Sharp pain localized under the right ribs, especially pain that intensifies with inhalation, is a common and concerning symptom. This specific type of pain is often described as pleuritic, meaning it is exacerbated by the movement of breathing, coughing, or sneezing. Since the right upper quadrant contains structures from multiple body systems, including the digestive, respiratory, and musculoskeletal systems, identifying the source requires careful consideration of accompanying symptoms. While many causes are non-serious and resolve quickly, this symptom can sometimes signal a condition requiring prompt medical evaluation. This information is intended to provide context and should not be used as a substitute for professional medical advice or diagnosis.
Common Musculoskeletal and Digestive Causes
The most frequent origins of sharp, localized pain are often related to the structures of the chest wall or the digestive tract. Pain that worsens with movement or deep breaths often points toward an issue with the ribs, muscles, or cartilage. Intercostal muscle strain, which involves the muscles between the ribs, is a common culprit, resulting from forceful or repetitive movements, such as a strong cough or strenuous exercise. This strain causes pain because the act of breathing requires the rib cage to expand, stretching the injured muscle fibers with every breath.
Another frequent cause is costochondritis, which is the inflammation of the cartilage that connects the ribs to the breastbone. While it typically affects the junction closer to the center of the chest, pain can radiate and feel sharp or stabbing under the right ribs, especially when the torso moves or when taking a deep breath. The movement of the chest wall during respiration irritates the inflamed cartilage, making the pain more pronounced.
Digestive system issues can also mimic respiratory-related pain, even though the origin is abdominal. Trapped gas, specifically in the right side of the colon, can cause a sharp or stabbing sensation under the rib cage. This discomfort, sometimes accompanied by bloating, occurs because the gas bubble presses against the inner lining of the abdomen and diaphragm. This pressure can be misinterpreted as musculoskeletal pain, particularly as the diaphragm descends during inhalation.
Organ and Respiratory Conditions
When the sharp pain is persistent or accompanied by other signs, the focus shifts to the major organs housed in the right upper quadrant (RUQ). The gallbladder, situated just beneath the liver, is a frequent source of pain in this area, often due to gallstones or inflammation known as cholecystitis. Gallstone pain, or biliary colic, can be sudden and sharp, frequently starting or intensifying 15 to 45 minutes after eating a fatty meal.
Gallbladder inflammation can cause pain that radiates to the right shoulder or back, and deep breathing may exacerbate it as the diaphragm pushes the inflamed organ. Liver conditions, such as hepatitis or abscesses, also cause pain under the right ribs because the liver is a large organ in the RUQ. Inflammation of the liver stretches the surrounding capsule, leading to discomfort that may be a dull ache but can become sharp with movement.
Respiratory conditions affecting the right lung or its lining are a direct cause of pain that is specifically worsened by breathing. Pleurisy is the inflammation of the pleura, the two layers of tissue that line the lungs and the inner chest wall. When these layers become inflamed, they rub against one another during breathing, causing a characteristic sharp, knife-like pain upon inhalation. Pleurisy is often a complication of viral or bacterial infections, like pneumonia, and the pain can sometimes radiate to the shoulder or back.
The diaphragm, the dome-shaped muscle separating the chest and abdomen, is also a potential source of pain. Irritation or spasm of the diaphragm can be perceived as sharp pain under the ribs, directly linked to the breathing cycle. Any inflammation or irritation of the structures immediately above or below the diaphragm, such as the base of the right lung or the top of the liver, can affect its movement and cause pain with deep inspiration.
Identifying Urgent Warning Signs
While many causes of sharp right-sided rib pain are managed with rest or basic medical care, certain accompanying symptoms indicate a need for immediate medical attention. A sudden onset of severe, crushing pain, especially if accompanied by shortness of breath or pain radiating to the jaw, neck, or left arm, warrants emergency medical services.
Systemic symptoms pointing to a serious infection or organ dysfunction are also critical indicators. These include the development of a high fever and chills, which may signal an infection like pneumonia or gallbladder inflammation. Jaundice, the yellowing of the skin and eyes, is a sign of potential liver or bile duct obstruction, requiring urgent assessment.
Persistent vomiting, especially if accompanied by an inability to keep fluids down, or signs of circulatory distress like fainting, require prompt medical evaluation. If the pain is constant and does not subside after a few hours, or if it severely inhibits breathing, seek medical care immediately. A healthcare provider can perform diagnostic tests to differentiate between benign causes and conditions that require urgent treatment, such as a pulmonary embolism or acute cholecystitis.