Why Does My Right Side Hurt After a Hysterectomy?

Right-sided pain after a hysterectomy can stem from a surprisingly wide range of causes, from residual gas irritating the diaphragm to a blood clot forming in the ovarian vein to scar tissue tethering loops of bowel. The location and timing of the pain matter enormously in narrowing things down. Some causes show up within hours of surgery, while others emerge weeks or even months later. Understanding what might be behind the discomfort helps you have a more productive conversation with your surgeon and recognize when something needs urgent attention.

Referred Shoulder Pain, Especially on the Right

If your right-sided pain is actually in or near the shoulder rather than deep in the pelvis, you are dealing with one of the most common complaints after laparoscopic hysterectomy. Carbon dioxide gas is pumped into the abdomen to give the surgeon room to work, and leftover gas can irritate the underside of the diaphragm. That irritation sends a pain signal along the phrenic nerve, which the brain interprets as shoulder pain. In one study of 50 patients after total laparoscopic hysterectomy, shoulder pain developed in 90% of them, and the right shoulder was significantly more painful than the left.¹

This kind of pain usually peaks on the first or second day after surgery and fades within about a week. Walking around helps the body reabsorb the gas faster, and gentle heat on the shoulder can ease the discomfort. A recent trial found that blocking the phrenic nerve before the gas was introduced dropped the incidence of this shoulder pain dramatically, though that technique is not yet standard practice everywhere.² If shoulder pain is intense, worsening after the first few days, or accompanied by shortness of breath, that picture changes and warrants prompt medical evaluation.

Ovarian Vein Thrombosis

One cause of right-sided pain that specifically favors the right is ovarian vein thrombosis, a blood clot that forms in the vein draining the ovary. The right ovarian vein is anatomically longer than the left and drains at a different angle, making it more prone to sluggish flow and clotting. This complication is most associated with the postpartum period, but it also occurs after hysterectomy and tends to show up within the first week or so after surgery.

In one reported case, a patient developed right ovarian vein thrombosis six days after laparoscopic-assisted vaginal hysterectomy, presenting with lower abdominal pain and intermittent fever.³ Another case following total laparoscopic hysterectomy was confirmed by CT scan showing a filling defect and enlargement of the right ovarian vein.⁴ The combination of right-sided abdominal or flank pain with fever in the first couple of weeks after hysterectomy should put ovarian vein thrombosis on the radar. Treatment typically involves blood thinners, and most patients recover well once the clot is addressed. Left untreated, the clot can extend into larger veins or, rarely, throw off a pulmonary embolus.

Adhesions and Scar Tissue

Any abdominal surgery creates the conditions for adhesions, bands of scar tissue that can form between organs, the abdominal wall, and the bowel. After hysterectomy, adhesions are a well-recognized cause of chronic pelvic pain, and if they happen to involve structures on the right side, that is where the discomfort lands.⁵

The pain from adhesions often has a particular quality. It tends to be worse with movement, stretching, or changes in position, and it can come in waves that mimic cramping. Researchers have proposed that adhesions tethering down the bowel are the type most likely to cause localized pain, because normal peristalsis pulls against the stuck tissue and tugs on the sensitive parietal peritoneum.⁶ This can produce symptoms that overlap with partial bowel obstruction: bloating, nausea, and intermittent sharp pains. Adhesions do not show up reliably on standard imaging, which makes them frustratingly hard to diagnose without a second look via laparoscopy.

If you had endometriosis, pelvic inflammatory disease, or prior abdominal surgeries before your hysterectomy, adhesion formation is more likely. The same factors that make the original surgery more difficult also seed the ground for more postoperative scarring.

Ovarian Remnant and Residual Ovarian Syndrome

These are two related but distinct conditions, and both can cause one-sided pelvic pain that starts weeks to years after hysterectomy. Residual ovarian syndrome occurs when one or both ovaries were intentionally left in place during the hysterectomy and later become a source of chronic pelvic pain, a pelvic mass, or pain during intercourse.⁷ The retained ovary may develop cysts, twist on its blood supply, or become encased in adhesions, any of which can generate persistent right-sided pain if it is the right ovary that was preserved.

Ovarian remnant syndrome is different. It happens when both ovaries were supposed to be removed but a small fragment of ovarian tissue was inadvertently left behind. Dense adhesions from endometriosis, prior pelvic infections, or earlier surgeries can make the ovary difficult to separate cleanly, and even a tiny piece of residual tissue can become functional and cystic.⁸ That fragment responds to hormonal signals, swells cyclically, and can produce pain that mimics the old menstrual cycle. In women with severe endometriosis and extensive pelvic adhesions, the recurrence of ovarian remnant syndrome has been documented even after what seemed like thorough removal.⁹

If your pain follows a cyclical pattern or if blood work shows premenopausal hormone levels despite having had both ovaries removed, ovarian remnant syndrome is worth investigating. Ultrasound or MRI can sometimes spot the remnant, and definitive treatment usually means another surgery to excise it.

Pelvic Hematoma and Vaginal Cuff Infection

A collection of blood in the pelvis after hysterectomy, known as a pelvic hematoma, can cause localized pain on whichever side it forms. Hematomas are especially common after vaginal hysterectomy and can become infected, which adds fever and worsening pain to the picture. In one study, all women with infected hematomas presented with lower abdominal pain, and the average time from surgery to diagnosis was about nine days.¹⁰ Most of the hematomas in that study were located above the vaginal cuff.

The vaginal cuff itself, the closed surgical site at the top of the vagina, can also be the source of trouble. Vault hematoma refers to blood pooling right at the cuff, and vault cellulitis is an infection of the cuff tissue. Both can present with pelvic pain and fever.¹¹ Infected pelvic hematomas after vaginal hysterectomy sometimes require surgical drainage on top of antibiotics.¹² The key signal that a simple hematoma has become infected is a new or worsening fever along with escalating pain, particularly if this happens in the one-to-two week window after surgery.

Nerve Entrapment

Surgeons working through a lower abdominal incision, particularly a transverse (bikini-line) cut, operate near the ilioinguinal and iliohypogastric nerves. These nerves run through the abdominal wall muscles and can be nicked, stretched, or caught up in scar tissue during closure. In a series of 23 patients with painful nerve entrapment following common lower abdominal surgeries, gynecologic procedures through transverse incisions were among the documented causes.¹³

Nerve entrapment pain has a distinctive character. It tends to be burning, shooting, or electric in quality and often worsens with certain movements like bending or twisting. The pain may radiate from the incision area down toward the groin or inner thigh on the affected side. If the surgeon’s port or incision was on the right, the right-sided nerves are the ones at risk. Nerve blocks can help confirm the diagnosis and sometimes provide lasting relief; in stubborn cases, surgical release of the trapped nerve is an option.

Ureteral Injury

The ureters, the tubes that carry urine from the kidneys to the bladder, pass very close to the uterus and its blood supply. This proximity puts them at risk during any hysterectomy, and injury to a ureter can produce flank or lower abdominal pain on the affected side. A Dutch analysis of ureteral injuries during laparoscopic hysterectomy found that, strikingly, only one injury out of dozens was recognized during the surgery itself. The average time to diagnosis was about a month.¹⁴

That delay matters. An injured ureter may become partially or completely blocked, causing urine to back up into the kidney. This produces pain in the flank or lower abdomen on the side of the injury, and it can progress to kidney infection. Some patients with post-hysterectomy ureteral injuries presented with full-blown sepsis and infected kidney fluid collections requiring emergency drainage.¹⁵ If you develop persistent right-sided flank pain, especially with fever, decreased urine output, or pain radiating to the groin, ureteral injury should be excluded with imaging.

Bowel Changes After Hysterectomy

Not all right-sided discomfort after hysterectomy is caused by a discrete complication. The surgery alters the pelvic anatomy and can affect nearby organs in subtler ways. After abdominal hysterectomy, patients have reported increased symptoms of gas incontinence, urgency to have a bowel movement, and difficulty distinguishing between gas and stool, though constipation rates did not go up significantly.¹⁶ These changes are thought to result from disruption of the nerve plexuses around the uterus that also serve the rectum and lower colon.

Altered bowel motility can produce crampy, intermittent pain that favors one side depending on which part of the colon is affected. Gas trapped in the ascending colon or cecum, both right-sided structures, can feel like a deep ache in the right lower abdomen. This kind of pain tends to fluctuate with meals and bowel movements and may respond to dietary adjustments, walking, and time as the pelvic nerves recover.

When the Cause Is Not Gynecologic at All

It is easy to attribute any new abdominal pain to a recent surgery, but sometimes the timing is coincidental. Appendicitis, gallbladder problems, kidney stones, and right-sided hernias can all produce right-sided pain that has nothing to do with the hysterectomy itself. There are case reports in the literature of acute appendicitis occurring within days of a laparoscopic hysterectomy, initially masked by expected postoperative pain. The surgical team, reasonably focused on hysterectomy-related complications, can miss an entirely unrelated problem if it is not on their radar.

Kidney stones deserve a special mention because the symptoms overlap with ureteral injury: flank pain, radiating groin pain, blood in the urine. If imaging was not done before the hysterectomy, a pre-existing stone could start causing trouble just as you are recovering, and the two get conflated. Any new right-sided pain that does not fit the expected recovery pattern should be evaluated on its own terms, not automatically chalked up to postoperative soreness.

When Acute Pain Becomes Chronic

Some women undergo hysterectomy specifically to treat chronic pelvic pain, and for many it helps. But pain can persist afterward. Research into persistent pelvic pain following hysterectomy has shown that it is a complex condition involving more than just the tissue that was removed. Ongoing input from peripheral sources like residual endometriosis can be amplified by sensitization of the nervous system itself, a process where the spinal cord and brain essentially turn up the volume on pain signals.¹⁷

This means that even after the uterus and any visible disease are gone, the nervous system may continue generating pain in the same location. If you had significant pain before surgery, or if the pain has been present for several months and none of the structural causes above have been found, central sensitization could be part of the picture. Treatment in these cases shifts away from surgical thinking and toward approaches that address the nervous system directly, including physical therapy, nerve-targeted medications, and sometimes pain psychology programs.

How Doctors Figure Out the Cause

The diagnostic workup for right-sided pain after hysterectomy usually starts with the basics: a physical exam, blood work looking for signs of infection or inflammation, and urinalysis to check for urinary tract involvement. Imaging comes next. Ultrasound is typically the first-line tool for evaluating the pelvis after gynecologic surgery, with MRI and CT used for more detailed assessment.¹⁸ CT scans are especially useful for spotting hematomas, abscesses, ovarian vein thrombosis, and ureteral obstruction. MRI gives the best soft-tissue detail and is the preferred tool when ovarian remnant syndrome or subtle adhesion-related problems are suspected.¹⁹

Timing matters for choosing the right test and the right level of urgency. Pain with fever in the first two weeks after surgery needs prompt evaluation, usually with CT, because hematoma infection, ureteral injury, and ovarian vein thrombosis all demand quick treatment. Pain that starts weeks to months later may warrant a more methodical approach, starting with ultrasound and blood work before proceeding to more advanced imaging. And if structural causes are ruled out, the evaluation shifts toward functional and neurological explanations. Nerve conduction studies can help identify entrapment, and a trial of targeted nerve blocks can be both diagnostic and therapeutic.

Positioning Injuries and Muscle Strain

One underappreciated cause of postoperative pain is purely mechanical. During surgery, you are positioned in ways you would never hold yourself while awake, often with legs elevated in stirrups and the body tilted. These positions can strain muscles, compress nerves, and leave you with pain that feels like something went wrong internally when the problem is actually in the abdominal wall or hip. Right-sided muscle pain from retractor pressure or prolonged positioning typically improves steadily over the first couple of weeks, responds to gentle stretching and anti-inflammatory medication, and does not come with fever or other systemic signs. If your right-sided pain feels muscular, is worst when you use your core or change positions, and is gradually getting better, positioning strain is likely.