Dull pain in the Lower Right Abdomen That Comes and Goes, 6 Causes.

Possible causes of right lower abdominal pain (that comes and goes):

• Excess gas inside your colon (gas pain).
• Irritable bowel syndrome.
• Appendicitis (especially the chronic form).
• Other gastrointestinal diseases: IBD, lactose intolerance, and others.
• Female-only causes right ovarian cysts, tumors, and others.
• Right ureteric stone or infection.
• Right inguinal hernia.
• Other causes also exist but are rare.

1. Gas pain.

Gas is typically produced inside your digestive symptoms. When gas increases inside your intestine and colon, you may feel pain.

Gas pain is often generalized all over your abdomen. However, it can localize in the lower right abdomen.

Causes of gas pain:

• Swallowing too much air (eating too fast).
• Gassy foods: beans, peas, fruits, vegetables, and whole grains.
• Intolerance to certain foods, such as lactose intolerance (in milk and dairy) and fructose intolerance (in fruits and honey).
• Some intestinal conditions: food intolerances, small intestinal bacterial overgrowth, and inflammatory bowel disease.

Learn more about the causes of gas inside your digestive system.

Symptoms:

• Bloating and distension.
• Frequent burping or passage of flatus.
• The pain is dull or colicky.
• Often, it comes and goes according to the food you eat.
• Gas pain can be diffuse or localized in the right lower abdomen.
• Gas pain is triggered by overeating or ingesting gassy foods and drinks.
• It is relieved by passing flatus or after bowel movements.

2. Irritable Bowel Syndrome.

Irritable bowel syndrome (IBS) is one of the common conditions affecting your gut. IBS is a functional disease that causes abdominal pain that comes and goes.

Symptoms of IBS:

• Abdominal pain that comes and goes.
• The pain is often dull colics; it comes and goes over months or years.
• Abdominal pain from IBS is often generalized, but it can localize in some regions of your abdomen, such as the right lower part. See IBS pain locations.
• Change in bowel habits (diarrhea or constipation).
• Change in stool form (hard stool or loose stool).
• The pain is often triggered by ingesting certain foods, such as FODMAPs, or stress and anxiety.
• Bloating and gas are also common with IBS.
• Passage of mucus with stool.

Learn More about IBS Symptoms and Diagnosis.

3. Appendicitis (chronic form).

Appendicitis is the most common cause of right lower abdominal pain. However, it came third in this list. Acute appendicitis is often severe stabbing rather than a dull ache.

The acute form of appendicitis is often more severe and is associated with extreme abdominal pain (not dull). The pain from acute appendicitis usually starts around the umbilical and then localizes in the right lower abdomen.

The pain from acute appendicitis is associated with nausea, vomiting, and often fever.

The Chronic form of appendicitis is less common. It represents recurrent attacks of minor inflammation of the appendix. Chronic appendicitis is challenging to diagnose because the pain comes and goes.

According to studies, Chronic appendicitis affects 14-30% of patients undergoing appendectomy operations (reference).

Symptoms of chronic appendicitis (reference):

• Right lower abdominal pain that comes and goes.
• The pain is dull, aching in nature.
• The pain is often prolonged (for weeks, months, or years).
• Fever is absent or mild and intermittent.
• Anorexia, nausea, and occasional vomiting.
• Tender right lower abdomen.

Chronic appendicitis is difficult to spot by your doctor because:

• You don’t have the typical symptoms (severe right lower abdominal pain and tenderness).
• The abdominal radiography may be negative for appendicitis.
• Average white blood cell count (it is typically elevated with acute appendicitis).

Learn More about chronic appendicitis

RELATED:

• Can Appendicitis Pain Come and Go for a Day or Week? 

• Post-Appendectomy Pain After 3 Months.

4. Other Gastrointestinal diseases.

Right lower dull aching abdominal pain can also result from various gastrointestinal diseases and conditions.

The dull, aching right lower abdominal pain may result from the following:

• Crohn’s disease.
• Ulcerative colitis.
• Diverticular disease and diverticulitis (more common in the left than right lower abdomen).
• Colorectal cancer.
• Infections of the colon (often manifest with acute-onset diarrhea and abdominal pain).
• And many other rare causes.

5. Female-only Causes (Right ovary, tube, and the uterus).

The causes in this section are related to the female genital system (mainly the right ovary and the right fallopian tube).

Diseases and conditions affecting the right ovary or tube cause dull lower right abdominal pain in females. The pain may come and go for several weeks or months when the condition is mild or chronic.

Common causes of DULL pain:

• Right ovarian cyst. It may become ruptured or infected.
• Abscess in the right ovary or the right fallopian tube.
• Ovulation pain (Mittelschmerz): mid-cycle pain that occurs every month.
• A right ovarian tumor (benign or malignant).
• Ectopic pregnancy: maybe in the right fallopian tube, ovary, or pelvis.
• Pelvic inflammatory disease: affecting the right tube and ovary.
• Ovarian vein thrombosis.

6. The right ureter (renal colics).

The right ureter lies mainly in the right lower abdomen. Therefore, it can cause right lower abdominal pain that comes and goes.

Causes:

• Right ureter stone.
• Urinary tract infection.
• Ureteric narrowing (stricture).
• Rarely, trauma or cancer.

Symptoms:

• Pain in the right lower abdomen.
• The pain is dull and colicky (comes and goes).
• It may spread to the right back, right groin, or right testis in males.
• Pain lasts from minutes up to a few hours.
• The pain completely resolves between the attack.
• NOT related to eating, bowel movements, posture, or movement.
• Ureteric pain may become severe cases are associated with nausea and vomiting.
• Frequently, you may experience painful urination, bloody or turbid urine.

Learn more about renal colic.

7. Right inguinal hernia (more common in males).

A hernia is the protrusion of a part of your intestine through a defect in the abdominal wall.

One of the most common hernia locations is the right lower abdomen and the right groin—namely, The right inguinal hernia (the direct and the indirect types).

Symptoms:

• Vague or dull pain in the right lower abdomen.
• A bulge or swelling on the right lower part of your abdomen or groin.
• The Bulge may extend downwards to reach the right testis in males (the indirect type of inguinal hernia).
• The Bulge is often compressible, and it increases in size with straining and lifting heavy objects.
• The pain comes with straining, standing, walking, and eating.

9. Others (rare).

• Pain from the right lower abdominal wall muscles (muscle strain).
• Decreased blood supply to the colon or intestine (mesenteric ischemia).
• Enlarged lower right abdominal lymph nodes (mesenteric lymphadenitis).
• Familial Mediterranean Fever.
• Pseudoappendicitis.
• Psychological diseases.
• Acute intermittent porphyria.
• Abdominal migraine.
• Perforated ileum or ascending colon.
• Intestinal obstruction.
• Pelvic congestion syndrome.
• Right hip bone disease or fractures.

More: Mid-back Right-sided Pain: 6 Causes & How to Differentiate.