Side pain below the ribs explained
The rib cage is composed of 24 total ribs 12 on the right and 12 on the left. The first seven pairs are connected to the sternum and the remaining five pairs are not connected to the sternum.
See a visual representation of the rib cage and its attachments here.
The ribs function to enclose and protect various organs of the upper chest, including but not limited to the lungs and the heart. As a result, pain below either the left or right ribs can indicate various conditions that range from serious to benign.
Common accompanying symptoms of pain below the ribs
If you're experiencing pain below the ribs, it's also likely to experience:
- Nausea and vomiting
- Abdominal pain
- Chest pain
- Pain that increases with inhalation or exhalation
- Back pain
- Changes in urine or stool: Such as color, consistency, or frequency
- Unexplained weight loss
- Changes in skin color: Such as yellowing
Common characteristics of pain below the ribs
It is also important to characterize the location, quality, and intensity of the pain below your ribs.
- May be sharp or dull
- Persistent or transient
- Located on the right or left side
- Anterior or posterior
- Pain may be mild, moderate, or severe
Your specific symptoms and their associated characteristics will be important in helping your physician come to the appropriate diagnosis and treatment plan. Since the ribs surround such vital organs, it is important to always follow up on your symptoms and never ignore the pain.
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What causes abdominal pain under the ribs?
The potential causes of pain below the ribs are so varied that it may seem daunting; especially since the rib cage contains many organs and the area below the ribs is equally large. However, the different causes can be grouped into categories that may help your physician get to the bottom of your pain and symptoms.
Any damage, injury or disease to the organs enclosed by the ribs or in close proximity to the ribs can result in referred pain to the area below the ribs. The lungs and the kidneys are located on both sides of the body and can often cause pain below the ribs and oftentimes in the back.
- Left-sided organs: The spleen, the stomach, and at times, the left ventricle of the heart are located in this general area and can cause pain below the left ribs. Disease or enlargement in these organs can be associated with symptoms such as fatigue, chest pain, changes in bowel movements and abdominal pain.
- Right-sided organs: The liver and gallbladder are located in this area and can cause pain below the right ribs. Disease, enlargement and/or obstructions in these organs can be associated with symptoms such as fatigue, nausea and vomiting, fever, changes in skin color, changes in bowel movements and abdominal pain.
General inflammation or inflammation caused by infection to the lungs can result in pain in the lower ribs on both sides. The lungs end close to the bottom of the rib cage and any irritation to this area can result in pain felt below the ribs.
Direct, high impact injury to the ribs that results in a fracture can cause pain in the lower ribs. A severe fracture in itself can obviously result in severe pain, but even small fractures can puncture, lacerate or irritate other organs resulting in pain below the ribs.
Constipation, heartburn, and indigestion are all digestive conditions that may also cause pain and feelings of bloating in the lower ribs. These conditions are usually benign and transient and can be easily treated once identified.
Indigestion, also called upset stomach, dyspepsia, or functional dyspepsia, is not a disease but a collection of very common symptoms. Note: Heartburn is a separate condition.
Common causes are eating too much or too rapidly; greasy or spicy foods; overdoing caffeine, alcohol, or carbonated beverages; smoking; and anxiety. Some antibiotics, pain relievers, and vitamin/mineral supplements can cause indigestion.
The most common symptoms are pain, discomfort, and bloating in the upper abdomen soon after eating.
Indigestion that lasts longer than two weeks, and does not respond to simple treatment, may indicate a more serious condition. Upper abdominal pain that radiates to the jaw, neck, or arm is a medical emergency.
Diagnosis is made through patient history and physical examination. If the symptoms began suddenly, laboratory tests on blood, breath, and stool may be ordered. Upper endoscopy or abdominal x-ray may be done.
For functional dyspepsia – "ordinary" indigestion – treatment and prevention are the same. Eating five or six smaller meals per day with lighter, simpler food; managing stress; and finding alternatives for some medications will provide relief.
Top Symptoms: nausea, stomach bloating, dyspeptic symptoms, bloating after meals, vomiting
Symptoms that always occur with indigestion (dyspepsia): dyspeptic symptoms
Symptoms that never occur with indigestion (dyspepsia): vomiting (old) blood or passing tarry stools, rectal bleeding, bloody diarrhea, fever
A peptic ulcer is a sore in the lining of the stomach or the first part of your small intestine (the duodenum), which causes pain following meals or on an empty stomach.
Top Symptoms: fatigue, nausea, loss of appetite, moderate abdominal pain, abdominal cramps (stomach cramps)
Symptoms that never occur with stomach ulcer: pain in the lower left abdomen
Urgency: Primary care doctor
Gallstones are small, round deposits found in the gallbladder, the organ where bile is stored. Gallstones can be subclassified a number of ways. Oftentimes, gallstones will be referred to as either cholesterol stones or pigment stones depending on the makeup of the gallstone.
Gallstones can also be class...
When something interferes with the protective mechanisms of the stomach, a range of problems can occur from mild indigestion to deadly bleeding ulcers. Gastritis is an umbrella term for one of the most common problems, inflammation of the stomach lining.
Symptoms include nausea or vomiting,...
Normal variation of constipation
Constipation means bowel movements which have become infrequent and/or hardened and difficult to pass.
There is wide variation in what is thought "normal" when it comes to frequency of bowel movements. Anywhere from three times a day to three times a week is considered normal.
As long as stools are easy to pass, laxatives should not be used in an effort to force the body to a more frequent schedule.
Constipation is usually caused by lack of fiber in the diet; not drinking enough water; insufficient exercise; and often suppressing the urge to have a bowel movement.
A number of medications and remedies, especially narcotic pain relievers, can cause constipation.
Women are often affected, due to pregnancy and other hormonal changes. Young children who demand low-fiber or "junk food" diets are also susceptible.
Constipation is a condition, not a disease, and most of the time is easily corrected. If simple adjustments in diet, exercise, and bowel habits don't help, a doctor can be consulted to rule out a more serious cause.
Top Symptoms: abdominal pain (stomach ache), nausea, stomach bloating, constipation, constipation
Symptoms that always occur with normal variation of constipation: constipation
Symptoms that never occur with normal variation of constipation: vomiting
Viral (norovirus) infection
If you ever heard of an entire cruise ship of people coming down with the same “stomach bug,” chances are that was norovirus. Fortunately, norovirus usually goes away on its own after a few days, but is pretty unpleasant and can spread extremely easily. The ...
Gall bladder infection (cholecystitis)
Gallbladder infection, also called cholecystitis, means there is a bacterial infection of the gallbladder either with or without gallstones.
The gallbladder is a small organ that stores bile, which helps to digest fats. If something blocks the flow of bile out of the gallbladder – gallstones, damage to the bile ducts, or tumors in the gallbladder – the bile stagnates and bacteria multiplies in it, producing an infected gallbladder.
Risk factors include obesity, a high-fat diet, and a family history of gallstones.
Symptoms include fever; chills; right upper quadrant abdominal pain radiating to the right shoulder; and sometimes nausea and vomiting. A gallbladder infection is an acute (sudden) illness, while the symptoms of gallstones come on gradually.
Untreated cholecystitis can lead to rupture of the gallbladder, which can be life-threatening.
Diagnosis is made through physical examination, ultrasound or other imaging, and blood tests.
Treatment involves hospitalizing the patient for fasting with IV fluids, to rest the gallbladder; antibiotics; and pain medication. Surgery to remove the gallbladder is often done so that the condition cannot recur.
Top Symptoms: abdominal pain (stomach ache), nausea, loss of appetite, diarrhea, constipation
Symptoms that always occur with gall bladder infection (cholecystitis): abdominal pain (stomach ache)
Symptoms that never occur with gall bladder infection (cholecystitis): pain in the upper left abdomen, pain in the lower left abdomen
Urgency: Hospital emergency room
Acid reflux disease (gerd)
GERD (gastroesophageal reflux disease) in infants refers to the passage of stomach contents into the throat causing troublesome symptoms, such as feeding intolerance, inadequate oral intake of calories and/or poor weight gain. Vomiting or visible regurgitation ...
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Treatments for side pain below the ribs
Treatment will depend on the specific cause of your symptoms. Treating the underlying cause whether it is a disease in a particular organ, trauma, or anything else usually alleviates the lower rib pain. There are two main categories of treatment for most diagnoses:
- Medication: Medications can treat any chronic damage or disease to organs such as the liver, kidney or heart. Conditions such as heart disease, kidney disease and liver disease are often medically managed before treatments such as surgery or transplant need to be considered. Medications are also the first-line treatment for digestive complications that result in lower rib pain.
- Surgery: Surgery is often the first-line treatment for traumatic causes of lower rib pain such as fractures. Surgery will also be utilized to repair any organs that become damaged during a traumatic event such as the lungs or spleen. Surgery may also be considered in severe organ conditions such as liver or kidney failure, and to remove obstructions in the kidney or gallbladder.
FAQs about pain below the ribs
Do women have fewer ribs than men?
Studies show that women have approximately 10 percent less rib cage volume than men, despite controlling for factors such as height and weight. However, the number of ribs between men and women is generally the same.
Why does my lower rib pain worsen when I take a deep breath?
When the lining of the lungs (the pleura) becomes inflamed, this causes a condition called pleurisy sharp chest pain that worsens during breathing. The pleura is divided into two thin layers. One layer wraps around the lungs and the other layer lines the inner chest wall. Breathing causes the lungs to expand and the inflamed pleura rub against each other, causing pain during inhalation and exhalation.
Is pain on one side of the lower rib more serious than the other?
No. Pain below either side of the ribs should be taken seriously since the ribs enclose important organs on both sides. Always follow up with your physician if you experience pain in the lower ribs, especially if the pain persists and does not improve.
Are there at-home remedies I can use to help alleviate my lower rib pain?
If the pain below your ribs is associated with digestive etiologies, there are many over-the-counter medications you can use to help combat symptoms. Antacids and other acid blockers can help neutralize stomach acids that may be causing indigestion, and stool softeners can also be bought over-the-counter to help with constipation.
When will the pain subside?
The pain below the ribs may subside with appropriate treatment of the underlying cause, especially with conditions that involve inflammation of the lung pleura. In regards to conditions that affect particular organs, the pain may return intermittently depending on the cause.
Questions your doctor may ask about pain below the ribs
- Have you experienced any nausea?
- Any fever today or during the last week?
- Have you lost your appetite recently?
- How would you describe the nature of your abdominal pain?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
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- Mayo Clinic. Published February 6, 2018. Mayo Clinic Link
- Symptoms & causes of indigestion. National Institute of Diabetes and Digestive and Kidney Disorders. Published November 2016. NIDDK Link
- Vorvick LJ. Ribcage pain. U.S. National Library of Medicine: MedlinePlus. Updated January 26, 2017. MedlinePlus Link