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9 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?

1 March 2021

Ribcage pain – whether on the left or right hand side – can occur for many reasons. Most commonly this will not be due to any serious underlying condition but there are some medical reasons that may need to be ruled out:

What are the possible causes of ribcage pain?

1) Trauma or muscular pain

Trauma - if you have had a traumatic injury to the ribs, or even something such as forceful coughing, you may have caused some bruising, or even broken a rib. If you feel that this may be the cause of your pain the best things you can do are to take painkillers as required and use an ice pack to the affected area to help reduce inflammation. Try to practice 'deep breathing' also, as this will make sure that your lungs are fully inflating and reduce the risk of developing a chest infection (NHS, 2021).

Straining of the intercostal muscles - These are the muscles that connect the ribs and expand and contract when we breathe; like any other muscle in the body, these can become inflamed and cause us pain. Pain through a muscular strain will tend to occur when taking deep breaths. The treatment options for this type of strain will be similar to that above for a broken or bruised rib.

2) Cardiac Pain

We may feel pain in our ribcage that could indicate a cardiac concern, such as heart failure. If you were suffering from a condition that was affecting the function of the heart you would most likely be experiencing some additional symptoms (BHF, 2021) including: 

  • Shortness of breath
  • Swelling feet and legs; this swelling can also spread to higher up in the body
  • Feeling unusually tired and week
  • Coughing or wheezing, sometimes bringing up 'frothy' or blood-stained mucus
  • Fast heart rate.

If you are experiencing pain along with any of the symptoms noted above it is important to seek and urgent review through your GP to determine the diagnosis.

If you experience chest pain that is severe, that radiates to your arms, back or jaw, or is accompanied by nausea, shortness of breath, sweating, dizziness or feeling extremely unwell then you must seek an emergency review at your local Accident and Emergency department.

3) Costochondritis

This condition refers to the inflammation of the cartilage which joins your rib cage to your breastbone (sternum). This condition does not lead to any long-term complications and will usually improve on its own within a few weeks, however, unfortunately, some people will have relapses (NHS, 2021).

Symptoms of costochondritis include:

  • Pain when deep breathing, coughing or sneezing
  • Pain that worsens when you put pressure on the chest
  • Pain that is worsened when lying down.

The main treatment for costochondritis is pain killing medications such as anti-inflammatories (NHS, 2021). If these do not manage your pain or you condition is not resolving, then your GP may want to look into other alternative treatments.

4) Gall stones

Gallstones are formed when a substance, usually cholesterol, forms into a small stone within the gall bladder. Gallstones will often cause no problems, and you may have no symptoms at all of them, but if one of the stones becomes lodged in a duct inside the gall bladder this this can trigger a pain called biliary colic (NHS, 2021). 

Pain from gallstones is usually felt in the centre of your abdomen, under the ribs or on your right-hand side. Sometimes the pain will be triggered by eating particularly fatty foods, and you won't notice relief after being sick, having your bowels open or passing wind.

If you develop complications from gall stones, including biliary colic or inflammation of the gallbladder known as cholecystitis you may experience:

  • Jaundice (yellowing of the skin and whites of the eyes)
  • Persistent severe pain
  • Vomiting
  • Fevers.

Gallstones usually only need to be treated if they are causing complications. If you do require treatment then this will usually be surgery to remove the gallbladder using keyhole surgery (NHS, 2021).

5) Diseases of the liver

There are a number of different types of diseases that can affect our livers, including cirrhosis or hepatitis, and most of these will often have no symptoms in the early stages. As the disease progresses you may expect to see some symptoms, including abdominal pain. Some symptoms you might experience include (British Live Trust, 2021):

  • Nausea
  • Jaundice
  • Itching of the skin
  • Dark coloured urine
  • Pale/clay coloured stools
  • Abdominal pain, often on the right side under the ribs
  • Fatigue
  • Weight loss
  • Frequent or easy bruising or bleeding
  • Changes in personality.

If you are experiencing abdominal pain with any of the above symptoms, or you are concerned about your liver, the best thing to do is to get in touch with the GP for a physical review and some blood tests.  Lifestyle choices can have a really big impact on our liver health and liver disease is often preventable.

6) Pancreatitis

Pancreatitis is the inflammation of the pancreas (an organ that plays a vital role in hormone production and digestion) which can be both acute and chronic. Acute pancreatitis can make someone feel extremely unwell and can be very dangerous so needs prompt medical attention (NHS, 2021). 

One of the main causes of pancreatitis can be gallstones or heavy alcohol use but it can also develop due to other causes including injury and infection. 

The main symptom of acute pancreatitis is severe pain that is felt in the upper abdomen, just below the ribs, but you may experience other symptoms along with this pain including (NIDDK, 2021):

  • Fever
  • Nausea or vomiting
  • Fast heartbeat
  • Swollen abdomen
  • Jaundice
  • Diarrhoea.

As above someone with pancreatitis may be extremely unwell, and will often look and feel it as well, so if you believe you may be suffering from this condition it is very important to seek an urgent medical assessment, either through your local Accident and Emergency department or by calling NHS 111.

7) Acid reflux and stomach ulcers

Pain from heartburn and acid reflux can sometimes be felt int he chest area. The pain here is caused by stomach acid travelling up the oesophagus. Along with heartburn, if you are experiencing acid reflux you may also experience:

  • A sour or unpleasant taste in your mouth
  • Bad breath
  • Bloating
  • Nausea
  • A hoarse voice
  • Recurring coughs or hiccups.

Your symptoms will often worsen after eating, and when lying down and bending down, if your pain is due to acid reflux (NHS, 2021).

If you develop an ulcer in the lining of your stomach, then you will likely also experience the symptoms listed above. If you believe you have a stomach ulcer or struggling with acid reflux it is best to seek an assessment with your GP for investigations into this (NHS, 2021). In some cases, a stomach ulcer can perforate, and bleed, if you are experiencing any of the symptoms below then you must seek an urgent medical review:

  • Vomiting blood
  • Sudden intense pain that worsens
  • Passing black or tar like bowel motions.

As you say your pain seems to come on after eating then this may be something your doctor may need to investigate further.

8) Inflammatory bowel disease

Inflammatory bowel disease is the collective name for the diseases that cause inflammation in the digestive tract; the main two forms being ulcerative colitis and Crohns disease (Crohns and colitis UK, 2021). Pain from these conditions will usually be felt lower down in the abdomen, however sometimes we can get referred pain to other areas of the body, including in the ribs. If you are suffering with an inflammatory bowel disease you will likely have other accompanying symptoms including: 

  • Diarrhoea - this can sometimes be mixed with mucus, blood or pus
  • Cramping in the abdomen
  • Fatigue
  • Loss of appetite and unexplained weight loss
  • Anaemia
  • Mouth ulcers
  • Inflammation in other areas of the body (Crohns and colitis UK, 2021).

If you are experiencing any of the symptoms noted above along with the rib pain, then you should speak to your GP to discuss your symptoms.

9) 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 (NHS, 2021). This pain will usually be felt in the lower right hand side of the abdomen but if you are experiencing worsening pain, especially if accompanied by fever, nausea and loose stools then it is important to seek an assessment to rule this out.

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 over the counter pain killers to see if they help your symptoms; as long as there’s no medical reason you can’t take them (please note that long term use of some anti-inflammatory medications can cause irritation of the stomach lining). 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

References

BHF, 2021. Heart failure. (Accessed: 25 Feb 2021).

British Liver Trust, 2021. Symptoms of liver disease. (Accessed: 25 Feb 2021).

Crohns and Colitis UK, 2021. About Crohns and colitis. (Accessed: 26 Feb 2021).

NHS, 2021. Acute pancreatitis. (Accessed: 25 Feb 2021)

NHS, 2021. Appendicitis. (Accessed 26 Feb 2021).

NHS, 2021. Bruised or broken ribs. (Accessed: 25 Feb 2021).

NHS, 2021. Costochondritis. (Accessed 25 Feb 2021).

NHS 2021. Gallstones. Symptoms. (Accessed: 25 Feb 2021)

NHS, 2021. Heartburn and acid reflux. (Accessed 25 Feb 2021).

NHS, 2021. Stomach ulcer. (Accessed 25 Feb 2021)

NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases), 2021. Symptoms and causes of pancreatitis. (Accessed 25 Feb 2021).

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