Pain under the right ribs is common and can be concerning. This area, known as the right upper quadrant (RUQ), contains organs like the liver, gallbladder, right kidney, pancreas, and intestines. While many cases of pain here are benign and resolve naturally, some indicate underlying conditions needing medical attention. This article provides general information about potential causes of RUQ pain and is not a substitute for professional medical advice.
Common Causes of Right Upper Quadrant Pain
Pain under the right ribs often comes from less severe issues, frequently related to the digestive system or musculoskeletal structures. Indigestion, for example, can cause pain behind the ribs, often starting in the upper abdomen and moving upwards. This discomfort stems from excess stomach acid irritating the stomach lining or esophagus, and may include nausea, vomiting, bloating, and a burning sensation. Eating heavy or fatty meals, consuming alcohol, or stress can worsen indigestion symptoms.
Gas trapped in the digestive tract is a common cause of discomfort in the right upper quadrant. This pain can be felt under the ribs or elsewhere in the abdomen, and may feel like tenderness, fullness, or a sharp sensation. Gas pain can shift and is linked to constipation or gas-producing foods. Conditions like irritable bowel syndrome (IBS) also cause discomfort under the right ribs, often with stomach rumbling and flatulence, especially after meals or during stress.
Musculoskeletal issues, such as an intercostal muscle strain, can cause localized rib cage pain. The intercostal muscles are muscles between the ribs that aid breathing. When these muscles are overstretched or torn from sudden movements, a blow to the chest, or vigorous coughing, they can cause sharp pain, tightness, and difficulty with deep breathing. Symptoms include tenderness to the touch and worsening pain with movement, coughing, or sneezing.
Costochondritis, an inflammation of the cartilage connecting the ribs to the breastbone, can cause pain under the right ribs. This condition causes sharp pain in the front or side of the chest that worsens with upper body movement, lying down, deep breathing, or direct pressure on the affected area. While the pain most commonly occurs on the left side, it can affect either side of the breastbone and usually resolves over weeks to months.
Gallstones, hardened deposits of digestive fluid that form in the gallbladder, cause sudden, severe pain in the upper right abdomen, often radiating to the back or right shoulder. This pain, known as biliary colic, often occurs after eating, particularly fatty meals, and may include nausea and vomiting. The pain can last for minutes to hours and can be intense. Though gallstones may not always cause symptoms, they can cause significant discomfort if they obstruct bile ducts.
Mild liver issues, such as fatty liver disease, can cause discomfort in the right upper quadrant. In its early stages, fatty liver disease often has no symptoms. If symptoms occur, they may include a dull or aching pain in the upper right abdomen, fatigue, general unwellness, or unexplained weight loss. This pain can worsen when the liver is under strain, like after alcohol consumption or weight gain.
More Serious Conditions Requiring Prompt Attention
While less common, certain conditions causing pain under the right ribs can be more serious and require immediate medical evaluation. Appendicitis, though usually associated with lower right abdominal pain, can cause right upper quadrant pain atypically, especially if the appendix is in an unusual position, like behind the colon or near the liver. Symptoms may include nausea, vomiting, loss of appetite, and a low-grade fever, and can develop rapidly.
Kidney stones or infections can cause pain under the right ribs, as the right kidney is in this area. Kidney stone pain is often described as excruciating, sharp, or colicky, and can radiate from the lower back or flank to the lower abdomen or groin. This pain may come in waves and may include nausea, vomiting, painful urination, frequent urination, or blood in the urine. A kidney infection (pyelonephritis) can cause a steady, aching pain due to kidney swelling, along with fever and chills.
Pancreatitis, inflammation of the pancreas, can cause steady or sharp pain in the upper abdomen that may spread to the back, chest, or sides. The pancreas is located behind the stomach and extends across the upper abdomen, with a portion in the right upper quadrant. Symptoms can include bloating, nausea, vomiting, a rapid heartbeat, fever, and a loss of appetite. Gallstones and heavy alcohol consumption are common causes of pancreatitis.
Severe liver disease, including conditions like hepatitis (liver inflammation) or cirrhosis (liver scarring), can cause pain or soreness under the right ribs. Early stages may be asymptomatic, but as they progress, symptoms can include fatigue, loss of appetite, weight loss, a swollen abdomen, and jaundice (yellowing of the skin and eyes). Other signs include easy bruising or bleeding, and changes in mental state.
Pleurisy, an inflammation of the pleura (the membranes lining the lungs and chest cavity), can cause sharp, stabbing chest pain, usually on one side, that worsens with deep breathing, coughing, or sneezing. This pain may also spread to the shoulder or back. Pleurisy often results from a chest infection, such as pneumonia, and can lead to fluid buildup between the lung and chest wall, potentially causing shortness of breath.
Pneumonia, an infection that inflames the air sacs in the lungs, can cause chest pain, especially with breathing or coughing. If the lower lobe of the right lung is affected, this pain can be felt under the right ribs. Other symptoms include a cough with mucus, fever, chills, shortness of breath, and rapid breathing. Confusion may also occur in older adults.
Shingles, a viral infection caused by the reactivation of the varicella-zoster virus, causes a painful rash that often appears in a band around the rib cage on one side. The pain, burning, or tingling sensation often precedes the rash and can be intense. Rarely, shingles pain may occur without a visible rash (zoster sine herpete). Headaches, muscle aches, and general unwellness can accompany the pain.
When to Seek Medical Care
Seek medical evaluation if you experience pain under your right ribs with certain warning signs. Seek immediate medical attention if the pain is severe, sudden, or rapidly worsening, or if it makes it impossible to find a comfortable position. Also seek care if the pain worsens when you touch your abdomen.
Other concerning symptoms include fever, persistent nausea and vomiting, or jaundice (yellowing of the skin and eyes). Blood in urine or stool, black stools, coughing up blood or coffee-ground-like substance, or unexplained weight loss are also serious indicators. Difficulty breathing, shortness of breath, rapid heartbeat, confusion, or lightheadedness with the pain also require urgent assessment. Any persistent pain lasting longer than a few days or interfering with daily activities should be evaluated by a healthcare provider.
Managing Mild Symptoms and Prevention
Once serious conditions are ruled out, mild right-sided rib pain can often be managed with general measures. Rest is beneficial, allowing strained muscles or inflamed tissues to heal. Applying a heat pack or cold compress to the affected area can alleviate discomfort and reduce swelling. Over-the-counter pain relievers, such as ibuprofen or acetaminophen, may provide temporary relief for mild pain, but consult a healthcare provider before use, especially with other health conditions or medications.
For digestive issues like indigestion or gas, dietary adjustments help. Avoiding fatty or greasy foods and incorporating high-fiber foods like fruits, vegetables, and whole grains can ease digestive strain. Staying hydrated by drinking plenty of water also supports overall digestive health and waste elimination.
General healthy lifestyle practices can help prevent common causes of right upper quadrant pain. Maintaining a balanced diet, engaging in regular exercise, and managing stress promote overall well-being and support healthy digestive and organ function. These practices help reduce issues like indigestion, gas buildup, and contribute to liver health.