Pain under the right rib. What's the pain telling us?

Pain under the right rib. What's the pain telling us?
Photo source: Getty images

Pain under the right rib can occur with physical exertion, but it can also indicate a more serious problem.

Pain under the right rib is also known as right hypochondrium pain. The hypochondrium is the part of the abdomen located under the right rib arch.

The abdomen is medically divided into four quadrants, which makes it easier to identify and localize symptoms.

How is the abdomen divided into quadrants?

Imagine the abdomen and divide it vertically into two halves. Then add a horizontal line at the level of the umbilicus, and you arrive at a division into four quadrants.

On the right side below the rib cage are important organs such as the liver, gall bladder, pancreas, kidney and part of the small and large intestine. Pain in this area is also known as upper quadrant abdominal pain.

The pain may occur after physical exertion, after running, because of the blood supply to the intra-abdominal organs, especially the liver and spleen. It is manifested by stinging. At rest, the pain gradually subsides.

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What could be behind the pain on the right below the ribs?

The pain can be of different nature - stabbing, sharp, dull, colicky, throbbing, pinching, burning or you may feel it as a pressure sensation.

Most often, pain under the right rib arch is associated with liver and gallbladder disease.

Pain in the upper quadrant of the abdomen can cause disease:

Liver disease

The liver is the largest gland in the body. It is located under the right arch of the diaphragm. The gallbladder is located to the right below the liver.

The liver filters the blood after digestion, detoxifies and metabolizes drugs and fats. Their other function is the production of bile necessary in the digestion of heavy and fatty foods.

The gallbladder is small and pear-shaped. It stores bile produced by the liver.

All diseases of the liver can cause pain in the upper right lower back.

Liver diseases that can cause pain under the right rib arch include:

  • Steatosis of the liver - fatty liver
  • Cirrhosis - damage to the liver by scarring that leads to liver cell death and decreased liver function
  • Liver failure - a life-threatening condition in which the liver stops functioning
  • Portal hypertension - an increase in blood pressure in the portal area
  • Liver cancer - a malignant tumour located in the liver
  • Amebiasis of the liver - an abscess in the liver and other liver diseases

Symptoms of liver disease

  • Pain in the upper quadrant of the abdomen
  • Yellow discoloration of the whites of the eyes and skin, as a manifestation of jaundice
  • The abdomen is hard to the touch
  • Abdominal tenderness
  • Nausea and vomiting
  • Urine may be dark coloured
  • Fever
  • Fatigue
  • Weight loss
  • Feeling of fullness in the upper quadrant
  • Itchy skin
  • Abdominal pain with shooting into the right shoulder
  • Loss of appetite, feeling full after eating
  • Swelling in the abdominal area
  • Formation of bruises

Liver abscess

Is a circumscribed cavity filled with pus located in the liver.


  • Pain in the right lower back
  • Fever, chills
  • Weight loss
  • Nausea to vomiting
  • Yellow discoloration of the skin
  • Stools of light colour - only in some types
  • Frequent and easily bruising or bleeding
  • Gallbladder disease

Gallbladder diseases are often the cause of sharp pain that arises suddenly under the right rib.

  • Cholestolithiasis - gallbladder stones
  • Cholecystitis - inflammation of the gallbladder
  • Choledocholithiasis - the presence of gallstones in the bile duct
  • Cholangitis - inflammation of the bile ducts
  • Gallbladder tumours


Gallstones can occur commonly in people and yet cause no problem. They are often only detected incidentally on examination.

Blockage of the bile duct by a gallbladder stone is manifested by sudden, sharp, sharp pain that can be sharp and stabbing.

Untreated gallbladder disease with gallstones can cause up to inflammation of the gallbladder. This can lead to fever and persistent pain.

Gallbladder disease manifests itself by:

  • Pain in the right subcostal region.
  • Nausea and vomiting
  • Fever
  • Chills
  • Dark-coloured urine and light-coloured stools may appear
  • Jaundice - yellow discoloration of the skin and whites of the eyes

Diseases of the digestive tract

The digestive tract is a group of organs that are responsible for the intake, processing of food, absorption of nutrients and excretion of waste materials.

Pain can occur in the right lower abdomen in many diseases of the digestive tract, such as dyspepsia (indigestion), gastritis (inflammation of the stomach), stomach ulcers and peptic ulcers, as well as in cancers of the oesophagus, stomach, small and large intestine.

Other symptoms include:

  • Bloating
  • Feeling of pressure in the stomach
  • Heartburn
  • Burping
  • Bloating, flatulence
  • Nausea and vomiting
  • Vomiting blood
  • Blood in stool

Bowel disease

The intestines are one of the longest sections of the digestive system and ensure the intake of nutrients from food.

They are divided into the small intestine and the large intestine.

In the small intestine, digested food is further broken down by enzymes in the pancreas and mixed with bile.

The large intestine absorbs water, vitamins, salts. It thickens the faeces, which are then expelled from the body.

In inflammatory bowel diseases, such as ulcerative colitis or Crohn's disease, pain occurs in the lower abdomen in most cases, but can also occur in the upper quadrant.

These diseases are often accompanied by symptoms such as:

  • Diarrhoea, sometimes with an admixture of mucus, blood, pus
  • Cramps in the abdomen
  • Fatigue
  • Nausea
  • Loss of weight
  • Anemia
  • Mouth ulcers
  • Inflammations in the body

Diseases of the pancreas

The pancreas is also known as the pancreas. It is a small organ with internal and external secretions.

It produces pancreatic juice, which is secreted into the small intestine and is needed in the digestion of food. The pancreas contains cells called islets of Langerhans, which produce insulin and glucagon.

Symptoms of pancreatic disease appear suddenly, especially in acute pancreatitis.

Pain tends to manifest in the upper mid-abdomen and may radiate to the right and left lower abdomen.

Pancreatitis may develop due to the presence of gallstones or irritation of the pancreas after consuming excessive amounts of alcohol or food that is too fatty and difficult to digest.

The pain usually worsens and symptoms such as:

  • Sharp pain
  • Bloating
  • Nausea, vomiting
  • Fever may or may not be present
  • Heart palpitations and rapid pulse

Kidney disease

The kidneys are a paired bean-shaped organ located in the lumbar part of the spine and extend with their upper part below the diaphragm.

The kidneys filter up to 180 litres of blood a day. They produce the hormone erythropoietin, which affects the production of red blood cells, and they also produce the hormone renin, which maintains your blood pressure, metabolises some vitamins, especially vitamin D, and plays a major role in the production of urine and excretion of waste products.

Kidney disease, kidney stones, inflammation and tumors can cause pain in the upper quadrant of the abdomen.

The pain may move to the side or back. It often shoots to the lower abdomen or groin.

Kidney inflammation can be triggered by bacteria and viruses that may have spread from the bladder to the kidney.

Read more about kidney inflammation in the article:

Typical symptoms of kidney inflammation are:

  • Pain and burning when urinating
  • Urine is cloudy and smelly
  • Urine may be admixed with blood, pus
  • Elevated temperature to fever
  • Chills
  • Feeling nauseous and vomiting
  • Back pain and in some cases upper quadrant abdominal pain
  • Frequent urge to urinate

Kidney stones cause symptoms:

  • Pain in the right upper quadrant of the abdomen or back
  • Blood in the urine, urine may be colored pink, brown or with an admixture of fresh red blood
  • Fever and chills
  • Pain on urination
  • Frequent urge to urinate
  • Urination of small amounts of urine to inability to urinate

Pain under the right rib in pregnancy

In pregnancy, pain in the right lower rib cage may occur due to pressure from the enlarging uterus and pressure on internal organs. However, it can also indicate a more serious problem in the form of pre-eclampsia.


Pre-eclampsia is a serious condition occurring only during pregnancy, usually after the 20th week of pregnancy. It is manifested by high blood pressure and protein excretion in the urine.

  • Some women experience pain under the right rib
  • High blood pressure
  • Severe headaches
  • Swelling of the lower limbs to the whole body
  • Nausea, vomiting
  • Presence of protein in the urine - proteinuria
  • Decreased urination, smaller urine volume
  • Liver and kidney problems
  • Blurred vision
  • Shortness of breath

HELLP syndrome

This is a serious disease in pregnancy. It is manifested by the breakdown of red blood cells (haemolysis), reduced platelets and increased liver enzymes associated with pre-eclampsia.

It is also manifested by:

  • Protein in the urine
  • Abdominal pain
  • Flatulence, bloating
  • Nausea and vomiting

Other causes of pain occurring below the right rib include

Injuries to the abdomen and ribs after accidents, falls that may have caused impact to fracture the ribs or injure the abdominal wall.

Chest and rib pain can be dull, sharp and the pain becomes more acute when the painful area of the chest is touched.

Pain also increases with deep breathing, but also with coughing, sneezing.

Sometimes there is a feeling of pressure in the chest area.

Pain occurs with changes in movement. Some positions are very poorly tolerated because of worsening pain.

In diseases of the thoracic spine, pain may appear under the right subcostal spine, with tingling sensations and muscle spasms.

Pneumonia - in pleurisy (inflammation of the pleura, the membrane covering the lungs), in pleuropneumonia (pneumonia associated with pleurisy), symptoms may present with pain on the right or left side in the lower rib cage. It depends on which side of the lung is affected.

Inflammation of the rib cartilages manifests itself similarly to a heart attack with chest pain and stinging near the heart. The pain is accentuated with deep breathing, coughing, sneezing.

When pressure is exerted on the chest and when lying down, the pain worsens.

Shingles - manifested by burning, unpleasant tingling, pain in the skin in the affected area. If it affects the area below the ribs, it can manifest itself in pain in this place.

When to seek immediate medical attention?

When symptoms such as:

  • Severe abdominal pain, abdominal cramps that do not subside even in a position of relief.
  • Fever or feeling of internal fever
  • Feeling nauseous and vomiting
  • Feeling of a distended abdomen, flatulence, or feeling of stopped winds, with no passing winds
  • Blood in stool
  • Weight loss
  • Yellow discoloration of the skin and whites of the eyes


Diagnosis consists of taking a medical history and physical examination, based on which the doctor makes a diagnosis. He refers the patient for further diagnostic testing, which includes:

  • Blood collection for liver and kidney function, mineral sampling, examination for ongoing inflammation in the body, pancreatic function, blood count
  • Urinalysis for the presence of glucose, protein, blood and for the presence of agents of inflammation in the kidneys
  • Stool examination to detect bleeding in the digestive tract and the presence of pathogens that may have caused the disease
  • Endoscopic examination of the stomach and intestines to detect inflammation, ulceration, bleeding and other diseases
  • Imaging examinations to detect kidney or gallstones, tumours or other diseases causing pain in the right lower abdomen. These examinations include ultrasonography, X-ray, CT scan or MRI.


Treatment depends on the disease that caused the pain.

Pain killers are given for the pain and in case of fever also to lower the temperature such as paracetamol (Paralen), non-steroidal anti-inflammatory drugs (Ibuprofen, care should be taken when taking it as it can cause side effects in the form of bleeding in the digestive tract).

Antacids are given for heartburn to neutralise stomach acid.

Proton pump inhibitors and H2 receptor blockers help to treat ulcer disease by reducing stomach acid production.

Antibiotics are given for bacterial infections and to treat inflammation.

Surgery is performed to confirm gallstones, abscesses and cancer.

Prevention to reduce the risk of diseases of the liver, pancreas, digestive tract, kidneys and gallbladder

  • Eat plenty of fibre-rich foods, fruit, vegetables, legumes
  • Avoid unhealthy fats and replace them with olive oil or fish oil
  • Avoid refined sugar and artificial sweeteners
  • Use less salt
  • Drink plenty of fluids
  • Don't drink alcohol and don't smoke
  • Eat smaller portions of food more often during the day
  • Avoid fatty, spicy, hard-to-digest foods
  • Maintaining a healthy weight is also important
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