Pain in the lower right rib cage, also known as the right upper quadrant of the abdomen, can arise from various sources. This area houses several important organs, including the liver, gallbladder, a portion of the right kidney, part of the pancreas, and sections of the intestines. Discomfort can range from mild and temporary to more persistent or severe, indicating a spectrum of underlying conditions.
Common Reasons for Pain
Musculoskeletal issues often cause pain under the lower right rib cage. Strained intercostal muscles, located between the ribs, can become sore from vigorous coughing, twisting, or injury. Pain from these strains often worsens with deep breathing, coughing, or movement. Inflammation of the cartilage connecting ribs to the breastbone, known as costochondritis, can also lead to localized tenderness and pain. A bruised or fractured rib, typically from trauma or persistent coughing, can cause significant pain and tenderness.
Digestive issues frequently contribute to discomfort. Indigestion (dyspepsia) can cause bloating, nausea, or upper abdominal discomfort, sometimes radiating right, especially after eating. Acid reflux (GERD) involves stomach acid flowing back into the esophagus, producing a burning sensation and pain under the ribs. Trapped gas can create unease and pressure, often resolving with passing gas. Irritable bowel syndrome (IBS) may also cause abdominal pain that can refer to the right upper quadrant.
Less severe organ issues can also cause pain. Mild gallbladder irritation might cause transient discomfort. Non-alcoholic fatty liver disease (NAFLD), where fat accumulates in the liver, often presents without symptoms but can sometimes cause a dull ache or discomfort under the right ribs, along with fatigue. Nerve pain, such as intercostal neuralgia, involves irritation or compression of nerves between the ribs, resulting in sharp, shooting pain along the rib path.
Serious Underlying Conditions
More concerning causes often involve organs within this quadrant. Gallbladder problems are a frequent culprit, with gallstones a primary concern. Gallstones can block bile ducts, leading to sudden, severe pain (biliary colic), typically after fatty meals, radiating to the back or right shoulder. Prolonged blockage and inflammation of the gallbladder by a gallstone results in cholecystitis, characterized by constant, intense pain, tenderness, nausea, vomiting, and fever.
Liver conditions can also cause pain in this area. Hepatitis, liver inflammation, can cause discomfort along with fatigue, nausea, vomiting, and jaundice. A liver abscess, a collection of pus, typically presents with pain in the right upper abdomen, accompanied by fever, chills, and occasionally jaundice.
Issues affecting the right kidney can produce pain radiating to the lower right rib cage. Kidney stones can cause severe pain moving towards the lower back or groin, often with painful or bloody urination. Kidney infections (pyelonephritis) involve bacterial inflammation of the kidney, leading to fever, chills, and flank pain that may extend to the front.
Lung or diaphragm conditions can also cause referred pain. Pleurisy, inflammation of the lung lining, typically results in sharp pain worsening with deep breaths, coughing, or sneezing. Severe pneumonia can also cause referred pain to the lower right rib cage, along with coughing, fever, and difficulty breathing. Occasionally, a diaphragm spasm, sometimes due to physical activity or impact, can lead to localized pain. Atypical appendicitis, typically in the lower right abdomen, can sometimes cause pain felt higher up, though less common for rib cage pain.
Recognizing Concerning Symptoms
Identifying specific accompanying symptoms is important for determining when medical attention is needed. Severe, sudden, or rapidly worsening pain warrants immediate evaluation. Persistent pain, pain radiating to the back or shoulder, or pain intense enough to awaken you from sleep are also concerning.
Several accompanying symptoms serve as red flags, suggesting a more serious underlying issue. These include fever and chills, which can indicate infection. Nausea and vomiting are common, particularly with digestive or gallbladder problems. Jaundice (yellowing of skin or eyes, dark urine, pale stools) points to liver or bile duct issues.
Other concerning signs include unexplained weight loss, difficulty breathing, or blood in urine or stool. If pain occurs after trauma or is accompanied by chest pressure, seek immediate medical attention. Seek professional care if symptoms do not improve with self-care or if new, worrying symptoms develop.
Medical Evaluation and Diagnosis
When lower right rib cage pain becomes a concern, a medical evaluation typically begins with a thorough assessment. This involves discussing medical history, including pain onset, what makes it better or worse, and other symptoms. A physical examination will also be performed, where the doctor may palpate the affected area, check for tenderness, and listen to your lungs.
To identify the underlying cause, various diagnostic tests may be considered. Blood tests can provide insights into potential infections, inflammation, or organ function (liver, kidneys). Urine tests may be conducted to check for kidney issues. Imaging studies are often used to visualize internal organs and structures.
These can include an abdominal ultrasound (useful for gallbladder), X-rays (ribs, lungs), or more detailed computed tomography (CT) and magnetic resonance imaging (MRI) scans for comprehensive views of soft tissues and organs. Only a healthcare professional can accurately diagnose the cause and recommend appropriate action.