Pain beneath the right rib cage, medically known as the right upper quadrant or flank, can originate from the skeletal, digestive, respiratory, and nervous systems that converge in this region. Understanding the source requires considering if the pain relates to movement, breathing, digestion, or nerve pathways. This information is for educational purposes and is not a substitute for professional medical evaluation.
Musculoskeletal and Chest Wall Issues
Pain related to the physical structure of the rib cage is frequently a localized issue, often triggered by movement or pressure. A common cause is costochondritis, which is an inflammation of the cartilage connecting the ribs to the breastbone. This condition typically causes tenderness when pressed, with a sharp or aching pain that can worsen with deep breathing or physical activity.
A strain of the intercostal muscles, located between the ribs, can also cause sharp pain in the right side. This injury often results from strenuous activity, sudden twisting motions, or forceful coughing. The pain from a muscle strain is highly specific, localized between two ribs, and intensifies during movements like bending or sneezing.
Traumatic injuries, such as bruised or fractured ribs, cause strong, localized pain that is tender to the touch. With a rib fracture, the pain is particularly aggravated by deep inhalation or coughing, which can lead to shallow breathing to avoid discomfort. While a bruised rib may take a few weeks to heal, a fracture carries a risk of injury to underlying organs.
Digestive Organ Causes
The liver and the gallbladder, lying directly beneath the right rib cage, are frequent sources of right-sided rib pain. Gallbladder problems, such as gallstones or inflammation (cholecystitis), are common causes. Gallstones are hardened deposits that can block bile ducts, leading to pressure buildup and intense pain.
This gallbladder pain is often described as colicky, meaning it comes in waves, and is typically triggered after eating a large or fatty meal. Fat ingestion stimulates the gallbladder to contract and release bile. If a stone obstructs the flow, the contraction causes sharp pain in the upper right abdomen that may also radiate to the back or the right shoulder blade.
The liver, which sits mostly under the right rib cage, can also cause discomfort, though the sensation is often different. Liver tissue itself does not contain pain-sensing nerves, but it is encased in a fibrous membrane called Glisson’s capsule. Conditions like hepatitis, fatty liver disease, or liver enlargement can cause the organ to swell, stretching this capsule.
This stretching results in a dull, persistent ache or a feeling of uncomfortable fullness beneath the right ribs. Unlike the sharp, post-meal pain of gallbladder issues, liver-related pain tends to be a steady, mild aching sensation. This discomfort signals underlying liver pathology and requires medical investigation.
Pulmonary and Breathing-Related Issues
The respiratory system can cause right rib pain when the lining surrounding the lungs becomes irritated or infected. Pleurisy is an inflammation of the pleura, the membranes separating the lungs from the chest wall. When inflamed, these layers rub against each other instead of gliding smoothly during respiration.
This friction causes a sharp, stabbing pain known as pleuritic chest pain. The pain is severely aggravated by movements that expand the chest cavity, such as deep breathing, coughing, or sneezing. Patients often adopt shallow, rapid breathing patterns to minimize movement.
Infections like lower lobe right-sided pneumonia can cause pleurisy as a complication, localizing pain near the lower right ribs. This sharp, breathing-dependent pain is typically accompanied by symptoms of infection, including fever, a cough that may produce mucus, and shortness of breath.
Distinguishing pleuritic pain from musculoskeletal pain is important for diagnosis. While both worsen with deep breathing, pleuritic pain is not usually tender to the touch. Musculoskeletal issues, such as muscle strains, are often sore when pressed directly.
Referred Pain and Systemic Conditions
Pain felt in the right rib area that originates elsewhere is called referred pain. The right kidney is situated in the flank, partially shielded by the lower ribs, and its disorders manifest as pain in this region. Kidney stones, for instance, often start pain in the back or side and radiate toward the abdomen and groin as the stone moves down the urinary tract.
This pain, known as renal colic, is sharp and comes in fluctuating waves of intensity. A kidney infection (pyelonephritis) also causes pain beneath the lower ribs or in the flank. This is usually accompanied by systemic symptoms like fever, chills, and painful or frequent urination, distinguishing it from digestive issues.
Shingles is a viral infection caused by the reactivation of the varicella-zoster virus. The virus travels along nerve pathways, and when it affects the intercostal nerves between the ribs, it causes burning or shooting pain. This pain may precede the characteristic blistering rash by several days, making initial diagnosis challenging.