Pain beneath the right side of the rib cage is categorized as right upper quadrant (RUQ) pain. This location houses several organs, meaning the discomfort can stem from issues ranging from temporary muscle strain to serious internal conditions. Pinpointing the source requires considering the pain’s character, intensity, and accompanying symptoms.
Organs Located in the Right Upper Quadrant
The region below the right ribs contains several organs, primarily the liver, which occupies the majority of the RUQ. Beneath the liver is the gallbladder, which stores and concentrates bile. The head of the pancreas and the duodenum (the first section of the small intestine) also extend into this quadrant. The right kidney is situated in the upper posterior abdomen, and issues with it can cause pain felt under the ribs. Finally, the hepatic flexure, the bend in the large intestine near the liver, can also contribute to symptoms in this area.
Musculoskeletal and Minor Causes
Pain under the ribs is not always from internal organs; it can relate to the surrounding chest wall structures. Musculoskeletal issues often present as localized tenderness reproduced by pressing on the area or by movement. Costochondritis, inflammation of the cartilage connecting the ribs to the breastbone, is a common cause. This condition causes sharp, localized pain that worsens with deep breaths, coughing, or torso movements.
Muscle strain, affecting the intercostal or abdominal muscles, is another cause. Vigorous exercise, such as heavy lifting, can lead to inflammation and cause a dull ache or sharp pain during movement. Trapped gas, accumulating in the hepatic flexure of the colon, is a temporary source of discomfort. This distension causes a cramping or sharp pain that resolves as the gas moves through the digestive tract.
Digestive System Causes
The digestive organs, particularly the gallbladder and liver, are common sources of RUQ pain. Gallstones (hardened deposits of digestive fluid) often cause intense, cramping pain called biliary colic when they temporarily block a bile duct. This pain begins suddenly, may radiate to the upper back or right shoulder blade, and often occurs after eating a fatty meal. Prolonged blockage by a gallstone can lead to cholecystitis (gallbladder inflammation), resulting in persistent, severe pain often accompanied by fever.
Liver issues typically manifest as a dull, throbbing ache rather than sharp pain. Conditions like hepatitis (liver inflammation due to infection or alcohol) can cause the liver to swell (hepatomegaly). Metabolic dysfunction-associated steatotic liver disease (MASLD) can also cause chronic inflammation and mild pain as the organ’s capsule stretches. Although the pancreas is mostly central, inflammation (pancreatitis) can radiate pain to the right side, often with severe nausea and vomiting. Acute pancreatitis is serious, causing sudden and intense upper abdominal pain when digestive enzymes damage the organ.
Kidney and Urinary Causes
The right kidney is located in the posterior upper abdomen, so problems are often felt in the flank or back, but the pain can radiate forward under the right ribs. Kidney stones (renal colic) cause severe, sharp pain that comes in waves as the body attempts to pass the stone through the ureter. The pain typically starts in the back and moves downward toward the groin or front of the abdomen. It is often accompanied by blood in the urine or painful urination.
A kidney infection, known as pyelonephritis, is usually a complication of an untreated urinary tract infection. This condition causes a dull, persistent ache in the flank area that radiates forward. Systemic symptoms include a high fever, chills, and a general feeling of being unwell. Unlike muscle pain, kidney-related pain rarely changes with body position but is often tender when the back is percussed.
Warning Signs and When to Seek Help
While many causes of RUQ pain are minor, certain accompanying symptoms require immediate medical attention. Any sudden, severe, or rapidly escalating pain that prevents finding a comfortable position should be evaluated promptly.
Urgent “red flag” symptoms include:
- The development of jaundice (yellowing of the skin and eyes), suggesting a serious problem with the liver or bile ducts.
- A high fever and chills along with the pain, signaling a severe infection like acute cholecystitis or pyelonephritis.
- Persistent vomiting, especially if unable to keep fluids down.
- The appearance of blood in the stool.