What causes pain under the right rib cage? Related conditions and treatments

If you have pain under the right rib cage, it can be alarming, but it is quite common. Pain under the right rib cage, also known as the right upper quadrant (RUQ) of the ribs, could be due to a variety of conditions, considering this is where the pancreas, right kidney, gallbladder, liver, and part of the intestines are located. 

Pain under the right rib cage can have many potential causes, such as medical conditions, lifestyle habits, and injuries.

Key takeaways:

• Pain under the right rib cage is a common symptom that a chest injury, a sedentary lifestyle, or conditions such as kidney stones and gallbladder disease may cause.
• Typically, pain under the right rib cage does not require immediate medical attention but may require treatment.
• Treatment of pain under the right rib cage may include surgical removal of the gallbladder, treatment of hepatitis or pancreatitis, beta-blockers, and anticonvulsants but varies by cause. Read more about treatments for kidney stones, preeclampsia, and asthma.
• Mild pain under the right rib cage can be managed with rest and pain relievers.

The most likely reasons for pain under the right rib cage

The most likely reasons for pain under the rib cage vary but include gallbladder disease, kidney stones, preeclampsia, asthma, injuries, and lifestyle factors like smoking.

Gallbladder disease

The gallbladder is a pear-sized organ that is found in the right upper quadrant of the abdomen, under the liver and next to the pancreas. It is a reservoir that stores bile, a thick liquid that is produced by the liver to help the body digest fat. When you eat, your gallbladder’s lining contracts to get bile into your small intestines to help digest food. When the gallbladder is inflamed, infected, or blocked, it is a sign of gallbladder disease, such as cholecystitis, an inflammatory condition of the gallbladder that causes swelling and a sudden sharp pain in the upper right side of the abdomen that radiates to the right shoulder. 

Cholecystitis can be sudden (acute) or long-term (chronic). Chronic cholecystitis may not cause any symptoms but can damage your gallbladder over time. Acute cholecystitis is the most common cause of RUQ pain among people admitted to the emergency room. Treatment depends on the cause but usually includes surgical removal of the gallbladder. 

Kidney stones

Kidney stones can form in your right kidney and cause colicky, intense RUQ pain. Causes of kidney stones include high levels of oxalate, calcium, or phosphorus in the urine. Other than pain under the right rib cate, kidney stones can cause the following symptoms:

• Sharp pain in your lower abdomen, groin, back, or side
• Frequent need to urinate
• Pain when urinating
• Blood in urine
• Nausea, vomiting, and fever

Preeclampsia

Preeclampsia is an uncommon pregnancy complication in which there’s a sudden rise in blood pressure. The Centers for Disease Control and Prevention (CDC) estimates preeclampsia affects 1 in 25 pregnancies in the United States. 

According to the Preeclampsia Foundation, preeclampsia can also cause upper right quadrant pain. This may be similar to heartburn, indigestion, or gallbladder problems. 

Other symptoms of preeclampsia include:

• Persistent headaches
• Unexplained weight gain
• Difficulty breathing
• Blurry vision

Smoking

The CDC notes that smoking can harm all your organs and is responsible for more than 480,000 annual deaths in the United States. It also increases your risk of developing bladder, kidney, and liver cancer.

According to a study published in 2019, vaping devices can cause spontaneous pneumothorax, which occurs when air accumulates outside the lung within the pleural cavity. This adds pressure to the lung, causing it to collapse. People who vape and develop this condition may experience right-sided chest pain when sleeping and pain underneath the ribs that radiates to the right scapula. Immediate medical attention is needed to diagnose this and evaluate whether oxygen supplementation or a chest tube is needed to treat it.

Alcohol

Consuming too much alcohol can cause acute kidney injury, which can lead to pain, reduced muscle mass, and muscle cramps. An acute kidney injury happens when waste builds up in the blood much faster than the kidneys can filter it.

Signs of acute kidney injury include: 

• Shortness of breath
• Nausea 
• Confusion
• Fatigue
• Chest pain or pressure

Chest injury

Rib cage pain can happen due to trauma, such as a traffic collision accident or a sports-related injury. You may have rib fractures, a bruised rib, or a pulled muscle. 

It is important to see a healthcare provider if you suspect a rib fracture since the ribs need to be intact in order to protect their underlying organs. Your healthcare provider may perform chest X-rays to assess your symptoms and provide an accurate diagnosis. 

Asthma or allergy cough

Intense coughing, sneezing, and infections such as bronchitis or pneumonia can tear your rib muscles, leading to pain. 

Rib pain can also develop if you have pleurisy, in which there is inflammation in the tissue between the lungs and rib cage.

Should I be worried about pain under the right rib cage?

The severity of pain under your right rib cage depends on the cause. The pain can be a symptom of various conditions. See a healthcare provider if you have additional symptoms, such as fever, vomiting, and jaundice. A referral to a gastroenterologist may be needed for further workup of digestive issues or conditions like heartburn, pancreatitis, or liver disease that can contribute to right rib cage pain. Other possible referrals are to a pulmonologist or a rheumatologist to investigate lung or autoimmune issues.

You may require emergency treatment if right rib cage pain is the result of an accident or pain that makes it difficult to move. Untreated or unaddressed pain can cause complications. For example, without the right treatment plan, preeclampsia can be fatal to the mother and or her baby. Kidney stones can cause urinary retention and raise your risk for infection and increased pressure on the kidneys.

How is the cause of pain under the right rib cage diagnosed?

Your healthcare provider may perform the following tests to determine the cause of your pain:

• Physical examination: Helps them evaluate the affected area and check whether you have any swelling or inflammation
• Ultrasound: Takes pictures of your internal organs in order to identify problems contributing to your pain, such as gallstones, gallbladder inflammation, and pancreas problems 
• CT scan: Provides a detailed image of your tissues, bones, and blood vessels 

A doctor may also ask about your medical history and questions like the following to help diagnose your condition:

• How long have you been in pain?
• What makes the pain better and worse?
• Have you had this pain before?  If so, what was the diagnosis at that time?
• When was your last menstrual period? Is there a chance you are pregnant?
• How does the pain feel like? Is it persistent? Or does the pain come and go?
• Do you drink alcohol? If so, how often and how much? 
• Any history of hepatitis?
• Does the pain interfere with other activities? 
• Do you have other symptoms? Fever? Difficulty breathing? Bloody urine?

How long does pain under the right rib cage last?

The duration of pain on the right-hand side of your body depends on your condition. However, if symptoms do not improve within a few days of treatment, it may be time to seek medical care. 

Sean Ormond, MD, a pain management physician board-certified in anesthesiology and interventional pain management, says, “Pain under the right rib cage can be chronic. This is especially true if the pain is caused by a condition such as gallstones, liver problems, or pancreatitis. Chronic pain can be difficult to treat, but a number of things can be done to manage it, such as medication, physical therapy, and lifestyle changes.”

How to stop pain under the right rib cage

Treatment for pain under the right rib cage depends purely on the root of the problem. For example, your healthcare provider may recommend rest, cold or hot compresses, or pain medications such as Tylenol (acetaminophen), Advil or Motrin (ibuprofen), or naproxen (Aleve) to treat a bruised rib. In some instances, such as a fracture or gallbladder disease, surgery is necessary.

Most importantly, see a doctor if pain under the right rib cage is persistent and accompanied by chest tightness and shortness of breath

Pain under the right rib cage causes may include different causes, such as gallbladder disease, preeclampsia, or chest injury. The cause of pain under the right rib cage may resolve on its own without treatment. However, if pain under the right rib cage continues, worsens, or is accompanied by shortness of breath, chest pressure, or blood in phlegm, it could be a sign of pneumonia or preeclampsia and require immediate medical attention. Only your healthcare provider can rule out infection or other serious health conditions. Visit your doctor to determine the best treatment for the pain under the right rib cage.