Pain under the rib cage, medically referred to as upper quadrant abdominal pain, is a common complaint that can feel alarming due to the location’s proximity to several major organ systems. This area, protected by the lower part of the bony rib cage, houses portions of the digestive tract, the liver, the spleen, and parts of the kidneys and pancreas. The nature of the pain can range significantly, from a minor, temporary discomfort, such as trapped gas, to a symptom of a serious condition requiring immediate medical attention. Understanding the potential origins of this pain is the first step, but this information is not a replacement for professional medical diagnosis.
Common Musculoskeletal and Digestive Causes
The most frequent reasons for discomfort under the ribs are often related to the muscles and the digestive system, affecting either side or the center of the upper abdomen.
One of the most common culprits is trapped gas, which occurs when gas moves slowly through the digestive tract. This causes pressure, bloating, and sometimes sharp, cramping pain that can be mistaken for a more serious issue. This discomfort often feels like a dull ache or pressure and may be accompanied by belching or flatulence.
Another common source of pain is musculoskeletal, involving the structures of the chest wall itself. Costochondritis is an inflammation of the cartilage that connects the ribs to the breastbone (sternum). This causes a sharp or aching pain that is often tender when pressed. This pain typically worsens with deep breathing, coughing, or any movement of the chest wall.
Muscle strain in the intercostal muscles, which run between the ribs, can also cause sharp pain. This often results from strenuous activity or heavy lifting, particularly when breathing deeply or coughing.
Digestive issues can also cause a burning sensation that radiates upward into the chest and under the ribs. Gastroesophageal Reflux Disease (GERD), or chronic acid reflux, is a condition where stomach acid flows back into the esophagus, causing heartburn that can be felt below the rib cage. Peptic ulcers, which are open sores in the stomach lining, can also cause a dull or burning pain in the upper abdomen that comes and goes, sometimes relieved by food or antacids.
Pain Related to the Right Upper Abdomen
Pain focused under the right rib cage, known as the right upper quadrant (RUQ), frequently points toward organs like the liver and the gallbladder.
The gallbladder is a small organ that stores bile, and issues here, such as gallstones or inflammation (cholecystitis), are a common cause of severe RUQ pain. Gallstone pain is often described as colicky and intense, typically occurring after eating a fatty meal. This discomfort can radiate to the back or the right shoulder blade.
The liver occupies a large area in the RUQ and can be the source of pain if it is inflamed or diseased. Conditions like hepatitis or fatty liver disease may cause a persistent and dull ache under the right ribs. An enlarged liver can cause discomfort due to the stretching of the organ’s capsule.
Pain from the right kidney, located toward the back below the ribs, can also be felt radiating to the front upper abdomen. Kidney stones or a kidney infection typically cause pain that radiates toward the groin and is often accompanied by painful or frequent urination.
Pain Related to the Left Upper Abdomen
Discomfort under the left rib cage is often associated with the spleen, pancreas, and stomach.
The stomach sits primarily in this area, and problems like gastritis, which is inflammation of the stomach lining, can cause pain, indigestion, and a feeling of fullness. Peptic ulcers in the stomach or upper small intestine (duodenum) can also cause a burning pain in this area.
The spleen is tucked behind the left ribs and is involved in filtering blood and fighting infection. An enlarged spleen (splenomegaly) can cause a dull, aching pain under the left rib cage and may lead to a feeling of fullness after eating only a small amount of food. In cases of trauma, a ruptured spleen is a medical emergency that causes sharp pain and signs of internal bleeding.
The pancreas, situated behind the stomach, can cause severe pain when inflamed, a condition known as pancreatitis. Pancreatitis pain is typically intense and located in the upper abdomen, often radiating straight through to the back. Similar to the right side, the left kidney can also be the source of pain from stones or infection, with the discomfort sometimes radiating forward beneath the left ribs.
Recognizing Emergency Symptoms
While many causes of pain under the rib cage are not immediately life-threatening, certain symptoms signal a medical emergency that requires immediate attention. Sudden, severe, or crushing pain in the upper abdomen or chest is a significant warning sign that should prompt an emergency room visit. This is especially true if the pain is accompanied by signs of a heart attack.
These signs include:
- Shortness of breath, chest pressure, or pain that radiates to the jaw, neck, or arm.
- Pain accompanied by a high fever, chills, rapid heartbeat, or signs of circulatory shock.
- Vomiting blood, passing blood in the stool, or having black, tarry stools, suggesting internal bleeding.
- Pain developing following a direct blow or trauma to the chest or abdomen, requiring immediate medical evaluation for internal injury, such as a ruptured spleen or liver.
- Any pain that causes confusion, light-headedness, or paleness also warrants emergency care.