What causes lower right side back pain in females?

Lower back pain is very common. It affects up to 23% of adults, but the incidence is higher in women than men.

If you are a female who has suffered from a strained muscle, spinal cord injury, or menstrual pain, you know lower back pain can interfere with daily life. So, what are the most common causes of lower right-side back pain in females? And what treatment options help?

Anatomy of the lower back

Lower back pain refers to discomfort in the lumbar region. It starts below the ribcage and ends above the tailbone and hips. The lumbar spine comprises five vertebrae (L1-L5), the pads between them (called intervertebral discs), and the muscles and ligaments attached to them.

Five pairs of nerves extend out of the lumbar region, so sometimes inflammation or infection in the nearby organs and tissues of the pelvis can cause lower back pain. That’s why lower back pain on either side can be linked to female reproductive organs such as the uterus, ovaries, and fallopian tubes, according to Douglas Tanita, MD, FACOG, medical director of Henderson Women’s Care in Henderson, Nevada.

Lower right-side back pain in females may feel like a dull ache or a sharp twinge. In severe cases, such as slipped discs, causes of back pain are a medical emergency. The type of pain can sometimes help healthcare professionals pinpoint the underlying cause. If the cause is related to internal organs, lower back pain in females can be accompanied by lower abdominal cramps, nausea, and abnormal bleeding.

What causes right-side lower back pain in females?

“Back pain is typically caused by musculoskeletal structures as opposed to organs,” says Jennifer Kendall, DO, a board-certified osteopathic physician at M Health Fairview Maplewood Spine Center in Maplewood, Minnesota. However, she says the bladder, kidneys, and, in women, the uterus and ovaries can cause pain in the lower back.

Thus, the primary causes of right-side lower back pain in females are:

• Musculoskeletal injury or strain

• Urinary tract problems

• Gynecological infection or inflammation

Musculoskeletal injury and lower back pain

In the general population, the most common cause of lower back pain on either side is a mechanical injury — specifically a muscle strain. Muscle strains can be caused by heavy lifting, injuries from sports or car accidents, or even poor posture or a sedentary lifestyle.

“Usually, low back pain is caused by musculoskeletal structures, such as an irritated or tight muscle or ligament, a disc herniation, or irritation of joints in the back,” Kendall says.

Other musculoskeletal-related lower back pain in females causes include spinal stenosis, sprains, fractures, sciatica, or osteoarthritis, a degenerative joint disease. In the case of spinal stenosis or degenerative disc disease, the lower back discomfort often becomes chronic pain.

Menstrual cycle and menopause

Lower back pain is very common during menstruation. Generally, this monthly bout of muscular pain lasts one to two days and is thought to be caused by hormonal changes. The cramping can also affect the lower abdomen and general pelvic region.

“Ovulation can cause back pain in some women,” Kendall adds. Perimenopause — the period of several years before the start of menopause — is also associated with a higher incidence of lower back pain in females. Ovulation pain occurs mid-way between menstrual cycles and can cause 12-24 hours of pain, usually on one side or the other. 

Ultimately, menstruation, ovulation, and perimenopause all involve hormonal changes, which can trigger the release of uterus-contracting prostaglandins.

Sciatica

Sometimes lower right-side back pain in females is caused by sciatica. Sciatica is pain caused by inflammation or compression of the sciatic nerve, sometimes by bone spurs. It usually only affects one side and runs from the lower back to the back of the thigh.

Age-related changes to the spine often cause sciatica, so your risk of back pain increases as you get older. Unlike musculoskeletal causes of lower right-side back pain, sciatica pain often worsens the longer you sit.

Kidney stones and UTIs

“Common causes of lower right side back pain in the general population may include urinary tract infections [and] kidney stones,” Tanita says. There’s a good explanation for this: referred pain. The nerves rooted in your lower back serve as communicators — or referrers — of pain originating in other body parts.

Kidney stones can cause back and side pain. This pain is often excruciating as the stone moves from your kidneys down the ureter to your bladder. The pain is sharp and comes and goes. The pain resolves when the stone is expelled from the urethra. 

In a reverse pathway, a urinary tract infection (UTI) that begins in your urethra can migrate up to the bladder and occasionally up to the kidneys, causing a kidney infection. This, too, could cause intense lower right-side back pain in females or males. If a kidney infection is left untreated, it can infect the bloodstream and cause fever, chills, nausea, and vomiting. 

Pregnancy

Hormonal changes and shifting weight distribution can lead to lower back pain in pregnant women. However, new or severe back pain should be reported to your healthcare provider rather than brushed off as a normal part of pregnancy. That’s because lower right-side back pain can indicate an ectopic pregnancy, Tanita says.

Other reasons for right-side lower back pain in females

Any infection or inflammation of pelvic organs can cause pain in the lower back. Other possible causes of right-side lower back pain in females include:

• Appendicitis, inflammation of the appendix (in the right lower quadrant of the abdomen) can cause colicky abdominal pain that can start near the belly button and then migrate to the right lower quadrant

• Constipation, defined as having hard stools

• Ulcerative colitis, an inflammatory bowel disease that can also cause severe abdominal pain

• Uterine fibroids, noncancerous growths within the wall of the uterus

• Endometriosis, a medical condition in which the uterine lining grows outside the uterus

• Ovarian cyst, a small sac of fluid that sometimes cause dull lower back pain in females

• Polycystic ovary syndrome (PCOS), a hormonal disorder and sometimes painful condition that also causes irregular and heavy periods

• Pelvic inflammatory disease, which affects the uterus, fallopian tubes, and ovaries

• Sexually transmitted infections, such as syphilis or chlamydia

• In rare cases, cancers such as uterine cancer, ovarian cancer, or pancreatic cancer 

Should I be worried about right-side lower back pain in females?

Lower back pain on both sides is common in females, especially during menstruation or after strenuous activity. It rarely indicates a medical emergency.

It's a good idea to see a health care provider if your lower right-side back pain “persists for more than a few days, is severe, or is accompanied by other concerning symptoms such as fever, nausea, vomiting, blood in the urine, or difficulty urinating,” Tanita says. In these cases, lower right-side back pain in females may indicate an underlying medical problem such as kidney stones or uterine fibroids.

Get emergency medical treatment if the lower right-side back pain is accompanied by a loss of bladder or bowel function, says Kendall. Significant muscle weakness or loss of sensation in your pelvis or legs is considered an emergency. It can indicate a mobility-threatening disc herniation. Also, get emergency medical help if the lower back pain in a reproductive-age female is accompanied by sudden dizziness or weakness. This can be a sign of ectopic pregnancy, a potentially life-threatening condition.

How is the cause of lower back pain diagnosed?

In most cases, lower right-side back pain is self-diagnosed. The most common reason is muscle strain, after all. But if the pain is severe, lasts more than a week, or interferes with sleep or daily life, you should consult a healthcare provider about potential causes.

Causes of lower back pain in female patients are usually diagnosed through a physical examination and discussion of your medical history. Tanita says your doctor will likely ask about the following:

• The location, duration, and severity of pain

• Other symptoms, such as a change in menstrual cycle, abnormal vaginal bleeding, pain with urination or bowel movements, bloody urine or stool, or unexpected weight loss

• Recent injuries and sexual activity

• Activities that make the back pain better and worse

• Date of last menstrual period

After thoroughly discussing symptoms and medical history, the doctor will complete a physical examination. For females, this will likely include a pelvic exam. Healthcare providers who suspect an underlying issue may then move on to various diagnostic tests.

“These tests can include a urine pregnancy test, urinalysis, sexually transmitted infection testing, as well as imaging studies like Ultrasound, X-rays, or CT scans,” Tanita says.

How long does right-side lower back pain in females last?

How long right-side lower back pain lasts depends on the underlying cause. If there is no serious injury or underlying condition, Kendall says the pain should go away on its own within a week.

If the lower right side back pain is caused by age-related osteoarthritis, the pain may not completely disappear. Sticking to your treatment plan is important to prevent further disc degeneration.

In the instance of lower right-side back pain related to menstruation, the pain will likely ebb and flow based on the time in your cycle.

How to stop right-side lower back pain in females

No single medication addresses how to get rid of right-side lower back pain in females. How to treat right-side lower back pain in females depends on the underlying cause of the pain. Sometimes, the pain resolves on its own within a week or two.

A few common right-side lower back pain in females treatments might include:

• Over-the-counter pain relievers such as NSAIDs or analgesics

• Muscle relaxants (antispasmodics)

• Steroid injections

Living with right-side lower back pain

Depending on the severity and cause, you may be able to manage or reduce right-side lower back pain at home. Home remedies can even be useful for severe lower back pain while you wait for physical therapy or a consultation with specialists. 

Here are a few natural solutions for minor causes of lower right back pain:

• Apply heat. For lower back pain related to period cramps, heat can offer immediate short-term relief. Curl up with a heating pad, hot water bottle, or homemade heat pack (a microwaved sock full of rice will do).

• Ice it. For lower back pain related to a back injury, cold therapy can treat pain-causing inflammation. Apply an ice pack to the sore spot and apply light pressure. 

• Stretch. Gentle stretches can help keep your lower back muscles loose, which prevents pain from setting in. A physical therapist or osteopathic physician can demonstrate stretches to help resolve the cause of your pain.

• Massage therapy. For lower right side back pain related to muscle strain or stiffness, a massage can help. Tell your massage therapist about the source and severity of your pain and whether you have experienced any previous back injuries.

Additional resources for people with right-side lower back pain in females

Test and diagnostics

• 4 reasons you may have back pain on only one side, Penn Medicine

• Lower right back pain, Cleveland Clinic

• Low back pain — causes, diagnosis and treatment, American Association of Neurological Surgeons

Treatments

• Lower back pain treatments & medications, SingleCare

• 8 non-narcotic pain meds and other pain management tips, SingleCare

Scientific studies and clinical trials

• Increased low back pain prevalence in females than males after menopause age, Quantitative Imaging in Medicine and Surgery

• Prevalence and risk factors of low back and pelvic pain in women with rectus abdominis diastasis: a multicenter retrospective cohort study, The Korean Journal of Pain

More information on related health conditions

• Kidney stone treatments and & medications, SingleCare

• Herniated disc treatments & medications, SingleCare

• 12 ways to get rid of period cramps, SingleCare

• Your guide to fighting lower back pain while working at home, SingleCare