that affects the spine and the lower back(17). It is also known as a ruptured, protruding, or bulging disc.

Age-related spinal wear and tear,  called disc degeneration, often results in a herniated disc. Discs of children and young adults have higher water content compared to seniors.

The disc’s water content decreases, and it becomes less flexible as people grow older. It shrinks and the spaces between the vertebrae become narrower. Thus, discs of older adults are more prone to herniation.

Traumatic events, like a fall, may also cause a herniated disc.

Kidney Infection

Pain in the back or on the side may be a symptom of kidney infection(18). This type of urinary tract infection is caused by a common infection of the bladder known as cystitis.

Often, kidney pain is confused with back pain. However, kidney pain is higher up the back and deeper. The kidneys are found underneath the ribcage, on each side of the spine.

Meanwhile, back pain usually happens in the lower back muscles(19).

Kidney Stones

Kidney stones are rock-like crystal masses in the kidneys. The passing of the stones from the kidney to the bladder, or from the bladder to outside the body, causes individuals pain(20).

The pain resulting from these deposits is often felt in the back, side, lower belly, or groin area.

Here are some signs that back pain is caused by kidney stones(21):

  • Pain is felt on the side of the lower back
  • Pain is recurring and inconsistent in terms of intensity
  • Presence of blood in the urine
  • Back pain is accompanied by fever and chills
  • Urination is painful

Inflammatory Bowel Diseases

Research published in the PLOS One journal stated that a significant number of patients who had inflammatory bowel diseases also experienced pain, especially those with ulcerative colitis and Crohn’s disease(22).

The duration of the pain experienced by individuals with ulcerative colitis was shorter than that of Crohn’s disease. The authors also detailed that back pain and abdominal pain were the main localizations of pain.


Appendicitis is the tearing or rupturing of the appendix(23). This damage is caused by a substance getting stuck in the appendix and pressure building up, causing swelling and eventually a tear or rupture.

Fever is a symptom commonly associated with appendicitis. Usually, the small tear causes immense pain on the lower right side of the body.

If the pain worsens and is accompanied by other symptoms, such as vomiting and difficulty breathing, this medical emergency requires a healthcare expert’s attention.

Appendicitis in older adults is usually in a more advanced stage compared to younger individuals(24). The senior population also has higher mortality risks and complication rates.

Thus, the elderly and their caregivers are advised to seek medical attention once the condition seems to be appendicitis.

Problems in Other Organs

Lower right back pain in seniors may signal health issues involving other internal organs, particularly those in the middle back, pelvic, or abdominal area.

This pain may be caused by the infection, irritation, or inflammation of the affected organs, which often include the following:

  • Colon
  • Pancreas
  • Gallbladder

Causes Specific to Females

Gender may affect the likelihood of a senior developing pain on the right side of their lower back. 

A review published in the journal Quantitative Imaging in Medicine and Surgery suggested an increased low back pain prevalence in female seniors than in males(25).

According to the researchers, female sex hormones had an effect on degenerative musculoskeletal diseases. They also hypothesized that postmenopausal women exhibited accelerated disc degeneration because of estrogen deficiency.

Some causes of lower back pain specific to females include:

Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is defined as an infection of the female reproductive organs.

PID symptoms include low back pain, cramping pains in the lower abdomen, difficulty urinating, and pain during sexual intercourse.

PID is usually found in younger women and rarely in senior females. However, older women who are immunocompromised are still likely to develop PIDs.

A 2018 study found in the Journal of Medical Case Reports featured a case study of an elderly female with PID (pyosalpinx) and type 2 diabetes(26).

The researchers suggested that the senior woman’s type 2 diabetes had made her immunocompromised and susceptible to rare PIDs, like pyosalpinx.

Thus, the elderly are encouraged to take caution and seek medical advice if they are experiencing PID symptoms.

Uterine Fibroids

Also known as myomas, uterine fibroids are growths of the uterus that usually begin appearing during a woman’s childbearing years(27). These growths are noncancerous and not associated with an increased risk of cancer, like uterine cancer.

Their sizes vary, ranging from tiny seedlings to bulky masses that may affect and enlarge a woman’s uterus.

When fibroids press against the nerves and muscles of the lower back, they may cause back pain. However, this occurrence is rare(28).

Large fibroids on the uterus’ back surface are more likely to induce back pain compared to small fibroids growing within the uterine wall.

Uterine fibroids are estrogen-dependent. The hormone commonly regresses post-menopause.

Thus, fibroid degeneration in postmenopausal women is rare.

However, a study featured a case of a 56-year-old female who reported low-grade fever, leukocytosis, and acute abdominal pain associated with fibroid degeneration(29).

The authors believe that fibroid degeneration may still occur after menopause.


Endometriosis is a chronic condition where tissues similar to the womb’s lining are found in other areas of the body(30).

The tissue may appear in the right side of the abdomen, causing pain in women.

Pain in the lower back is one of endometriosis’ most common symptoms.

In women of reproductive age, 6% to 10% have pelvic endometriosis. Despite the health issue’s association with menstrual cycles, it may still affect 2% to 5% of postmenopausal women.

Causes Specific to Males

Lower back pain on the right side may arise due to health conditions exclusive to males, including testicular torsion.

Testicular Torsion

Testicular torsion happens when the testicle twists around the spermatic cord because it is not attached well(31). This occurrence results in the cutting off of blood flow, causing swelling and pain in the scrotum.

Abdominal pain is also one of the condition’s symptoms.

The severity of this situation calls for urgent medical attention.

According to a study in the journal Urology Case Reports, testicular torsion is rare in older or senior males(32).

However, the researchers found the case of a 66-year-old man who reported scrotal pain in the emergency department, which was eventually diagnosed as testicular torsion.

Thus, the authors emphasize the need to consider torsion in diagnosing any male presenting with scrotal pain regardless of age.

Testicular Cancer

Some of the first signs of testicular cancer include an enlarged testicle and a small lump or area of hardness(33).

One of the symptoms of this type of cancer is lower back pain.

According to the American Cancer Society, testicular cancer is usually diagnosed at the age of 33(34). This cancer type usually occurs in young and middle-aged men.

However, it was found that 8% of testicular cancer cases were diagnosed in men over 55 years old.

Lower Right Back Pain Symptoms

Lower back pain has a variety of symptoms, including(35):

  • Tingling
  • Burning sensations
  • Dull, achy feeling or sharp pain
  • Pain in the hip, leg, or bottom of the foot
  • Weakness in the feet and legs

Pain in this part of the lower back may also signal more serious health conditions, like the following:

Lower back pain has a variety of symptoms, including(35):

  • Tingling
  • Burning sensations
  • Dull, achy feeling or sharp pain
  • Pain in the hip, leg, or bottom of the foot
  • Weakness in the feet and legs

Pain in this part of the lower back may also signal more serious health conditions, like the following:

  • Cauda equina syndrome – happens when the cauda equina’s nerve roots are compromised, disrupting sensory and motor functions in the lower extremities and the bladder(36).
  • Osteomyelitis – a vertebral infection characterized by several symptoms, like severe back pain, weight loss, and fever(37).
  • Aneurysm – the weakening of the artery wall, resulting in its abnormal ballooning and widening(38).

More About Lower Right Back Pain

The lower part of the back has five vertebrae. It is where the spine connects to the pelvis, supporting the upper body’s weight(39).

The movement and stress experienced by this area of the back may result in its inevitable wear and tear. Several organs may also be affected by lower right back pain.

The following organs are found in the right lower quadrant of the body(40):

  • Part of the colon
  • The lower portion of the right kidney
  • Right ureter
  • Appendix
  • Right fallopian tube (females)
  • Right ovary (females)
  • Right spermatic cord (males)

The two types of back pain are acute and chronic back pain(41).

Acute pain:

  • Short-term back pain
  • Lasts a few days to a few weeks
  • Gets better on its own
  • No residual loss of function
  • Most cases of low back pain are acute

Chronic pain:

  • Back pain that lasts for over 12 weeks
  • Chronic back pain may still be felt after the initial injury or underlying cause has been addressed
  • 20% of people with acute low back pain develop chronic low back pain(42)
  • Persistent pain does not automatically signify that there is a serious underlying cause

According to research published in the Journal of the Japan Medical Association, the age-related degeneration of intervertebral disc cartilages and intervertebral joints causes low back pain(43).

The development of low back pain may be classified into three stages:

  • Dysfunction 

At this stage, ruptures happen in the intervertebral cartilages.

Early lesions, like minimal damage to the intervertebral joints and mechanical inflammation, also develop.

  • Instability 

During this phase, intervertebral disc function is disrupted, and the intervertebral joints degenerate.

Instability develops in the functional motor unit. Clinical symptoms, like low back pain and lower limb neurological symptoms, worsen.

  • Restabilization 

Motion is restricted at this stage because of spur formation on the vertebral bodies and the thickening and deformation of the intervertebral joints.

However, the severity of low back pain also decreases even if the lumbar spine’s motion is reduced.

Risk Factors

Several factors may increase the risk of an individual developing low back pain, including(44):


As people age, back pain becomes more common. A person’s intervertebral discs lose more fluid and flexibility as they grow older, decreasing their ability to cushion the vertebrae.


Genes affect an individual’s likelihood of developing back pain. For instance, some causes of back pain, like ankylosing spondylitis, are related to genetics.

Ankylosing spondylitis is a type of arthritis involving the fusion of the spinal joints, which may lead to the spine’s immobility.


The obese or overweight are more prone to developing pain on the right side of the lower back. Weight puts stress on the back, potentially causing low back pain.


Individuals required to do heavy-lifting, pulling, pushing, and other activities involving the twisting of the spine are more prone to developing back pain and injuries.

A study was conducted on over 1,500 older adults ages 58 to 67 years old(45).

The researchers observed that previous occupational exposure to bending, twisting, or driving for at least 10 years increased the risk of these retired adults developing persistent low back pain.


Smoking restricts oxygen and blood flow to the discs, which may result in their rapid degeneration.

Treating Lower Right Back Pain

According to Cleveland Clinic, there are several ways seniors and their caregivers may take to help ease the back pain of older adults(46):

Take Medications

Over-the-counter (OTC) pain medications, like acetaminophen, naproxen, aspirin, and ibuprofen, may be taken under a doctor’s guidance to ease lower back pain.

Nonsteroidal anti-inflammatory medications (NSAIDs) help with inflammatory pain.

Note that some pain relievers require a doctor’s prescription. Before purchasing OTC or prescription drugs, always consult a medical professional.

Apply Cold and Heat

When the backache begins, use an ice pack on the affected area. Apply ice on the painful region for 20 minutes, and then wait for another 20 minutes before re-applying the ice pack.

This method helps with swelling, muscle spasms, and inflammation.

Two to three days following the onset of lower back pain, apply heat to the back area to stimulate blood flow, relax the back muscles, and help with muscle strains.

Heat may be applied through warm baths, heating pads, or lying under a heat lamp for a few minutes.

Once the heat source is removed, it is essential to stretch the warmed muscles to avoid muscle spasms.

Join Physical Therapy Programs Or Activites

A program that targets the strengthening of the back and abdominal muscles may be promising in improving balance and flexibility, Tai Chi for seniors is perfect for this.

These exercises with certified physical therapists may help in making the spine more resilient.

Complementary Therapies

Aside from conventional treatments, other approaches may be employed, like:

  • Osteopathic manipulation – by using only their hands, chiropractors (osteopathic doctors) adjust, mobilize, massage, and stimulate the spine and the surrounding tissues
  • Acupuncture – by inserting fine needles in the affected area, acupuncturists manipulate specific body points to relieve chronic pain and help with the body’s healing process

Undergo Surgery

According to the National Institute of Neurological Disorders and Stroke, a component of the National Institutes of Health (NIH), surgery is usually not recommended for acute back pain(47).

The NINDS recommends that only when other therapies fail should surgery be considered.

The agency notes that surgeries are not always successful. Also, it adds that it takes months post-surgery before the individual fully heals.

Permanent loss of flexibility may be a result of surgical procedures.

How to Diagnose Lower Right Back Pain

Doctors have several measures of diagnosing the source of low back pain(48). 

For a more accurate diagnosis, seniors are encouraged to provide a description of the pain, the time it started, possible related symptoms, and any history of chronic conditions.

Usually, physical examinations and a complete medical history are already sufficient to help doctors identify the cause of the back pain.

However, in some cases, additional testing may be needed, including:

  • Blood tests – for signs of cancer, arthritis, infection, and inflammation.
  • Bone scans – to detect and monitor bone disorders, fractures, or infections.
  • Discography – injecting a contrast dye into the spinal disc to determine the damaged areas on the computed tomography (CT) scans taken post-injection.
  • Electrodiagnostics – to determine issues related to the nerves of the legs and the back.
  • Diagnostic imaging tests – the use of X-ray, CT, and MRI (magnetic resonance imaging) scans to show internal body structures, like soft tissues, ligaments, and blood vessels.

These scans help diagnose problems in the spinal canal, spinal cord, lumbar spine, and other body systems associated with lower back pain.

When to Visit the Doctor

One-sided back pain is normal(49). However, if the pain extends beyond six weeks, a visit to the doctor is encouraged.

Seniors who have lower right back pain should get in touch with their doctor if they experience the following(50):

  • Severe pain that does not subside
  • Loss of urine or stool control
  • Weakness in the pelvis, buttocks, leg, or thigh
  • Swelling on the back or spine
  • Sudden fever accompanying the back pain
  • Pain radiating to legs, below the knee
  • Back pain following a severe fall or blow
  • Burning sensations during urination
  • Blood in the urine
  • A history of cancer
  • Pain that exacerbates when lying down
  • Pain severe enough to wake an individual up at night
  • Sudden and unintentional weight loss
  • Back pain that feels different or worse (even if back pain has been experienced before)
  • Back pain episode has lasted over four weeks

The elderly and their caregivers should observe pain on the right side of the lower back. If the condition escalates and becomes intense pain, a doctor should be seen immediately.

Sean Byers, MD

Sean Byers, MD

Sean Byers is currently a Resident in the Internal Medicine program at UTMB. He studied at the University of Queensland School of Medicine as well as received his Master’s in Public Health with a focus in epidemiology and biostatistics at the University of Southern California. His background is in biology, computer science, public health, and internal medicine.

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