8 possible causes of aching rib cage

For the past three months, I've had a niggling pain/ache under my right rib cage. It's nothing major or particularly sore, just a niggle. I feel it especially just after eating. I'm a 48 year old male that doesn't drink alcohol or smoke, so I'm hoping it's nothing to do with my liver, and I work out regularly with a fitness instructor. What could it be?

28 May 2018

Ribcage pain – whether on the left or right hand side – can occur for many reasons:

What are the causes of ribcage pain?

1. Gallstones

Gallstones can sit in the gall bladder and occasional block the bile duct causing inflammation and infection. These will usually need an operation. Commonly gallstones cause pain on the right side and cause a ‘band’ type pain around the chest. Symptoms also include;

  • Vomiting and nausea
  • Pain across chest and abdomen
  • High temperature
  • Rapid heart rate

Gallstones often need surgical removal but can be managed with pain killers.

Straining of the intercostal muscles, which connect the ribs. These are the muscles that expand and contract when we breathe. These muscles like other muscles in our body can become inflamed and cause pain. This pain tends to occur during taking deep breaths in and out. Usually resolved over time with deep breathing exercises and painkillers, however any chest pain should be investigated by GP unless the cause is known

2. Diseases such as hepatitis, fatty liver, heart failure

Diseases such as hepatitis, fatty liver, heart failure can cause the liver to become infected and inflamed, resulting in pain. However these diseases would be usually be accompanied by other signs and symptoms in addition to the pain you describe.

Hepatitis or a fatty liver will include symptoms such as:

  • Fatigue / weakness
  • Nausea
  • Poor appetite / Weight loss
  • Mild fever

Similarly, heart failure would have additional signs and symptoms, which may include:

  • Swelling in your legs and feet
  • Fast irregular heart beat (above 100 beats per minute)
  • Persistent cough or wheezing with white or pink blood-tinged phlegm

If you are in any doubt consult your GP.

3. Costochondritis

Costochondritis, or inflammation of the muscles around the rib cage, is often accompanied by fever, cough, fatigue and sore throat. Usually treated with anti-inflammatory medication, if your doctor says you’re ok to take these.

4. Acid reflux and ulcers

Pain from stomach ulcers occurs after eating meals and can radiate up into neck and down into naval. Other symptoms can include:

  • Heart burn
  • Indigestion
  • Loss of appetite
  • Being sick

Generally the pain can be managed by taking regular antacid medication. Stomach ulcers can lead to bleeding and tearing therefore it is important that an adequate examination and diagnosis is carried out.

5. Pancreatitis

Pancreatitis - The pancreas is the organ on the left side of the body, which produces insulin.

Pancreatitis occurs when this organ becomes inflamed, producing severe pain and nausea/vomiting. This condition can be fatal, so any severe pain should be investigated by GP or specialist doctor.

6. Inflammatory bowel disease

Inflammatory bowel disease, is the collective name for ulcerative colitis and Crohn’s disease. These 2 diseases involve the inflammation of the gut. The symptoms usually include:

  • Abdominal pain
  • Recurring or bloody diarrhoea
  • Weight loss
  • Extreme fatigue

7.Trauma/damage to ribs and cartilages

Trauma/damage to ribs and cartilages - If you have had an accident recently you may have bruising to the ribs or may have even cracked a rib.

8. Appendicitis

Appendicitis, is when the small part of the intestine known as the appendix becomes infected and inflamed. This needs examination by a GP or emergency doctor as it may need surgery.

With any of these issues it is important to get a diagnosis and treatment through your GP. If symptoms worsen or you experience any of the following, you should go to the accident and emergency department of your hospital:

  • Pain becomes unbearable
  • Vomiting blood or passing blood when you have your bowels open
  • Black stools
  • Crushing pain in chest
  • Worsening symptoms that you cannot manage at home

While of course no amount of healthy living can absolutely guarantee good health, the fact that you have such a healthy lifestyle makes a serious cause much less likely.

If you’re otherwise entirely well and have no other symptoms, it would be reasonable for you to try some regular anti-inflammatory tablets to see if they help your symptoms (as long as there’s no medical reason you can’t take them). Otherwise, after this length of time, see your GP – they can ask more detailed questions on associated symptoms.

Answered by the Health at Hand team.  

Sources and further reading

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