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Is right rib pain a sign of something serious? When to call the doctor

Pain on the right side under the ribs isn’t always a sign of a serious problem, but here are possible causes and when to see a doctor.
Female athlete. Side stitch - woman runner side cramps after running.
Sometimes pain under the rib is nothing more than a symptom of sleeping wrong or exercising too hard.Lifemoment / Getty Images
/ Source: TODAY

Pain on the right side of the abdomen under the ribs is a common complaint. We’ve all felt it at some point. The pain may be sharp or dull. Perhaps it was sudden or slowly crept up on you.

At the first sign of a mysterious ache or pain, many of us do the same thing: Flock to the internet for answers. A quick search for pain on the right side under the ribs could yield hundreds of concerning results and send an otherwise healthy person down a digital self-diagnosis rabbit hole.

A random, minor ache probably isn’t a sign of something serious. However, it could indicate an underlying health problem depending on other factors and symptoms. Before jumping into potential explanations of right-sided pain under the ribs, here’s a little anatomy refresher on this part of the body.

What organ is on the right side under the ribs?

The right upper quadrant of the abdomen contains bones, muscles, organs and other tissues.

The ribs are the bony structure that makes up the thorax, or the region of the body between the neck and the abdomen, Dr. John Vasudevan, associate professor of physical medicine and rehabilitation at University of Pennsylvania, tells The rib cage’s function is to protect the organs in the chest, including the lungs and heart. In between the rib bones are the intercostal muscles, Vasudevan adds, which allow the chest to move.

Several organs are located in the right upper quadrant of the abdomen just behind and under the ribs — these include the liver, gallbladder, pancreas, right kidney and duodenum, a part of the small intestine just beyond the stomach, Dr. Joseph Murray, a gastroenterology and hepatology specialist at the Mayo Clinic in Rochester, Minnesota, tells

Right rib pain could be caused by a problem with the ribs themselves, the muscles or the organs beneath them. The key is to look at your medical history, other symptoms and the severity or duration of the pain, but a proper diagnosis will require a health care professional.

If the pain is bad enough — or you are stressing yourself out enough trying to self-diagnose — it may be time to get checked out, the experts note.

When should I be worried about pain on the right side under the ribs?

In most cases, a random, minor ache or pain will go away on its own, and it isn’t something to worry about, the experts say. However, if the pain becomes severe, persistent or it’s accompanied by other symptoms like a fever, it may be time to seek medical attention.

In any case, heed this advice: “If the pain is keeping you from working or just enjoying your day, then see your doctor,” Dr. Amit Bhan, gastroenterologist at the Henry Ford Health System in Detroit, tells Scouring the internet for answers about what’s causing the pain may only make you more confused or delay care.

Don’t be surprised if the checkup reveals a simple solution like changing your sleeping position, stretching before exercise or eating more fiber, the experts say.

“There’s nothing we like more than telling someone that everything is OK or finding something more serious in the earliest stages so treatment is most effective,” Bhan adds.

What could cause pain under the ribs on the right side?

Here’s a rundown of 10 possible causes of that right-under-the-right-rib ache:

1. Muscle pains

Often, a sudden ache on the right side under the ribs is caused by a strained or pulled muscle. This includes the intercostal muscles between the ribs, the diaphragm, or the oblique abdominal muscles, Vasudevan explains.

Strained or pulled muscles in this part of the body are typically caused by overuse injuries or from twisting and swinging motions in sports such as golf or tennis. However, even poor posture or sitting for too long at a desk or in an uncomfortable position can cause an intercostal muscle strain.

Poor stability, a weak core and weak upper back muscles can also put added pressure on the ribs, Vasudevan explains, which may lead to soreness or aches.

The pain can be sharp, and the area may feel stiff or very tender when you press down on the ribs, Murray adds. “If movements like stretching, twisting or turning are causing the pain, it might well be musculoskeletal,” says Murray. In some cases, a strained rib muscle may cause pain with breathing.

A strained or pulled muscle typically isn’t serious and will heal on its own in a matter of weeks, says Vasuvedan.

2. Sleeping wrong

Side and stomach sleepers, take note. Spending the entire night lying on your right side or in an odd position can certainly cause your right ribs to ache the following day, the experts note.

“Sometimes a pain under the rib is nothing more than you slept wrong,” Dr. Gregory Cooper, a gastroenterologist at the University Hospitals Cleveland Medical Center, tells Sleeping on one side or with the torso twisted can put excessive pressure on the ribs or strain the intercostal muscles during the night. An uncomfortable mattress may also cause you to ache the next day.

If you notice the right rib pain occurs after waking up or you know you sleep on the right side, try sleeping in an upright position on your back instead.

3. Bruised or broken ribs

Sometimes, right rib pain can be caused by a bruise to the rib bones, the experts note. These typically occur after some type of trauma, such as falling or getting hit in the chest or side during sports, for example, Vasudevan explains. A bruised rib may also be caused by severe coughing.

“A (bone bruise) is more common than a full-on fracture. ... It can feel like a fracture, and it can cause pain for weeks, but the rib bone is not broken” says Vasudevan.

Less commonly, right rib pain can be a sign of a stress fracture or full-on bone break. “With a fracture, you have pain with activity and also at rest, and there's clear trauma, so you can feel a crack, divot or indentation ... or there’s visible bruising,” says Vasudevan. Another telltale sign of a fractured rib is when the area feels like “rice krispies” under the skin, he adds.

The pain is usually localized, sharp and worsened by movement or breathing, according to the experts. Broken ribs typically take about six weeks to heal, Vasudevan notes, but it can take longer depending on the severity of the break or the person.

4. Liver issues

If the right rib pain doesn't get worse with exertion and there’s no obvious signs of injury, it could potentially be a sign of a problem with your internal organs in that part of the body, says Vasudevan.

The first one that comes to mind for many people is the liver, which is one of the most important organs in the body. The liver is a large, football-shaped organ located on the right upper side just under the rib cage, and it's essential for digestion and ridding the body of toxic substances, per the Mayo Clinic.

An isolated ouch under your right ribs doesn’t mean your liver is diseased, but it could be a sign of another condition. Aside from pain, which may be dull or severe, the symptoms of liver problems usually include a combination of jaundice, itchy skin, darkened urine, changes in stool color (including pale or tar-colored stool), fatigue and appetite loss, according to the experts.

“Less commonly, you can get pain if you have some kind of benign or malignant growth in your liver and from (liver) infections,” says Murray.

If you have concerns about your liver, talk to your doctor.

5. Gallstones

Pain in this part of the body may be related to the gallbladder, a small, pear-shaped organ located on the right side of your body, beneath the liver. It acts as a reservoir for bile, says Murray, which is produced in the liver and released by the gallbladder into the small intestines to aid digestion.

There’s a host of conditions that can plague the gallbladder, but a common culprit is biliary colic. This is a type of abdominal pain caused by an obstruction of the bile duct, usually from gallstones, the experts note.

The bile ducts drain bile from the liver, Murray explains, and gallstones occur when the gallbladder concentrates bile, causing crystals to form into small, hard deposits that look like tiny stones. “You can have one, two or tens of stones, and these can block the bile ducts,” says Murray.

Gallstone pain is typically sudden and worsens over time. “Gallstone pain can also be ‘referred’ around to your back on the right side, or up to your right shoulder,” says Murray. In addition to side or back pain, you experience nausea and tenderness in the abdomen for a day or so due to gallstones, the experts note.

Acute cholecystitis, or a gallbladder attack, can also cause severe and steady pain in the right upper ribs. This occurs when the gallbladder becomes inflamed, often due to a gallstone blocking the cystic duct, the experts note. Symptoms include pain, fever, chills, nausea and vomiting.

6. Kidney problems

Pain on the upper right side can also be a sign of a kidney issue. We have two kidneys, one on either side of the body, and the right kidney is situated just under the liver. The kidneys remove waste and excess fluid from the body and produce urine, per the Mayo Clinic.

Something as simple as dehydration can sometimes cause right kidney pain.

Kidney stones are a common condition and may cause aches in this area, says Murray. Kidney stones are small, hard deposits made of minerals and salts that form inside your kidneys, per the Mayo Clinic, which can concentrate together and become difficult to pass through the urinary tract.

The pain from kidney stones may start in the right side under the ribs and radiate to the back, Murray notes. It may be persistent or come in waves. Urinary tract infections can also spread to one or both of the kidneys, causing pain in the right side of the abdomen, the experts note. The pain may be accompanied by a fever, a burning sensation while urinating, and other symptoms.

Chronic kidney disease, growths, malignancies or cancers can also cause right-sided kidney pain, according to the Mayo Clinic.

7. Trapped gas

Trapped gas in the intestines can be surprisingly painful.

The large intestine has two points under the rib cage where it bends, and the right-sided bend is called the hepatic flexure, according to the experts. When excess gas from digestion or swallowing air isn’t moving through your system, it can accumulate in this part of the digestive tract. This may cause tenderness or a sharp, stabbing pain in the right side under the ribs. The pain can be more severe if you have digestive issues such as irritable bowel syndrome.

Right-sided pain from trapped gas is often mistaken for gallstones or even appendicitis, Cooper notes. In most cases, the trapped gas is temporary and will be released through the rectum. Upping your fiber intake and taking over-the-counter medicines can also help relieve trapped gas and pain, the experts note.

8. Gastrointestinal issues

A common culprit of right-sided rib pain is gastrointestinal problems, such as indigestion and gastroesophageal reflux disease (GERD).

If the pain is worsened by eating or fasting, this could indicate that it’s related to the upper digestive system, says Murray. “In the duodenum, you can get pain in that area from ulcers, or from gastritis and stomach irritation,” Murray says.

If the pain gets worse or better after bowel movements, it may have to do with the colon. “Sometimes the colon can go into a spasm, which often occurs with irritable bowel syndrome, and this can present with pain on the right side,” says Murray. Although it is rare, it’s not unheard of for colon cancer to cause right-sided pain under the ribs, Murray adds.

9. Coughing or sneezing too hard

A hard cough or sneeze can also cause pain in the space under your right rib cage. Severe or prolonged coughing may occur due to colds or respiratory infections, smoking or an underlying lung disease, such as asthma, the experts note. Intense sneezing may be due to allergies to pets, mold or pollen, for example.

Coughing and sneezing puts pressure on the intercostal muscles between the ribs and causes them to work harder, Vasudevan explains. Over time, this can result in a painful strain. But even one random, violent cough or sneeze can cause a pulled rib muscle. Rarely, severe coughing can fracture the ribs, he adds.

The pain may be progressive or occur suddenly after coughing and sneezing and worsen with these movements. Typically, these muscle strains will go away on their own, the experts note.

10. Lung infections or diseases

Pain in the right upper quadrant under the ribs may be caused by lung diseases, pneumonia, bronchitis or upper respiratory infections, the experts note. The pain could be caused by the underlying disease or infection itself or related to symptoms like swelling and coughing. Sometimes, the membrane lining the lungs can become inflamed (pleurisy), which may cause pain in this area, especially while breathing, says Murray.

Less commonly, the pain may be caused by air that is trapped between the lungs and the ribcage. “This can collapse the lung over a matter of hours or even days, which is called a pneumothorax,” says Vasudevan.

If the rib pain is accompanied by a shortness of breath or it feels too painful to breathe properly, contact your health care provider immediately.