Pain under the right rib cage may be caused by a spasm of the diaphragm, stones in the right kidney, gallbladder stones, hepatitis, gastritis, pancreatitis or pleuritis.

Depending on the underlying cause, the pain may come on suddenly and be accompanied by other symptoms, such as nausea, vomiting, fever, difficulty breathing. Right rib pain can also increase when moving or coughing.

In you notice pain under the right rib cage, you should see a doctor for assessment, especially if the pain is persistent or accompanied by other symptoms. With a thorough assessment and further testing as necessary, the doctor can confirm a diagnosis and start appropriate treatment.

What causes right rib pain?

The main causes of pain under the right rib cage are:

1. Diaphragm spasm

Spasm in the diaphragm muscle due to direct blow in the area or intense physical activity, for example, can cause pain under the right or left rib cage, or it can be felt on both sides.

The diaphragm is a muscle that separates the lungs and heart from the abdominal cavity and is involved in breathing.

What to do: If you have undergone an injury to the abdomen or ribs and the pain persists, you should see your doctor for assessment and treatment. Pain under the right rib cage that is felt following intense exercise will usually resolve on its own.

2. Pulled muscle

A pulled muscle is characterized by a muscle strain that could have occurred from intense workouts, heavy lifting, repetitive movements or heavy coughing. This sharp pain can be felt as a result of stretching or tears in the muscle fibers found under the right rib cage.

Other common symptoms of a pulled muscle include pain that worsens with movement or turning the torso, bruising or swelling in the area, and discomfort when the area is palpated.

What to do: To treat a pulled muscle, you can apply a cold compress to the area for 15 minutes, 3 times per day within the first 48 hours of the injury. This can help to reduce inflammation and swelling the area. After 48 hours, you can apply a hot compress to promote adequate blood flow and healing. You can also apply a topical anti-inflammatory ointment to help reduce discomfort, or take analgesics for more moderate pain.

A pulled muscle that in the right rib cage that does not improve within a few days should be assessed by a doctor.

3. Gallstones

Pain caused by gallstones is also referred to as biliary colic. It is normally felt under the ribs on the right side. This pain can last up to 5 hours in some cases and can radiate to the right upper back or shoulder.

It is common for gallstone pain to appear after eating very fatty foods and to be associated with other symptoms such as nausea and vomiting. Learn more about the symptoms of gallstones and what can cause it.

What to do: if you suspect you may have gallstones, you are advised to consult a gastroenterologist. Gallstones that cause moderate to intense symptoms may require gallbladder removal. Check out natural remedies for gallstones to help relieve mild symptoms.

Symptoms that present with rib cafe pain, such as fever, low blood pressure or mental confusion, should be assessed urgently, as these may be a sign of a gallbladder infection.

4. Pancreatitis

Pancreatitis is characterized by inflammation of the pancreas which can cause pain in the upper part of the abdomen. This pain can radiate to the right rib cage, to the left abdomen and all the way to the back, presenting with a "belt" sensation.

In addition to pain, pancreatitis can also cause symptoms such as nausea, vomiting and increased sensitivity in the abdomen.

What to do: If you suspect you may have pancreatitis, especially if the pain is very strong or persistent, you should proceed to an emergency room for evaluation. Treatment may involve analgesics, antibiotics and IV fluids.

Read about the pancreatitis diet that your doctor may prescribe to help speed-up recovery and prevent future flare-ups.

5. Gastric ulcer

Gastric ulcer pain is usually located in the pit of the stomach and is usually reported as a burning sensation. However, it can sometimes be felt under the rib cage on the right or left side.

A gastric ulcer is a wound in the wall of the stomach and is most commonly caused by the overuse of anti-inflammatories or by an H. pylori infection. In addition to pain, it can cause other symptoms such as indigestion, nausea, loss of appetite and malaise. Learn more about the symptoms of a stomach ulcer to help you identify it.

What to do: It is important to see a gastroenterologist to perform an endoscopy, which will confirm or rule out the presence of a stomach ulcer. Treatment for this condition may involve the use of antibiotics (if it is caused by H. pylori bacteria) and antacids.

6. Pleuritis

Pleuritis is inflammation of the pleura, the membrane that lines the lungs. When this inflammation affects the lower edge of the right lung, it can cause pain under the right rib. This pain is particularly felt when taking a deep breath, coughing, sneezing or moving.

Depending on the cause, other symptoms may also appear, such as difficulty breathing, cough and fever. Pleuritis can be caused by bacterial, viral or fungal pneumonia, lung cancer or lung failure.

What to do: If you suspect you may have pleuritis, you should see a doctor for assessment. Severe symptoms such as chest pain or shortness of breath, should be assessed urgently in an emergency room.

Pleuritis is treated with anti-inflammatories, such as ibuprofen or naproxen, antibiotics and/or anticoagulants, depending on the underlying cause. The doctor may also recommend the use of bronchodilators to improve breathing in some cases.

7. Kidney stones

The presence of stones in the right kidney can cause renal colic, a type of pain that can affect the lower back and spread to the right side of the belly below the ribs. In addition to pain, other symptoms such as nausea, vomiting and blood in the urine may also appear.

Complete our online kidney stones symptoms quiz to determine whether your symptoms may be related to stones.

What to do: If you think you may have kidney stones, proceed to an emergency room for assessment. The doctor may administer IV analgesics to help relieve pain.

Furthermore, it is important to consult a urologist upon discharge to ensure the stones are adequately treated. The doctor may prescribe medications that help eliminate the stone, while large stones stones may require surgical removal.

8. Gastritis

Gastritis is inflammation of the stomach, and usually causes pain in the upper part of the belly. This pain can sometimes spread further down to the ribs on the right side. It is also common to experience other symptoms with gastritis, such as nausea, indigestion, feeling of fullness even after eating little, abdominal bloating and frequent belching.

Check-out our online gastritis symptoms checker to assess whether your symptoms may be related to this condition.

Gastritis can be caused by H. pylori infection, use of non-steroidal anti-inflammatory medications or excessive alcohol consumption. Read more about the causes of gastritis and how it is treated.

What to do: You should consult a gastroenterologist if you suspect you may have gastritis. Treatment can be done with the use of antacids and antibiotics in case of H. pylori infection. Read more about the gastritis treatment your doctor may consider to manage this condition.

You can also prepare these home remedies for gastritis to complement the treatment prescribed by your doctor.

9. Hepatitis

Hepatitis is an inflammation of the liver that usually causes pain under the right rib cage. Other symptoms may also appear, such as weakness, tiredness, nausea, vomiting, diarrhea, loss of appetite and fever, for example, may also appear.

Normally, hepatitis is caused by a virus, but it can also be caused by the use of some medications or the production of abnormal antibodies (which is also referred to as autoimmune hepatitis). Read more about the causes of acute hepatitis and the symptoms associated with it.

What to do: Patients with hepatitis are advised to be assessed by a liver specialist, who will identify the type of hepatitis present and indicate the most appropriate treatment to prevent further complications.

10. Cirrhosis

Cirrhosis is a chronic inflammation of the liver and, as it progresses, it can cause symptoms such as loss of appetite, nausea, vomiting, weakness, tiredness, weight loss and pain under the right rib cage.

What to do: If you suspect you may have cirrhosis you should consult a liver specialist. Treatment may involve the use of medications, such as diuretics or antihypertensives, nutritional monitoring and avoiding alcoholic beverages. Check-out a list of foods that are good for the liver that you can add to your diet.

11. Rib fracture

A rib fracture describes a crack or full break in the rib bones caused by injuries from a car accident, fall from a height, contact sports or even repetitive movements. Patients with severe osteoporosis or bone cancer can also experience rib fractures from heavy coughing.

A broken rib is especially characterized by intense pain that worsens when inhaling, which can impact how you breathe. Therefore, if it is left untreated, it can lead to a lung infection.

What to do: The doctor will first order a chest x-ray to confirm the presence of a fracture. Broken ribs typically heal on their own in about 6 weeks, without any compresses or bandages. Pain management is essential during this time, and therefore the doctor may prescribe over-the-counter analgesics, like ibuprofen and naproxen, or stronger medications, like narcotics, if the pain is very severe.

12. Pulmonary embolism

A pulmonary embolism this is an emergency situation in which a blood vessel in the lung gets blocked by a blood clot. This results in decreased blood flow to the affected area, resulting in pain when breathing or sudden shortness of breath that gradually worsens.

Pulmonary embolisms are most common in people who have had a recent thrombosis, who have undergone recent surgery, or who are bedridden or chronically sedentary.

What to do: A pulmonary embolism is a medical emergency that requires immediate interventions in a hospital setting. Anticoagulant medication such as heparin, is usually administered to help dissolve the clot and restore blood flow. In addition, the patient may also need to take analgesics to relieve chest pain.

Which doctor to consult

It is common for pain under the right rib cage to be associated with digestive system problems. Therefore, it may be advisable to initially consult a gastroenterologist for assessment. The gastroenterologist may order tests, such as abdominal ultrasound or endoscopy, to identify the cause of abdominal pain and indicate the most appropriate treatment.