Pain on the right side under the ribs when coughing can be a concerning symptom. This discomfort can arise from a diverse range of underlying conditions, from minor issues resolving with rest to more significant health problems requiring medical attention. This article provides general information on potential causes and appropriate actions to consider.
Potential Causes
Musculoskeletal Issues
Musculoskeletal issues frequently contribute to pain on the right side under the ribs. A common culprit is intercostal muscle strain, involving the muscles located between the ribs. These muscles can become stretched or torn due to forceful or prolonged coughing, leading to sharp or aching pain that intensifies with movement or deep breaths. Another possibility is a rib fracture, which might occur from direct trauma, though severe, persistent coughing can also stress and fracture a rib, causing localized, sharp pain exacerbated by respiratory movements.
Costochondritis
Inflammation of the cartilage connecting the ribs to the breastbone, a condition known as costochondritis, can also manifest as pain in this region. This inflammation typically causes tenderness when pressure is applied to the affected cartilage and can worsen with coughing or deep breathing. The pain from costochondritis is often described as sharp or aching, frequently localized to the upper chest or rib cage.
Respiratory Conditions
Respiratory conditions are directly linked to pain experienced during coughing. Pleurisy, an inflammation of the pleura—the two large, thin layers of tissue that separate the lungs from the chest wall—can cause sharp, stabbing pain that worsens with breathing, sneezing, or coughing. Conditions such as pneumonia or acute bronchitis, which involve inflammation or infection of the lung tissue or airways, can also lead to chest pain that intensifies with coughing due to the associated inflammation and irritation.
Severe and Prolonged Coughing
Severe and prolonged coughing fits themselves can also induce or exacerbate pain in the right rib area. The repetitive, forceful contractions of the abdominal and chest muscles can lead to muscle fatigue, soreness, or even minor muscle tears. This mechanical stress on the chest wall structures can result in a generalized ache or sharp pains that are directly triggered by each cough. This type of pain often subsides as the coughing lessens and the muscles recover.
Digestive System Problems
Digestive system problems can sometimes refer pain to the right upper quadrant, which may be aggravated by the abdominal pressure changes during coughing. Gastroesophageal reflux disease (GERD), for instance, involves stomach acid flowing back into the esophagus, which can cause heartburn and chest pain that might be perceived in the rib area. The physical act of coughing can sometimes increase intra-abdominal pressure, pushing acid higher and intensifying the discomfort.
Gallstones, small hardened deposits that form in the gallbladder, can cause sudden, intense pain in the upper right abdomen that might radiate to the back or shoulder blade. This pain, often occurring after fatty meals, can sometimes be exacerbated by movements like coughing. Irritable bowel syndrome (IBS) can also cause abdominal discomfort, bloating, and cramping, which can sometimes include the right upper quadrant and be worsened by muscle contractions from coughing.
Liver and Gallbladder Concerns
Liver and gallbladder concerns represent another category of potential causes for pain in this region. Hepatitis, an inflammation of the liver, can lead to a dull ache or tenderness in the upper right abdomen, where the liver is located. This discomfort might become more noticeable with physical exertion or pressure, including the movements associated with coughing. Cholecystitis, which is inflammation of the gallbladder, typically causes severe pain in the upper right abdomen that can radiate to the right shoulder or back. This pain often intensifies after meals and can be aggravated by deep breaths or the jarring motion of a cough.
When to Seek Medical Attention
Seeking medical attention is advisable if the pain on the right side under the ribs when coughing is severe, persistent, or accompanied by other concerning symptoms.
Immediate evaluation is warranted if you experience:
Sudden and sharp pain, especially if it makes breathing difficult or is associated with shortness of breath.
A high fever, chills, or a persistent cough that produces discolored sputum.
Coughing up blood, unexplained weight loss, or yellowing of the skin or eyes (jaundice).
Pain accompanied by dizziness, fainting, or signs of shock.
Diagnostic Process
Medical History
When evaluating pain on the right side under the ribs, a healthcare professional typically begins with a thorough medical history. This involves asking detailed questions about when the pain started, its specific characteristics, what makes it worse or better, and any associated symptoms. This initial conversation helps narrow down potential causes and guides the subsequent examination.
Physical Examination
Following the medical history, a physical examination is performed, focusing on the chest and abdomen. The doctor will likely palpate the rib cage and abdomen to check for tenderness, swelling, or masses. They will also listen to lung sounds using a stethoscope to detect any abnormalities, and assess heart and abdominal sounds.
Diagnostic Tests
To further investigate the cause, various diagnostic tests may be ordered. An X-ray of the chest can help identify rib fractures, pneumonia, or other lung abnormalities. If more detailed imaging is needed, a computed tomography (CT) scan of the chest or abdomen might be performed. An ultrasound of the abdomen is often used to visualize the gallbladder, liver, and bile ducts. Blood tests may also be conducted to check for signs of infection, inflammation, or liver and gallbladder function.
Supportive Measures
While awaiting or after medical consultation, several supportive measures can help manage the discomfort. These include:
Resting and avoiding activities that exacerbate the pain to help reduce strain on the affected area.
Applying a warm compress or a cold pack to the painful region for relief, particularly if the pain is musculoskeletal in origin.
Using over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or acetaminophen, to help reduce pain and inflammation.
Performing gentle stretching exercises, if not painful, to alleviate muscle tension in the chest wall.
Supporting the rib cage with a pillow or a firm hand when coughing to minimize jarring impact and reduce pain intensity.
Staying hydrated and avoiding irritants like smoke to support overall respiratory health.
These measures are intended for symptomatic relief and do not address the underlying cause of the pain, underscoring the importance of professional medical diagnosis and treatment.