The sternum, commonly known as the breastbone, is a flat, dagger-shaped bone positioned in the center of the chest. It serves as an anchor point for the ribs and helps protect the heart and lungs. Understanding the structures located directly beneath this bone can help clarify sensations experienced in that area. This article explores the anatomy of the region below the sternum, common reasons for discomfort, and indicators for seeking professional medical advice.
Structures Located Beneath the Sternum
Directly below the sternum lies the xiphoid process, a small, cartilaginous extension at the bottom tip of the breastbone. While initially cartilage, it typically ossifies into bone between ages 5 and 18, sometimes continuing up to age 60. Just beneath the xiphoid process, the diaphragm, a dome-shaped muscle, separates the chest and abdominal cavities. It plays a central role in respiration, contracting during inhalation to pull air into the lungs.
Several upper digestive organs are near or partially beneath the sternum. The esophagus, a muscular tube, transports food from the mouth to the stomach, passing through the diaphragm at the tenth thoracic vertebra. The stomach is largely positioned just below and slightly left of the sternum, with its upper part extending behind the lower sternum. The left lobe of the liver, involved in metabolic functions, can also extend into this area.
The pancreas, located behind the stomach, contributes digestive enzymes and hormones. Pancreatic issues can cause pain radiating to the central upper abdomen, sometimes described as a deep ache spreading to the back. The gallbladder, beneath the liver, stores bile and can also refer pain below the sternum. While the heart is primarily behind the sternum, its lower portion can contribute to sensations in this vicinity. Muscles and connective tissues, including parts of the rectus abdominis and intercostal muscles, also form the wall directly beneath the sternum.
Common Causes of Discomfort in the Area
Discomfort below the sternum often stems from digestive issues. Heartburn (acid reflux or GERD) occurs when stomach acid flows back into the esophagus, causing a burning sensation behind the breastbone. Indigestion (dyspepsia) includes fullness, bloating, or mild upper abdominal pain, often after eating. Gastritis, an inflamed stomach lining, can cause gnawing or burning pain in the upper abdomen, potentially below the sternum. Ulcers, sores in the stomach or duodenum lining, manifest as burning or dull pain in this area, often worse on an empty stomach.
Musculoskeletal issues are another common source of pain. Costochondritis, inflammation of cartilage connecting ribs to the sternum, causes sharp or aching pain worsening with deep breaths, coughing, or pressure. This pain often affects the left side of the breastbone or multiple ribs. Muscle strains from coughing, lifting, or exercise can cause localized pain in chest wall muscles around and below the sternum. This pain intensifies with movement or specific postures and can be sharp or blunt.
Anxiety and stress can cause physical sensations in the chest and upper abdomen. These feelings might include tightness, pressure, or a generalized ache below the sternum, sometimes with shortness of breath or a rapid heart rate. This chest tightness can be localized or migratory, described as sharp, stabbing, or burning.
Less common but significant causes of referred pain to this region include gallstones and pancreatitis. Gallstones, hardened deposits in the gallbladder, cause sudden, severe upper right abdominal pain that may spread to the center of the abdomen, below the breastbone, or to the right shoulder blade. Pancreatitis, an inflamed pancreas, results in severe upper abdominal pain often radiating to the back and felt below the sternum, described as deep, aching, or cramping.
When to Seek Medical Attention
While many causes of discomfort below the sternum are not life-threatening, some symptoms require prompt medical evaluation. Seek immediate medical attention for severe or crushing chest pain, especially if it spreads to your arm, jaw, or back. Other emergency symptoms include sudden shortness of breath, dizziness, sweating, or nausea accompanying the pain. Pain that is sudden and extremely severe, or worsens with physical exertion, also warrants an emergency visit. Persistent vomiting or black, tarry stools, indicating internal bleeding, require urgent medical attention.
Consult a doctor if your discomfort is persistent, worsens, or significantly interferes with daily activities. Unexplained weight loss, difficulty swallowing, or pain that wakes you from sleep are also reasons to seek professional medical advice. A healthcare provider can accurately diagnose your symptoms through examination and diagnostic tests. This information is general guidance and not a substitute for professional medical consultation.