Symptoms A-Z

Pain Below The Ribs Symptoms, Causes & Common Questions

Understand pain below the ribs symptoms, including 8 causes & common questions.

This symptom can also be referred to as: epigastric pain, upper abdominal pain

An image depicting a person suffering from pain below the ribs symptoms

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Contents

  1. Symptoms
  2. Causes
  3. 8 Possible Pain Below The Ribs Conditions
  4. Treatments and Relief
  5. FAQs
  6. Questions Your Doctor May Ask
  7. Statistics
  8. References

Pain Below The Ribs Symptoms

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 [1]. As a result, pain below either the left or right ribs can indicate various conditions that range from serious to benign.

Main Symptoms

Symptoms associated with pain below the ribs can range from the following:

Characterizing pain

It is also important to characterize the location, quality, and intensity of the pain below your ribs.

  • Is it sharp or dull?
  • Is it persistent or transient?
  • Is it located on the right or left side?
  • Is it anterior or posterior?
  • How would you rate the pain on a scale of 1 to 10?

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.

Pain Below The Ribs Causes

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.

Systemic/Organs

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.

Inflammation

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.

Traumatic

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.

Digestive

Constipation, heartburn, and indigestion are all digestive conditions that may also cause pain and feelings of bloating in the lower ribs [4]. These conditions are usually benign and transient and can be easily treated once identified.

8 Possible Pain Below The Ribs Conditions

The list below shows results from the use of our quiz by Buoy users who experienced pain below the ribs. This list does not constitute medical advice and may not accurately represent what you have.

Indigestion (dyspepsia)

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.

Rarity: Common

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

Urgency: Self-treatment

Stomach ulcer

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.

Rarity: Uncommon

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

Gallstones are hardened deposits of digestive fluid that can form in your gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver.

Rarity: Uncommon

Top Symptoms: abdominal pain (stomach ache), nausea, loss of appetite, pain in the upper right abdomen, vomiting

Symptoms that always occur with gallstones: abdominal pain (stomach ache)

Symptoms that never occur with gallstones: abdominal pain that improves after passing stools

Urgency: Primary care doctor

Acute gastritis

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, a loss of appetite, belly pain, bloating and vomiting or passing blood in severe cases.

While chronic gastritis can be a lifelong affliction, acute gastritis clears up within days to weeks of onset.

Rarity: Uncommon

Top Symptoms: nausea or vomiting, nausea, stomach bloating, loss of appetite, mild abdominal pain

Symptoms that never occur with acute gastritis: fever

Urgency: Primary care doctor

Pain Below The Ribs Symptom Checker

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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.

Rarity: Common

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

Urgency: Self-treatment

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 main symptoms are vomiting and diarrhea, which can be severe enough to require hydration with intravenous fluids. However, other treatments are rarely necessary. In the developing world where access to supportive care is less available, norovirus infection is still responsible for tens of thousands of deaths each year, primarily due to dehydration.

Rarity: Common

Top Symptoms: diarrhea, vomiting or nausea, fatigue, nausea, abdominal pain (stomach ache), headache

Symptoms that always occur with viral (norovirus) infection: diarrhea, vomiting or nausea

Symptoms that never occur with viral (norovirus) infection: severe abdominal pain, throbbing headache, severe headache, tarry stool, vaginal bleeding, alertness level change

Urgency: Self-treatment

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.

Rarity: Uncommon

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)

Acid reflux disease, also known as GERD, occurs when the acidic contents of the stomach come back up into the esophagus. The most common symptoms are heartburn and regurgitation.

Rarity: Common

Top Symptoms: nausea, sore throat, pain below the ribs, cough with dry or watery sputum, deep chest pain, behind the breast bone

Urgency: Primary care doctor

Pain Below The Ribs Treatments and Relief

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

Here are some frequently asked questions 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 [2]. 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 [3]. 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

To diagnose this condition, your doctor would likely ask the following questions:

  • 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?

The above questions are also covered by our A.I. Health Assistant.

If you've answered yes to one or more of these questions

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Pain Below The Ribs Symptom Checker Statistics

People who have experienced pain below the ribs have also experienced:

  • 13% Nausea
  • 6% Diarrhea
  • 6% Abdominal Pain (Stomach Ache)

People who have experienced pain below the ribs were most often matched with:

  • 44% Stomach Ulcer
  • 44% Gallstones
  • 11% Indigestion (Dyspepsia)

People who have experienced pain below the ribs had symptoms persist for:

  • 41% Less than a day
  • 34% Less than a week
  • 11% Over a month

Source: Aggregated and anonymized results from visits to the Buoy AI health assistant (check it out by clicking on “Take Quiz”).

Pain Below The Ribs Symptom Checker

Take a quiz to find out why you're having pain below the ribs

References

  1. Graeber GM, Nazim M. The anatomy of the ribs and the sternum and their relationship to chest wall structure and function. Thoracic Surgery Clinics. 2007;17(4):437-489. NCBI Link
  2. Bellemare F, Jeanneret A, Couture J. Sex differences in thoracic dimensions and configuration. American Journal of Respiratory and Critical Care Medicine. 2003;168(3):305-312. NCBI Link
  3. Mayo Clinic. Published February 6, 2018. Mayo Clinic Link
  4. Symptoms & causes of indigestion. National Institute of Diabetes and Digestive and Kidney Disorders. Published November 2016. NIDDK Link
  5. Vorvick LJ. Ribcage pain. U.S. National Library of Medicine: MedlinePlus. Updated January 26, 2017. MedlinePlus Link