Pain under the ribcage, anatomically known as the upper abdomen or epigastric region, is a very common complaint with a wide range of potential sources. This area is protected by the lower ribs and houses several vital organs, including the liver, gallbladder, stomach, spleen, pancreas, intestines, and kidneys. Because of the density of organs, determining the precise cause of discomfort can be complex. Pain originating from one structure can often be felt in another location, known as referred pain.
Understanding the location and nature of the pain is the first step toward identification, but it is not a substitute for a professional medical diagnosis. This information explores the most frequent causes of pain in the upper abdominal area, differentiating between those that occur on either side and those specific to the right or left. This content is for informational purposes only and should not be used to self-diagnose or replace consultation with a healthcare provider.
Common Musculoskeletal and Digestive Triggers
Musculoskeletal and digestive issues are some of the most frequent, non-life-threatening causes of discomfort beneath the ribcage, often affecting the central area or either side. These types of pain are common because the structures involved are frequently used or are sensitive to daily activities and dietary choices.
One common source of pain is Costochondritis, which is an inflammation of the cartilage connecting the ribs to the breastbone (sternum). This condition causes a sharp, aching, or burning sensation in the chest wall, frequently on the left side, but it can occur centrally. The pain is aggravated by deep breathing, coughing, or movement of the upper body, which can be alarming as it may mimic symptoms of a cardiac event.
Pain can also arise from the intercostal muscles (the muscles between the ribs) due to a strain or pull. This injury often results from strenuous or repetitive activities like forceful coughing, twisting the torso, or heavy lifting. An intercostal muscle strain causes sharp, localized pain and tenderness that worsens with movement, deep inhalation, or when the affected area is touched.
Digestive problems are a major factor, with trapped gas causing significant distention pain throughout the upper abdomen. Gas can accumulate beneath the ribcage, leading to a feeling of pressure, a dull ache, or sharp, stabbing pain that can shift location. This discomfort can be intense and is sometimes mistaken for a more serious issue, especially when it collects under the left ribcage.
Gastroesophageal Reflux Disease (GERD), where stomach acid backs up into the esophagus, can radiate pain to the area under the ribcage. The characteristic symptom is heartburn, a burning sensation felt behind the breastbone. This acidic irritation can also manifest as epigastric pain or discomfort under the left ribcage, often worse after eating or when lying down.
Causes Specific to the Right Side
The right upper quadrant (RUQ) is home to the liver and the gallbladder, making pain here often indicative of issues with these structures. The nature of the pain can offer clues, with sharp, episodic pain often pointing toward gallbladder problems.
Gallbladder issues, such as gallstones or cholecystitis (inflammation), are a common source of RUQ pain. Gallstones, which are hardened deposits of digestive fluid, can block the bile duct, causing intense, colicky pain known as biliary colic. This pain is often triggered following a fatty meal, as the gallbladder contracts, and it can radiate to the right shoulder blade or back.
The liver can cause a dull, persistent ache beneath the right ribs if it becomes enlarged (hepatomegaly) or inflamed. Conditions like hepatitis or fatty liver disease can lead to this chronic discomfort. Liver-related pain tends to be a constant and generalized soreness in the RUQ.
Pain under the right ribcage can also be a symptom of a problem with the right kidney, which is positioned toward the back under the lower ribs. Infections, such as pyelonephritis, or the passage of a kidney stone can cause severe pain that starts in the flank but radiates forward to the upper abdomen. Kidney-related pain is often accompanied by fever, pain during urination, or blood in the urine.
Causes Specific to the Left Side
Pain under the left ribcage, in the left upper quadrant (LUQ), is frequently related to the stomach, pancreas, or spleen. The high severity of pain often associated with the pancreas makes this area particularly concerning.
Stomach issues are a common cause of LUQ pain. Gastritis (inflammation of the stomach lining) and peptic ulcers can cause a gnawing or burning discomfort. Ulcer pain may be worse when the stomach is empty, while gastritis typically causes general soreness and nausea.
The pancreas, which lies behind the stomach, can cause extremely severe pain when inflamed, a condition known as pancreatitis. Acute pancreatitis causes sudden, intense pain that often radiates straight through to the back, sometimes described as a band-like sensation. This pain is accompanied by nausea and vomiting, demanding immediate medical attention.
The spleen is another LUQ organ that can cause pain if it becomes enlarged (splenomegaly) due to infection or disease. An enlarged spleen may cause a feeling of fullness or tenderness under the left ribs, even after eating a small amount of food. A splenic rupture, often following trauma, is a medical emergency resulting in sudden, severe pain.
Pain in the far left LUQ can also originate from the colon, specifically the splenic flexure (a bend in the large intestine). Conditions like Irritable Bowel Syndrome (IBS) or constipation can lead to gas accumulation here, mimicking other types of pain. This localized gas or cramping can be a source of sharp or dull discomfort that may come and go.
When to Seek Immediate Medical Attention
While many causes of ribcage pain are minor, several “red flag” symptoms indicate a potentially life-threatening situation that requires immediate emergency medical evaluation.
- Sudden, crushing, or severe pain that is the worst you have ever experienced, especially if it spreads to the jaw, arm, or back.
- Pain accompanied by shortness of breath, difficulty breathing, or a feeling of chest pressure or tightness.
- Fever and chills alongside the pain, which can signal a serious infection in the kidney, gallbladder, or pancreas.
- Signs of internal bleeding, such as vomiting blood, passing tarry black stools, or having bloody urine.
- Jaundice, a yellowing of the skin or the whites of the eyes, often pointing to a severe liver or bile duct obstruction.