Pain under the right ribs when breathing can arise from a variety of sources. This discomfort, often noticed during inhalation or movement, might indicate issues ranging from simple muscle strain to more complex conditions involving internal organs. Understanding the possible origins of this pain is important for recognizing when medical attention may be beneficial.
Musculoskeletal and Respiratory Factors
Pain under the right ribs during breathing often stems from the musculoskeletal system, involving the chest wall, muscles, and diaphragm. Costochondritis, an inflammation of the cartilage connecting the ribs to the breastbone, is a common cause. This condition can cause sharp or dull pain that worsens with deep breathing, coughing, or twisting movements, and tenderness may be felt when pressing on the affected area. Intercostal muscle strains, injuries to the muscles between the ribs, can result from overexertion, sudden movements, or vigorous coughing. This pain is sharp and aching, worsening with breathing or torso movements.
Rib fractures or bruises also lead to significant pain under the right ribs, especially during breathing, coughing, or movement. Such injuries can cause tenderness, swelling, or a feeling of a crack. The diaphragm, a muscle crucial for breathing located beneath the rib cage, can also be a source of pain if it experiences spasms or irritation. These spasms can feel like cramps, tightness, or a piercing sensation, often exacerbated by deep breaths.
Respiratory conditions affecting the lungs or their surrounding membranes can also manifest as pain in this area. Pleurisy, an inflammation of the pleura (the lining around the lungs), causes sharp, stabbing chest pain that intensifies with deep breathing, coughing, or sneezing. This pain may also spread to the shoulder or back. Lung infections like pneumonia or bronchitis can inflame lung tissue or the pleura, resulting in pain that worsens with breathing.
Internal Organ Considerations
The upper right abdominal quadrant houses several vital organs, and issues with these can cause pain that radiates to or is felt directly under the right ribs, especially when breathing. The gallbladder, located beneath the liver, is a frequent source of discomfort. Gallstones (cholelithiasis) or gallbladder inflammation (cholecystitis) can cause sharp, intense pain in the upper right abdomen that may spread to the right shoulder or back. This pain often intensifies after fatty meals and can worsen with deep breathing.
The liver, also under the right ribs, can cause pain when inflamed or enlarged. Hepatitis (inflammation of the liver) can lead to a dull or aching pain in the upper right side of the belly. Liver pain can also be felt in the back, shoulders, or neck. An enlarged liver can push against the surrounding membrane, causing discomfort.
While often felt in the back or flank, right kidney issues like kidney stones or infections (pyelonephritis) can sometimes cause pain radiating to the front under the ribs. Various gastrointestinal problems can also cause referred pain to this area. Acid reflux (GERD) or peptic ulcers can sometimes lead to upper right abdominal discomfort. Pancreatitis, an inflammation of the pancreas, can also cause upper abdominal pain that may radiate to the right rib area or back.
When to Seek Medical Attention
Knowing when pain under the right ribs warrants medical evaluation is important. Seek medical attention if the pain is severe, persistent, or not relieved by over-the-counter remedies.
Immediate medical care is necessary if the pain is sudden and severe, or accompanied by shortness of breath, chest tightness, or a rapid heart rate. Other warning signs include fever, chills, persistent coughing, jaundice, unexplained weight loss, or vomiting. Pain radiating to the arm or jaw, or signs of shock, also necessitate urgent evaluation. Individuals with pre-existing heart, lung, or liver disease should consult a healthcare provider promptly if they experience this type of pain.
What to Expect at the Doctor
When visiting a healthcare provider for pain under the right ribs, diagnosis typically begins with a thorough medical history and physical examination. The doctor will ask detailed questions about the pain’s onset, characteristics (sharp, dull, constant), and factors that make it better or worse. A physical exam involves palpating the painful area for tenderness, swelling, or muscle spasms, and listening to your lungs and heart.
Based on this initial assessment, the doctor may order diagnostic tests to pinpoint the cause. Blood tests can check for infection, inflammation, liver, or kidney function. Imaging tests visualize internal structures. These may include an abdominal ultrasound (often the first choice for evaluating the gallbladder and liver), or a CT scan of the chest or abdomen.
An X-ray might check for rib fractures or lung abnormalities. If heart issues are suspected, an electrocardiogram (ECG) may be performed. Once diagnosed, management typically involves addressing the underlying cause, ranging from rest and pain relievers for musculoskeletal issues to specific medications for infections or organ-related conditions.