Pain beneath the right-side rib cage originates from various sources. This area houses major organs, including the liver and gallbladder, but discomfort can also stem from surrounding muscles, bones, or systems located slightly further away. Pain in this quadrant can signal issues ranging from simple muscle strain to potentially serious internal conditions. Understanding the characteristics of the pain—such as its quality, timing, and accompanying symptoms—is the first step in determining its likely cause.
Musculoskeletal and Direct Causes of Pain
The source of pain in the side ribs is often mechanical, involving the muscles, cartilage, or bone structure of the chest wall. The intercostal muscles, which run between the ribs and assist with breathing, are susceptible to injury from overexertion. A sudden, forceful movement, heavy lifting, or intense coughing can result in an intercostal muscle strain. This pain is typically sharp, localized, and intensifies when taking a deep breath, sneezing, or twisting the torso.
Direct trauma, such as a fall or impact, can lead to a bruised or fractured rib, causing intense and persistent pain. These injuries are marked by extreme tenderness when the affected area is touched or pressed. Costochondritis, inflammation of the cartilage connecting the ribs to the breastbone, is another cause. This condition produces sharp, pressure-like pain aggravated by movement, deep inhalation, and direct contact.
Pain Related to Key Upper Abdominal Organs
The most common internal organ concerns beneath the right ribs involve the gallbladder and the liver. Gallbladder issues, such as gallstones or inflammation, are characterized by sharp, steady pain, sometimes described as gripping or gnawing. This discomfort often presents 30 minutes to a few hours after consuming a high-fat or large meal, as the gallbladder contracts to release bile.
The pain from a gallbladder attack (biliary colic) can radiate from the upper right abdomen to the back or the right shoulder blade. If the gallbladder becomes acutely inflamed, the pain becomes constant and severe, potentially accompanied by a fever and chills. Liver-related discomfort is usually a dull, persistent ache or a feeling of fullness. Pain is felt when the organ swells due to conditions like hepatitis or fatty liver disease, stretching its protective layer, since the liver itself lacks pain-sensing nerves.
Digestive and Kidney-Related Sources
Pain under the right ribs can be referred from the digestive tract or the urinary system. The large intestine has a sharp bend near the liver, the hepatic flexure, which is a common site for gas and stool accumulation. This buildup can cause sharp, cramping pain and distension. Such pain is temporary and often resolves with the passing of gas or a bowel movement.
Kidney-related pain is distinct because the right kidney is located posteriorly, just beneath the lower ribs. A kidney stone passing through the ureter or a kidney infection causes intense, sharp pain, often called flank pain, that radiates from the back or side towards the front or groin. A kidney infection is accompanied by high fever, chills, and painful or frequent urination, distinguishing it from other discomfort. Shingles, caused by the reactivation of the varicella-zoster virus, can also cause sharp, burning, or tingling nerve pain along the right rib line days before the characteristic rash appears.
When to Seek Immediate Medical Attention
Certain symptoms necessitate immediate medical evaluation to rule out life-threatening conditions. Seek emergency care if the pain is sudden, crushing, or the most severe you have ever experienced. Immediate attention is required if the pain is accompanied by difficulty breathing, shortness of breath, or pain that radiates to your jaw or left arm. Rib pain paired with a high fever, chills, persistent vomiting, or the development of jaundice should prompt an urgent visit to a healthcare facility.