Pain located under the ribs on the right side, known as right upper quadrant (RUQ) pain, often prompts concern, especially when it worsens while lying down. This discomfort can stem from various issues, ranging from minor causes to conditions requiring prompt medical attention. The position of the pain provides a direct clue to the organs and structures that may be involved.
Understanding the Upper Right Quadrant
The upper right quadrant (RUQ) of the abdomen is situated beneath the right rib cage and houses several internal organs. The largest structure here is the liver, which occupies a substantial portion of the space. Tucked beneath the liver is the gallbladder, a small organ responsible for storing bile.
Portions of the digestive tract, specifically the duodenum and the hepatic flexure of the large intestine, also pass through this quadrant. Additionally, the right kidney and the right adrenal gland are positioned toward the back, partially protected by the lower ribs. The diaphragm, the muscle responsible for breathing, forms the roof of this area, separating the abdomen from the chest cavity.
Benign Causes Exacerbated by Lying Down
Several common, temporary causes of discomfort are specifically aggravated by adopting a supine position. One frequent culprit is trapped intestinal gas, which can accumulate in the hepatic flexure of the colon beneath the liver. Lying down allows gas bubbles to press against the abdominal wall, intensifying the sensation of a dull ache or sharp, temporary pain.
Another possibility is musculoskeletal strain, such as costochondritis, an inflammation of the cartilage connecting the ribs to the breastbone. Resting flat can stretch the chest muscles and ribs, placing pressure on the inflamed cartilage and making the tenderness more noticeable. Gastroesophageal Reflux Disease (GERD) is also a factor, as lying flat makes it easier for stomach acid to flow backward into the esophagus. This acid irritation is typically felt as burning chest pain, but the discomfort can sometimes localize as a dull ache under the right ribs, especially at night.
Internal Organ Conditions Requiring Evaluation
Pain in the upper right quadrant can signal more chronic or serious conditions involving the organs housed there, which necessitate a professional diagnosis. Gallbladder issues, such as gallstones or inflammation (cholecystitis), are among the most frequent causes of intense RUQ pain. This pain is often colicky or cramp-like, typically starting suddenly and sometimes radiating to the back or the right shoulder blade, especially after eating a fatty meal.
Conditions affecting the liver, such as hepatitis or fatty liver disease, can cause a persistent, dull ache as the organ swells and stretches its surrounding capsule. Issues with the right kidney, including kidney stones or a kidney infection, can also manifest as pain in the RUQ. Kidney pain is often described as severe and may wrap around the side and back toward the groin.
Warning Signs and When to Seek Help
While mild, fleeting pain often resolves on its own, certain accompanying symptoms, or “red flags,” indicate the need for urgent medical care. Severe, sudden-onset pain that is debilitating and does not subside requires immediate professional evaluation. This acute pain may signal a serious event, such as a blocked bile duct or acute inflammation.
Other alarming signs that require a comprehensive medical workup include:
- A high fever or chills, which can point to a systemic infection like acute cholecystitis or pyelonephritis.
- The presence of jaundice, a yellowing of the skin or the whites of the eyes, indicating liver or bile duct dysfunction.
- Persistent nausea or repeated vomiting.
- Pain accompanied by blood in the urine or stool.