Pain under the left rib: is it a symptom of some disease?

Pain under the left rib: is it a symptom of some disease?
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Pain occurring under the left rib can occur with muscle strains, after injuries, but can also indicate a serious problem.

Pain under the left rib is also referred to as pain in the left hypochondrium - subcostal area.

For better identification and localization of pain, the abdomen is medically divided into four quadrants, the upper left and right quadrants and the lower left and right quadrants.

Imagine the abdomen. Think of a vertical line in the middle of the abdomen dividing it into two halves, and another line horizontally at the level of the navel. That's how we arrive at the division of the abdomen into four quadrants.

In the upper left quadrant of the abdomen are important organs such as the left lung, heart, pancreas, spleen, stomach and left kidney.

The pain can be sharp, dull, stabbing and can occur at rest or on movement.

The cause of pain in the left lower back can be different.

It can be just a muscle strain, a rib impingement. But it can also indicate a serious problem such as an enlarged or ruptured spleen, pleurisy, pneumonia, pancreatic or stomach disease.

Most pain under the left rib does not indicate an acute, life-threatening condition. However, a thorough examination is necessary to confirm the diagnosis.

What diseases can cause pain under the left rib?

Pain under the left rib often occurs with problems with the spine or ribs.

Diseases of the spine and ribs

The rib cage is made up of 24 ribs - 12 ribs on one side and 12 ribs on the other.

They are responsible for protecting important organs.

The sternum is located exactly in the middle of the chest and is connected to the sternum by 7 pairs of ribs, also called the true ribs. The remaining 5 ribs are the so-called false ribs. 3 of them are connected to the sternum by cartilage and the last 2 pairs of ribs end loosely in the chest wall between the muscles.

The spine is the fixed axis of the body. It is located at the back of the trunk and is made up of 33 to 34 vertebrae. Between them are 23 discs that connect the vertebrae and cushion the body's impact.

The vertebrae have holes in them which form the spinal canal and protect it. The spinal cord is housed in it and the spinal nerves protrude between the vertebrae.

The spine divides into:

  • The cervical spine is made up of the first 7 vertebrae (C1-C7).
  • The thoracic spine - 12 vertebrae (T1-T12)
  • Lumbar spine - 5 vertebrae (L1-L5)
  • Sacral spine - 5 vertebrae (S1-S5)
  • Vertebral column - 4-5 vertebrae (Co1-Co4)

A blockage, fracture or impingement of the left-sided ribs, which often occurs after an accident or careless movement, can manifest as pain, muscle spasms, a feeling of tension, tingling or burning spreading to the left lower ribs and abdomen.

Worsening pain on breathing is typical.

Broken ribs usually heal spontaneously within 3-6 weeks

Disc herniation

When the outer layer of the disc is disrupted, part of the inner nucleus slides out. This causes a disc herniation, also known as a popped or displaced disc.

Disc herniation (herniated disc) of the thoracic spine is manifested by pain, tingling and discomfort. When the intervertebral disc of the thoracic vertebrae is affected, the pain appears on the left or right side below the ribs.

Degenerative changes in the thoracic spine

Pain appears in the left or right lower ribs with a tingling sensation and decreased sensation in the lower body.

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Costochondritis is an inflammation of the cartilage connecting the ribs to the sternum.

It manifests as a sharp pain that can be stabbing, worsening with deep breathing, coughing, sneezing.

The pain is sometimes more pronounced on the left side of the chest. It may radiate to the back, abdomen or limbs. Touching the sides of the chest is tender to painful.

The pain is reminiscent of a myocardial infarction.

The cause of the inflammation is unknown, but is attributed to overexertion or trauma.

Tietz syndrome

Tietz syndrome is a very rare disease and manifests itself with the same symptoms as costochondritis. But in the case of Tietz syndrome, there is also swelling and redness around the cartilage on the sternum.

Heart disease

The heart is a hollow muscular organ that works continuously as a muscular pump to ensure the circulation of blood in the body.

It is located in the chest above the diaphragm. Its wider part faces backwards and its tip faces forward to the left side.

The whole heart is located in the pericardium.

Almost everyone who feels pain in the left lower rib cage immediately thinks it's a heart attack. But most myocardial infarctions present as a pressing, burning pain in the middle of the chest, radiating to the lower jaw, back or left shoulder.

In a heart attack, there is also difficulty breathing, vomiting. Cold sweat appears on the body and dizziness is also associated.

Inflammation of the pericardium - pericarditis

Pericarditis is a condition where due to inflammation there is irritation and swelling of the pericardium and an increase in the amount of fluid between the heart and the pericardium.

It is manifested by a dull, stabbing pain behind the breastbone or on the left side below the ribs.

It manifests very similarly to a heart attack.


  • Pain may radiate to the jaw, shoulder or neck
  • Elevated temperature, fever
  • Fatigue
  • General weakness
  • Shortness of breath
  • Heart palpitations
  • Coughing fits
  • Swelling of the ankles and calves

Symptoms worsen when lying down, taking deep breaths, swallowing, coughing. On the contrary, they are relieved when sitting and bending over.

Pleurisy - pleurisy

The pleura is a thin membrane lining the chest cavity.

Pleurisy is a common disease but can have serious consequences if left untreated.

The causative agent of the inflammation is a bacterial or viral infection. It usually arises in association with another disease, such as pneumonia, scarlet fever or tuberculosis.

When the left side of the chest is affected, sharp pain appears on the left side below the ribs.

The pain worsens with deep breathing, coughing, yawning.

Because of the pain, breathing is often only superficial, leading to shortness of breath.

If pus accumulates in the space between the pleura, the temperature rises to fever and is accompanied by fatigue and debility.

Diseases and injuries of the spleen

The spleen is located in the abdominal cavity below the left diaphragm vault.

The posterior wall of the spleen is adjacent to the diaphragm, and its medial surface lies between the kidney and the stomach.

The spleen is known as a reservoir of red blood cells. Its other function is to remove old erythrocytes and platelets from the bloodstream. It also produces B-lymphocytes as well as antibodies needed for the immune system.

Enlargement and rupture of the spleen can cause:

  • Viral infections, such as mononucleosis
  • Bacterial infections such as syphilis
  • Parasitic infections such as malaria
  • Diseases of the blood or lymph nodes
  • Liver disease such as cirrhosis, hepatitis

Enlarged spleen - splenomegaly

An enlarged spleen is usually manifested by a feeling of pressure under the ribs after eating, rarely by pain.

Symptoms of an enlarged spleen:

  • Feeling of pressure or pain in the left upper quadrant, sometimes radiating to the left shoulder
  • Feeling of fullness independent of food.
  • Anemia
  • Fatigue
  • Increased bleeding
  • Frequent infections

rupture of the spleen

Rupture of the spleen is a life-threatening condition.

Splenic rupture often occurs after an accident, a severe fall, or a car accident.

Symptoms may appear several hours apart.

Manifestations include:

  • Severe pain in the left lower rib cage, sensitive to touch.
  • Low blood pressure
  • Heart palpitations
  • Dizziness and light-headedness
  • Blurred vision
  • Nausea

Pancreatic disease

The pancreas is located under the left side of the diaphragm.

It is an organ with external and internal secretions. It produces pancreatic juice, which is needed in the digestion of food, and produces both insulin and glucagon.

Pancreatitis, pancreatitis

Pancreatitis can be caused by excessive alcohol consumption, gallstones, pancreatic injuries, irritation from hard-to-digest and heavy food.

The pain usually appears slowly and increases in intensity after eating. Sometimes the pain persists or alternates.


  • Sharp pain in the left upper quadrant, which may radiate to the navel or back.
  • Nausea
  • Vomiting
  • Weight loss
  • Bloating
  • Fever may or may not be associated
  • Heart palpitations and rapid pulse

Read also:

What is the best treatment for pancreatitis?

The stomach is a hollow muscular organ in the shape of a sac that connects the oesophagus and the small intestine. It is located in the abdominal cavity under the left vault of the diaphragm. It passes by its terminal curve to the right upper quadrant of the chest.

The main function of the stomach is to prepare for the digestion and absorption of ingested food and its transport to the small intestine.

The ingested food is stored in the stomach for several hours, where it is broken down and reduced in volume. Through contractions and movements of the stomach, the ingested food is mixed with gastric juice and digestive enzymes.

Inflammation of the stomach - gastritis

Inflammation of the lining of the stomach (gastritis) can manifest itself with a burning, sharp pain in the left lower abdomen and a feeling of a distended stomach.


  • Pain in the upper left quadrant
  • Nausea, vomiting
  • Feeling of a heavy stomach
  • Nausea
  • Feeling of an aftertaste in the mouth
  • Unpleasant feeling of discomfort
  • Flatulence, bloating
  • Weight loss

Stomach ulcer

A stomach ulcer is manifested by a sharp pain in the middle of the abdomen just below the ribs, which may be more localised to the left side. The pain worsens after eating and at night.


  • Nausea, digestive problems
  • Pain comes on suddenly and tends to get worse
  • Black stools resulting from bleeding from the ulcer
  • Vomiting of blood

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Indigestion can cause pain in the upper left and right abdomen just below the ribs. It is a part of various digestive diseases.

You can read more about dyspepsia in the article:
What is dyspepsia: What are the symptoms and course of indigestion?


Diverticulitis is an inflammation of a bulge on the large intestine.

It can develop anywhere on the bowel, but most commonly occurs in the left esophageal spur.


  • Feeling of abdominal stiffness
  • Crampy abdominal pain
  • Pain worsens on movement
  • Constipation, diarrhea
  • Vomiting
  • Feeling of fullness, flatulence
  • Blood in stool


In full bowels that have not been emptied for a long time, there is a feeling of discomfort or pain in the abdomen.

Pain may also be localized in the left upper quadrant of the abdomen.

When experiencing pain, think about the last time you performed a large bowel movement and whether constipation may be the reason for the pain and bloated feeling.

Inflammatory bowel disease

This includes diseases such as ulcerative colitis, Crohn's disease, but also irritable bowel syndrome.

Inflammatory bowel disease can manifest itself:

  • Abdominal pain, which may be localised in the left upper quadrant
  • Frequent diarrhoea
  • Blood in the stool
  • Fatigue
  • Weight loss

Irritable bowel syndrome

Irritable bowel syndrome is a set of symptoms affecting the gastrointestinal tract.

Irritable bowel syndrome occurs during stressful life events, in people with depression, with food intolerances and with bacterial infection or changes to the bowel.


  • Abdominal pain, which can occur anywhere, even in the upper quadrant of the abdomen
  • Diarrhoea or constipation
  • Stomach cramps
  • Bloating, flatulence
  • Mucus content in stool
  • Fatigue

Kidney disease

The kidneys are paired organs. They are located in the right and left lumbar regions extending below the diaphragm.

The kidneys filter the blood and remove waste products from the body. The kidneys produce the hormone erythropoietin, needed for the production of red blood cells, and the hormone renin, which maintains optimal blood pressure.

Kidney inflammation

Inflammation of the kidneys can be caused by bacteria and viruses.

It manifests itself with symptoms:

  • Pain on the side of the affected kidney
  • Back pain, which may shoot to the front under the rib area, to the side
  • Pain and burning when urinating
  • Urine may be cloudy and smelly
  • Urine with an admixture of blood, may be pink, brownish or with an admixture of fresh clear blood
  • Urine with an admixture of pus
  • Elevated temperature to fever
  • Chills
  • Nausea, vomiting
  • Frequent urge to urinate

Kidney stones

With kidney stones, the pain may move forward along the lower back.


  • Pain under the ribs
  • Pain is fluctuating, alternating with periods of rest
  • Urine with blood or cloudy urine
  • Elevated temperature, even fever
  • Chills
  • Pain on urination
  • Frequent urge to urinate with urination of small amounts to inability to urinate
  • Pain in the left or right side, shooting into the abdomen or groin

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Other causes

  • Shingles is manifested by unpleasant tingling, burning and pain in the skin of the affected area
  • Cancer of the stomach, oesophagus, lungs, pleura, spleen. The tumour may press on internal organs and cause pain
  • Ascites is the accumulation of loose fluid in the abdominal cavity. Fluidothorax (pleural effusion) is the accumulation of fluid between the chest cavity and the lungs. It manifests with chest pain due to the loose fluid pushing out the organs and causing pressure on them. Often there is the presence of fluid and its multiplication around the liver and spleen, which manifests with pain in the left lower rib cage
  • Ileus is an obstruction, a kinking of the intestines and is manifested by abdominal pain that may affect the left upper quadrant

Pain in the left lower abdomen during pregnancy

During pregnancy, a woman may experience various unpleasant symptoms. One of them is rib pain.

Rib pain can be caused by the position of the uterus and the growing fetus in it. At the end of the second and third trimester, the uterus grows upwards. With the fetus growing day by day, pressure can be put on the ribs. This can cause pain in the lower ribs.

Another reason may be pain in the rib muscles, which are burdened by carrying the weight of the fetus. This pain is usually only mild in most cases.

The position of the fetus is another cause. When the fetus turns its head to the pubic bone, its little legs may put pressure on the ribs. The pain may be just below the breast on the side where the baby is laid.

Other reasons for pain left below the ribs may be:

  • Urinary tract infection and inflammation of the kidney
  • Constipation may present with pain in the upper abdomen in the lower rib cage
  • Pre-eclampsia and HELLP syndrome can cause pain under the ribs

Read also:
Dangerous constipation in pregnancy? What for constipation and how to defecate without difficulty?


Pain in the left upper quadrant is diagnosed on the basis of medical history - how the pain started, what may have triggered it, whether you have suffered any injury. It is also diagnosed on the basis of physical examination by looking, feeling and listening.

If pain is suspected to be due to heart disease, an ECG scan is performed to catch signs of possible heart attack, pulmonary embolism and other diseases.

Laboratory blood tests for blood count, inflammatory parameters, to detect kidney, stomach, pancreas, liver tests.

Urinalysis to detect inflammatory parameters and the presence of pus or blood.

Stool examination for occult bleeding, for the presence of Helicobacter pylori.

If gastric disease is suspected, the patient is referred for gastrofibroscopy.

Other imaging methods are ultrasonography, where the presence of free fluid in the abdominal cavity, enlargement of internal organs, splenic rupture, ileus, as well as kidney or gallbladder stones can be detected.

To detect pneumonia or rib fractures, an X-ray examination of the chest cavity is performed.

If the pain is due to trauma, the patient is referred for a CT scan or MRI scan to detect damage to the spine, ribs, and possible damage to internal organs.


Treatment depends on the cause that triggered the pain.

For bone and soft tissue injuries, bed rest, cold compresses on the affected area and administration of pain relieving drugs are recommended.

When the temperature is elevated, antipyretics, fever reducing drugs are given.

In inflammation caused by bacterial infection, antibiotics are given.

Surgery is performed for splenic involvement and tumors.

When to seek medical help immediately?

If the pain under the left rib is accompanied by:

  • Shortness of breath
  • Confusion
  • Excessive sweating
  • Pallor
  • Dizziness, vomiting, nausea
  • Rapid pulse
  • Possible disturbance of consciousness

Prevention of heart disease

  • Regular sporting activity, at least 30 minutes of physical activity. Suitable sports are light walking, swimming, cycling, running and stair walking. Not suitable are strength exercises
  • A varied and balanced diet. A regular diet based on breakfast and 5-6 meals a day
  • Increase intake of vegetable protein, legumes
  • Limiting animal fats and sausages
  • Eating fish at least once a week
  • Reduction of cholesterol
  • Increase fibre intake through diet or supplements
  • Daily intake of fruit and vegetables
  • Use vegetable oils or fish oil
  • Reduce intake of sweets and artificial sweeteners
  • Maintain a drinking regime
  • Limit salting
  • Breathing exercises, relaxation and exercise in nature to reduce stress
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Interesting resources

  • Brief Anatomy of Man: Pavel Fiala, Jiří Valenta, Lada Eberlová
  • - Pain under the left rib (in the left subcostal space): everything you need to know!: Michal Vilímovský, MD
  • - Tietz syndrome: everything you need to know: Michal Vilímovský, MD
  • - Active prevention of cardiovascular diseases in the conditions of public pharmacy: Mgr. Anita Šestáková, Mgr. Zuzana Šestáková, PharmDr. Peter Matejka, PhD. (PharmInfo spol. s.r.o., Bratislava)
  • - Whats Causing Pain Under My Left Ribs?
  • - What causes upper left abdominal pain under the ribs?
  • - Enlarged spleen (splenomegaly)
  • - What to know about rib pain during pregnancy
  • - Left Upper Quadrant Pain: Dr Hayley Willacy
The aim of the portal and content is not to replace professional examination. The content is for informational and non-binding purposes only, not advisory. In case of health problems, we recommend seeking professional help, visiting or contacting a doctor or pharmacist.