Pain under the right ribs is a common concern, arising from various sources within the upper right abdomen. This region houses several organs, meaning the pain could stem from a minor issue or indicate a more serious underlying condition. While many causes are not severe, some require prompt medical evaluation for accurate diagnosis and treatment.
Understanding the Anatomy Behind the Pain
The right rib cage protects several organs in the upper right abdomen. The liver, involved in blood detoxification and bile production, occupies a significant portion of this area, just beneath the diaphragm. The gallbladder, which stores bile, is found directly under the liver. Other structures in this region include the head of the pancreas, parts of the large and small intestines, the right kidney, and the diaphragm. Issues with any of these organs or surrounding musculoskeletal structures, such as the ribs and intercostal muscles, can manifest as pain in the right upper abdomen.
Common and Less Severe Causes of Right Rib Pain
Pain under the right ribs can often be attributed to common, less severe conditions.
One frequent cause is muscle strain or injury to the intercostal muscles, located between the ribs. This type of strain can result from physical activity, vigorous coughing, or direct trauma, causing sharp, localized pain that may worsen with deep breathing or movement.
Costochondritis involves inflammation of the cartilage that connects the ribs to the breastbone, leading to tenderness and pain in the chest area, which can extend to the right side. The pain from costochondritis often intensifies with deep breaths, coughing, sneezing, or pressure on the chest. While typically affecting the left side, it can also manifest on the right.
Digestive discomfort, such as gas and indigestion, commonly causes pain or pressure in the abdomen, including the right upper quadrant. This discomfort can present as sharp, stabbing pains or dull aches and may be accompanied by bloating.
Acid reflux (GERD) occurs when stomach acid flows back into the esophagus, causing a burning sensation in the chest that can be felt under the right ribs. Other symptoms can include nausea, vomiting, and a sore throat.
Constipation, characterized by infrequent or difficult bowel movements, can result in abdominal pain and discomfort, sometimes localized to the right upper abdomen as gas and stool get trapped.
Irritable Bowel Syndrome (IBS), a chronic digestive disorder, can also cause abdominal pain, cramping, bloating, and altered bowel habits, with pain sometimes felt on the right side. This pain can vary in intensity and may be relieved after a bowel movement.
Gallstones, hardened deposits of digestive fluid that form in the gallbladder, can cause sudden, severe pain in the upper right abdomen, often radiating to the back or right shoulder, particularly after fatty meals. These attacks, known as biliary colic, can be intense.
Serious Medical Conditions to Consider
More serious medical conditions can also cause pain under the right ribs and require prompt medical attention.
Cholecystitis, an inflammation of the gallbladder, often results from gallstones blocking the bile duct. It typically presents with severe, constant pain in the upper right abdomen that may radiate to the right shoulder or back, along with nausea, vomiting, and fever.
Hepatitis, an inflammation of the liver, can lead to a dull, aching discomfort in the right upper quadrant due to liver swelling. This pain may be accompanied by symptoms like fatigue, nausea, vomiting, loss of appetite, and jaundice (yellowing of the skin and eyes). Liver conditions such as cirrhosis or fatty liver disease can also cause pain in this area.
Kidney stones, hardened mineral deposits that form in the kidneys, can cause excruciating pain as they move through the urinary tract. This pain is often felt in the side or lower back (flank pain) but can radiate to the right upper abdomen, accompanied by nausea, vomiting, painful urination, and sometimes blood in the urine.
A kidney infection (pyelonephritis) also causes flank pain that can spread to the right upper quadrant, along with fever, chills, and frequent, painful urination.
Pancreatitis, inflammation of the pancreas, can cause sudden and severe pain in the upper abdomen, often radiating to the back and potentially felt under the right ribs. This pain can worsen after eating and may be accompanied by nausea, vomiting, and fever.
Pleurisy, an inflammation of the lining of the lungs (pleura), causes a sharp, stabbing chest pain that worsens with deep breathing, coughing, or sneezing. While often associated with lung infections like pneumonia, this pain can be localized to the right side of the chest.
Appendicitis, though usually causing pain in the lower right abdomen, can sometimes present atypically with pain in the right upper quadrant, especially if the appendix is located in a higher position. This atypical presentation can mimic other conditions affecting the gallbladder or liver.
Diverticulitis, an inflammation of small pouches in the colon, most commonly causes pain in the lower left abdomen, but a small number of individuals may experience pain on the right side. Symptoms include abdominal pain that can persist for hours or days, changes in bowel habits like constipation or diarrhea, and sometimes fever.
When to Seek Medical Attention
It is important to seek medical attention if pain under the right ribs is severe, sudden, or progressively worsening, or if accompanied by any of the following:
- Any pain accompanied by a fever, chills, or excessive sweating.
- The appearance of jaundice, characterized by yellowing of the skin or eyes, along with right rib pain.
- Severe nausea or persistent vomiting, particularly if it prevents keeping fluids down.
- Shortness of breath or chest tightness in conjunction with right rib pain.
- Pain that radiates to other areas, such as the back, shoulder, or arm.
- The presence of blood in stool or urine.
- Pain following a trauma or injury to the rib cage, requiring medical evaluation to rule out fractures or internal damage.
- Any right rib pain that does not improve with rest or over-the-counter remedies, or if there is any concern or uncertainty about the cause.