Can You Get a Hernia Under Your Ribs?

Hernias can and do develop under, between, and immediately below the ribs. While most people associate hernias with the groin or the belly button, the upper abdomen and lower chest wall have their own vulnerable spots where tissue, fat, or even loops of intestine can push through. Several distinct types of hernia occur in the rib area, each with different causes, symptoms, and surgical considerations. Some are surprisingly common; others are genuinely rare and easy to miss on initial examination.

Epigastric Hernias Sit Just Below the Breastbone

The most familiar “under the ribs” hernia is the epigastric hernia. It forms along the midline of the upper abdomen, between the bottom of the breastbone (the xiphoid process) and the navel. A small gap opens in the tough connective tissue that runs down the center of your abdominal muscles, and fat or occasionally a piece of organ bulges through. Epigastric hernias account for roughly two to four percent of all abdominal hernias, and they show up more often in men and in people who are overweight.¹ Other risk factors include chronic coughing and constipation, both of which raise pressure inside the abdomen repeatedly over time.

Many epigastric hernias are small and contain nothing more than a plug of fatty tissue. A large fraction produce no symptoms at all and are found incidentally during imaging for something else.² When they do cause symptoms, people usually describe a tender lump in the upper belly, sometimes with a pulling sensation when straining or bending forward. Rarely, a larger epigastric hernia can trap a piece of stomach or bowel and cause more serious problems like nausea, vomiting, or obstruction.¹

Intercostal Hernias Push Between the Ribs Themselves

A rarer and more dramatic variety is the acquired abdominal intercostal hernia, where abdominal contents push upward through a gap in the muscles and tissue between two ribs. In a systematic review of published cases, the most common location was beneath the ninth rib, and the cause was traumatic injury about two-thirds of the time, with previous surgery accounting for another fifth of cases.³ The typical symptom is a visible swelling on the chest wall, reported in about 85 percent of cases, frequently accompanied by discomfort or pain.

How does abdominal tissue end up between the ribs? The lowest ribs (the “floating” ribs and the cartilage tips of ribs 8 through 10) are not anchored as firmly as the upper ribs. When a forceful blow, a car accident, or even sustained violent coughing damages the muscle and fascial layers that normally seal the space between two lower ribs, the pressure inside the abdomen can drive fat or bowel into the gap. One reported case involved an 85-year-old woman who developed a transdiaphragmatic intercostal hernia after blunt trauma from a motor vehicle accident, with loops of small intestine herniating through a ruptured diaphragm and chest wall defect.⁴ Another case described a 51-year-old woman who arrived at the emergency room with a painful swelling between her left 10th and 11th ribs.⁵

Although most intercostal hernias are uncomfortable rather than dangerous, the systematic review noted that acute complications like incarceration (tissue getting stuck) or strangulation (blood supply getting cut off) did occur in a small number of patients.³ These are surgical emergencies, so any new, painful, firm lump between the lower ribs that cannot be pushed back in deserves prompt medical attention.

Coughing as a Surprising Trigger

Trauma from falls or car accidents is the leading cause, but intercostal hernias can also develop from something as mundane as a severe coughing fit. One documented case involved a woman whose intercostal hernia was triggered by coughing, and who had several compounding risk factors: obesity, chronic obstructive pulmonary disease, oral steroid use, and diabetes.⁶ Steroids thin connective tissues over time, obesity raises abdominal pressure, and COPD produces chronic forceful coughing. When these factors stack up, the tissue between the lower ribs can give way even without a direct blow.

In a related but distinct phenomenon, lung tissue itself can herniate through a chest wall defect. A reported case described a 40-year-old man with asthma and a history of chest trauma whose lung bulged through the third intercostal space after five consecutive days of vigorous coughing.⁷ Lung herniations are even rarer than abdominal intercostal hernias, but they illustrate the same principle: the rib cage is not an impenetrable cage, and sustained pressure can exploit any weak point.

Subcostal Incisional Hernias After Surgery

If you have had an operation that involved a cut along or just below the rib margin (common in gallbladder removal through an open incision, liver surgery, kidney surgery, or certain cardiac procedures), a hernia can develop at the scar site. These subcostal incisional hernias sit right under the costal margin and present unique surgical challenges. The bony rib cage immediately above them makes it difficult to achieve a secure repair because the mesh or sutures have limited soft tissue to anchor to on the upper side of the defect.⁸

Diagnosis typically relies on a physical examination combined with imaging. CT scans performed while the patient bears down (a Valsalva maneuver) can reveal defects that are invisible when the abdominal wall is relaxed.⁹ Because the behavior and anatomy of these hernias varies from person to person, there is no single standardized approach to fixing them. Surgeons have to adapt the repair strategy to each patient’s anatomy.⁸

Morgagni Hernias and the Diaphragm

The diaphragm sits right under the ribs, separating the chest from the abdomen, and hernias can form through it as well. The Morgagni hernia is a congenital type that occurs at the front of the diaphragm, near the junction of the rib cage and the breastbone. It is the least common form of congenital diaphragmatic hernia. In a series of seven children with Morgagni hernias across three pediatric centers, all had respiratory symptoms like coughing, and imaging showed gas-filled bowel loops sitting above the diaphragm in the chest.¹⁰

Although Morgagni hernias are present from birth, they sometimes go undetected until adulthood. A person can live for decades with a small defect that gradually allows more abdominal content to migrate into the chest. Symptoms, when they finally appear, tend to be respiratory (shortness of breath, recurrent chest infections) rather than the typical pain-and-lump picture of an abdominal wall hernia, which is why the diagnosis is often delayed or initially mistaken for a lung problem.

What Makes the Sub-Rib Area Structurally Vulnerable

The abdominal wall is not a uniform sheet of muscle. It is a layered structure with natural lines of weakness, and these layers thin out and transition at the edges where they meet the rib cage, the pelvis, and the spine. The lateral abdominal wall in particular presents reconstructive challenges because the defects border the rib cage, the diaphragm, and the retroperitoneum, meaning any repair has to be anchored to bony or cartilaginous structures that do not behave like soft tissue.¹¹ A functional abdominal wall does more than hold your organs in; it contributes to breathing, coughing, core stability, and even bladder control.¹² When any of these structural layers is compromised near the ribs, the result is not just a cosmetic bulge but a loss of mechanical function that can affect everyday activities.

Spigelian hernias, though rare, further illustrate how the abdominal wall’s design creates pockets of vulnerability. These form along a curved line on the side of the abdomen where the muscle layers transition to tendon-like tissue, sometimes at or near the level of the lower ribs. They carry a high risk of incarceration, likely because the defects are small and tightly bordered by firm tissue, which can pinch whatever slips through.¹³

How These Hernias Are Found

Many sub-rib hernias are first suspected from a physical exam: a doctor feels or sees a bulge that changes size when you cough, strain, or lie down. But physical exam alone can miss smaller hernias, especially in people with a larger body habitus or hernias that sit deep under the rib margin. CT scanning is the standard imaging tool, and performing the scan while the patient performs a Valsalva maneuver (bearing down as if straining) increases the chances of catching a hernia that reduces when the patient relaxes.

Dynamic ultrasound is another option that has shown strong diagnostic performance. One study evaluating dynamic abdominal sonography for hernia detection found a sensitivity of 98 percent and a specificity of 88 percent, and the technique identified hernias in four patients whose CT scans had been read as normal.¹⁴ Ultrasound lets the examiner watch the abdominal wall in real time as you cough or strain, which makes it especially useful for subcostal and lateral wall hernias that pop in and out.

When It Is Not a Hernia at All

Pain or a strange sensation under the ribs does not always mean a hernia, and a few conditions mimic the presentation closely enough to cause confusion. Slipping rib syndrome involves hypermobility of the cartilage at the tip of one of the lower ribs. The loose cartilage catches on the rib above it, irritating the intercostal nerve trapped in between. The result is a burning pain in the lower chest or upper abdomen that can be severe and disabling.¹⁵ Unlike a hernia, slipping rib syndrome does not produce a visible bulge, and imaging usually looks normal because the problem is in the cartilage and nerve rather than in a hole in the muscle wall. The diagnosis is often clinical: a doctor hooks a finger under the lower rib margin and reproduces the pain by pulling the rib forward.

Intercostal neuralgia, or pain along the course of a rib nerve, is another mimic. It produces sharp, burning, or aching pain that follows the path of a single rib and may wrap around from the back to the front. It can be caused by prior surgery, shingles, or trauma. While the pain can be intense, there is no structural defect in the abdominal wall and no risk of bowel complications. Gallbladder disease, costochondritis (inflammation where the ribs join the breastbone), and musculoskeletal strains also belong on the list of look-alikes. If you have upper abdominal or lower chest wall pain and no obvious lump, these conditions are worth considering before assuming a hernia is responsible.

Why Surgical Repair Near the Ribs Is Tricky

Fixing a hernia in the groin or around the navel follows well-established playbooks. Subcostal and intercostal hernias are more technically demanding because the rigid rib cage limits how far the surgeon can extend the repair. Standard mesh placement relies on overlapping the mesh well beyond the edges of the defect on all sides, but when one edge borders bone or cartilage, that overlap is constrained.

Surgeons have responded with creative solutions. In subcostal repairs, some teams use medical adhesive sprayed onto the mesh surface to fix it against the undersurface of the ribs where tacks or sutures would be impractical, combining adhesive in the area above the costal margin with traditional tacks below it.⁹ Others performing laparoscopic repair of large incisional hernias extending to the subcostal region have used a technique where the upper portion of the mesh is simply draped over the liver surface without being tacked down, relying on intra-abdominal pressure to hold it in place.¹⁶

For lateral abdominal wall defects near the ribs, the reconstruction has to account for the attachment points of the diaphragm, the rib cage, and the spine, creating a three-dimensional puzzle that flat mesh alone cannot solve. The repair needs to stabilize the wall by anchoring it to non-yielding structures at the anatomic borders far beyond the visible defect.¹¹ These operations often require collaboration between general surgeons and plastic or thoracic surgeons.

Bulge Versus Full-Thickness Defect

Not every bulge near the ribs is a true hernia. The lateral abdominal wall can develop what is called myofascial laxity: the muscle and its covering stretch and thin out without actually tearing open. The result is a visible bulge, sometimes large, but without a discrete hole through which organs could slip and become trapped.¹¹ This can happen after surgery, after trauma, or as a result of nerve damage during an operation (the denervated muscles lose tone and balloon outward). The distinction matters because laxity alone carries a lower risk of the dangerous complications associated with true hernias, like strangulation, and the management strategy can be quite different. Imaging helps sort out whether the wall is stretched or actually broken.

If you notice a new, soft bulge along your rib margin that changes size when you strain, it is worth getting it evaluated even if it is not painful. Many sub-rib hernias are asymptomatic early on and only become problematic as they enlarge. On the other hand, if you have pain in the area without a visible bulge, the issue may not be a hernia at all, and conditions like slipping rib syndrome or musculoskeletal strain are more likely culprits. Either way, a hands-on examination supplemented by appropriate imaging will give you a clearer answer than worrying at home.

1
PubMed Central. Epigastric anterior abdominal wall hernia: An unusual cause of gastric outlet obstruction
2
PubMed. Pathogenesis of the epigastric hernia
3
PubMed. Acquired abdominal intercostal hernia: case report and systematic review of the literature
4
PubMed. Transdiaphragmatic intercostal hernia following blunt trauma
5
PubMed Central. Acquired abdominal intercostal hernia: a case report and literature review
6
PubMed Central. Non traumatic acquired acute transdiaphragmatic intercostal hernia induced by coughing
7
PubMed Central. Intercostal lung herniation–the role of imaging
8
British Journal of Surgery. ENDOSCOPIC RETROMUSCULAR MESH REPAIR OF SUBCOSTAL INCISIONAL HERNIA-OUR EXPERIENCE AND EARLY OUTCOME
9
PubMed. The application of n-butyl-2-cyanoacrylate (NBCA) medical adhesive for IPOM mesh fixation in subcostal hernia repair: a retrospective study
10
PubMed Central. Morgagni hernia: an unexpected cause of respiratory complaints and a chest mass
11
PubMed Central. Lateral abdominal wall reconstruction
12
PubMed Central. Novel Technique for Innervated Abdominal Wall Vascularized Composite Allotransplantation: A Separation of Components Approach
13
PubMed. Laparoscopic Transabdominal Preperitoneal Approach Using Self-Fixating Mesh for Spigelian Hernia Repair: A Case Series Study of Four Patients
14
PubMed. Comparative Effectiveness of Dynamic Abdominal Sonography for Hernia vs Computed Tomography in the Diagnosis of Incisional Hernia
15
PubMed Central. A new sign of the slipping rib syndrome?
16
PubMed Central. Laparoscopic and percutaneous repair of a large midline incisional hernia extending to the bilateral subcostal region: A case report