Pain on the right side of the stomach, specifically under the ribs, can stem from various origins. This area, known as the right upper quadrant (RUQ) of the abdomen, houses several organs, including parts of the liver, gallbladder, right kidney, and intestines. Discomfort here may relate to issues within these organs, musculoskeletal structures, the respiratory system, or other body systems.
Understanding potential causes helps recognize when medical attention is necessary. This article provides general information about common reasons for RUQ pain but is not a substitute for professional medical advice. Any persistent, severe, or concerning pain should be evaluated by a healthcare provider for accurate diagnosis and treatment.
Digestive System Related Causes
The digestive system often contributes to pain under the right ribs due to the location of key digestive organs. Gallbladder problems are common culprits for RUQ pain. The gallbladder is a small organ beneath the liver that stores and concentrates bile, a digestive fluid aiding fat digestion.
Gallstones (cholelithiasis) are hard deposits that can form in the gallbladder and block bile ducts, causing pain. This blockage can lead to biliary colic, characterized by sharp, cramp-like pain in the right upper abdomen, often after fatty meals. If a gallstone completely obstructs a bile duct, it can cause cholecystitis (inflammation of the gallbladder). Cholecystitis presents as persistent, severe pain that may radiate to the back or right shoulder, often with nausea, vomiting, and sometimes fever.
Liver conditions can also cause discomfort in the RUQ. The liver, located primarily in this area, can be affected by fatty liver disease, hepatitis (inflammation from viral infections or alcohol), or a liver abscess. Pain from liver issues is described as a dull or aching sensation, which can be persistent. Other symptoms like fatigue, jaundice (yellowing of skin or eyes), or a feeling of fullness may accompany liver pain.
Pancreatitis (inflammation of the pancreas) can sometimes radiate to the RUQ, though it’s less common to present primarily as right-sided pain. The pancreas is an organ behind the stomach that produces digestive enzymes and hormones. Pancreatitis causes steady or sharp pain in the upper abdomen, which may spread to the back, and can include bloating, nausea, vomiting, and loss of appetite. Additionally, irritable bowel syndrome (IBS) or severe gas and constipation can cause general abdominal discomfort that might be felt in the RUQ, especially if the ascending colon is affected.
Musculoskeletal and Respiratory Causes
Pain under the right ribs is not always from internal organs; it can also stem from musculoskeletal issues. Costochondritis, inflammation of the cartilage connecting ribs to the breastbone, is a common cause. This condition causes sharp or dull pain and tenderness in the chest, worsening with deep breathing, coughing, sneezing, or certain movements. While it can affect either side, it occurs on the right.
Muscle strains in the abdominal wall or intercostal muscles (between the ribs) can also cause localized pain. Activities like vigorous coughing, strenuous exercise, or injury can lead to these strains. The pain is sharp, localized, and intensifies with movement, touch, or deep breaths. A bruised or fractured rib on the right side can also cause significant pain. Symptoms include strong pain worsening with breathing, coughing, or movement, along with tenderness and possible bruising over the affected ribs.
Respiratory conditions affecting the lower right lung or diaphragm can cause referred pain in the right upper abdomen. Pneumonia, an infection causing lung tissue inflammation, can lead to pain spreading to the right side, often with a cough, fever, and breathing difficulties. Pleurisy, inflammation of the lining surrounding the lungs and chest cavity, causes sharp chest pain that intensifies with deep breathing, coughing, or sneezing. This pain may be felt in the chest wall but can radiate to the right shoulder or back, or be perceived in the upper abdominal area.
Urinary Tract and Other Potential Causes
Beyond digestive and musculoskeletal issues, the urinary tract can also cause pain under the right ribs. The right kidney is in the upper posterior abdomen, just beneath the rib cage. Kidney stones (nephrolithiasis) cause intense pain (renal colic) that starts in the flank or back but may radiate forward to the RUQ or groin. This pain can come in waves and may include painful urination, blood in urine, frequent urination, nausea, or vomiting.
Kidney infections (pyelonephritis) are another cause of right-sided pain. An infection in the right kidney can lead to pain in the RUQ or flank, alongside symptoms like fever, chills, frequent urination, or pain during urination. Urine might also appear dark, cloudy, or foul-smelling.
Shingles, from reactivation of the varicella-zoster virus, is another cause of pain in this area. Before a rash appears, shingles causes a burning, tingling, or itching sensation in affected nerve pathways. If nerves supplying the right upper abdomen are involved, this neurological pain can be felt under the right ribs.
Referred pain means discomfort from one body part can be felt elsewhere. Though less common for the RUQ, conditions affecting other areas can manifest as pain here. For instance, liver problems can cause pain in the right shoulder due to shared nerve pathways. This highlights the complex nature of pain perception and why a thorough medical evaluation is necessary to pinpoint the exact source.
Recognizing Serious Symptoms and When to Seek Medical Care
While many causes of pain under the right ribs are not life-threatening, certain symptoms signal a need for prompt medical evaluation. Recognizing these “red flag” symptoms ensures timely care. Seek immediate medical attention if pain is severe, sudden, rapidly worsening, or causes you to double over.
Concerning symptoms warranting urgent medical help include pain with high fever, chills, or excessive sweating, which could indicate infection or inflammation. Jaundice (yellowing of skin or eyes) is a significant sign pointing to liver or gallbladder issues, requiring immediate medical attention. Persistent nausea and vomiting, especially if severe or preventing fluid intake, should also prompt an emergency room visit.
Other serious indicators include bloody stools, black or tarry stools, or unexplained weight loss, suggesting underlying gastrointestinal bleeding or other serious conditions. Any persistent, unexplained changes in bowel habits should also be discussed with a doctor. Given the wide array of potential causes, self-diagnosis and home remedies are not appropriate. A medical professional can accurately diagnose the cause through physical examination, medical history, and diagnostic tests like blood work or imaging. If pain is persistent, recurring, or causes concern, consulting a healthcare provider is the recommended action.