10 Causes for Pain Below the Ribs & Treatment Options

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Pain below your ribs can be caused by your GI tract, like GERD, indigestion, gallbladder disease, or constipation, or problems with your lungs, like pneumonia. You may also have nausea, bloating, chest pain, coughing, or pain that’s worse when you breathe in.

Written by

Chandra Manuelpillai, MD.

Assistant Professor, Department of Emergency Medicine at Boston University School of Medicine

Last updated June 27, 2023

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Most common questions

Causes

Next Steps

Emergency symptoms

Treatment

Table of Contents

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Written by

Chandra Manuelpillai, MD.

Assistant Professor, Department of Emergency Medicine at Boston University School of Medicine

Last updated June 27, 2023

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7 most common causes

Stomach Ulcer

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Dyspepsia

Constipation

Pneumonia

Gastritis

Gallstones

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Most common questions

Pain below the ribs can be caused by a variety of factors, including medical conditions related to the abdominal organs like gastritis or inflammation of the pancreas, musculoskeletal problems like muscle strain or costochondritis, or even referred pain from other organs like the heart, spleen, or kidneys.

Read about the 9 most common causes for pain below the ribs

It is important to consult with a healthcare provider to determine the underlying cause of your pain below the ribs. They may perform a physical examination, order diagnostic tests such as imaging studies or blood tests, and develop a treatment plan based on the specific cause of your pain.

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Pain below the ribs can have many potential causes, some of which are emergency situations. If you are experiencing severe and sudden pain with other symptoms, such as chest pain, shortness of breath, dizziness, or fainting, it’s important to seek medical attention right away. If the pain is mild and persistent, it is less likely an emergency, but should still be evaluated to determine the potential cause. Read more

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Pain below the ribs can be caused by various conditions and it’s important to first identify the underlying cause before attempting to treat the pain. However, there are some common strategies that may help relieve your pain, from over-the-counter medications and light stretching, to breathing exercises and lifestyle changes. If the pain persists or worsens, you should seek medical attention from a healthcare professional.

Read more about treatments for pain below the ribs

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If you are experiencing pain below the ribs, it’s a good idea to see a medical provider for an evaluation, especially if the pain is severe or persistent, or if it is accompanied by other symptoms. In some cases, pain below the ribs can be a sign of a more serious condition, such as a heart attack or pulmonary embolism (a blood clot in the lungs), so it’s important to seek medical attention promptly.

A medical provider can perform a physical exam, order any necessary tests or imaging studies, and provide a diagnosis and appropriate treatment. If you are experiencing severe or persistent pain below the ribs, seek medical attention right away.

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What causes pain below the ribs?

Pain below the rib cage may be caused by organs in the chest cavity (which are protected by your ribs) or ones just below it. These include the lungs, diaphragm, intestines, stomach, and gallbladder.

Pain below the ribs can feel dull or sharp. The pain may go away quickly or be ongoing. Depending on what’s causing the pain, you may only feel discomfort on one side of the body.

The conditions that cause pain below the ribs usually cause other symptoms as well. These symptoms include fever, nausea, vomiting, bloating, chest pain, coughing, back pain, or pain that gets worse when you inhale.

Some conditions that cause pain below the ribs, such as a pulmonary embolism, can be life-threatening and require emergency treatment.

If you experience chest pain, difficulty breathing, or have upper abdominal pain that radiates to the jaw, neck, or arm, call 911.

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Causes

1. Constipation

Symptoms

• Abdominal pain
• Nausea
• Bloating
• Hardened stool that’s difficult to pass
• Less frequent bowel movements (generally, fewer than three a week)

Constipation occurs when bowel movements become harder, more difficult to pass, and/or happen less frequently than normal. It’s common to get constipation for short periods of time. However, for some people, constipation can be a chronic problem.

Constipation is usually caused by a low-fiber diet, not drinking enough water, and lack of exercise.

How you treat constipation depends on what caused it.

• Eat more foods rich in fiber (such as fruit and vegetables)
• You may need to take a fiber supplement
• Drink more water
• Get more exercise
• Set up a “bowel routine” by trying to have a bowel movement at the same time each day

2. Indigestion

Symptoms

• Pain in the upper abdomen, including below the ribs
• Feeling full during a meal
• Feeling uncomfortably full after a meal
• Nausea
• Bloating
• Heartburn

Indigestion (dyspepsia) is often caused by your eating habits. It can occur if you eat too much or too quickly, eat greasy or spicy food, or drink too much caffeine, alcohol, or carbonated drinks.

Smoking and anxiety can also cause indigestion. Certain medications (antibiotics, pain relievers) and vitamin and mineral supplements can also trigger this condition.

How you treat your indigestion depends on what caused it. If you follow these tips for two weeks and don’t notice any improvement, see your doctor to rule out more serious conditions.

• You may need to eat smaller, lighter meals and eat them more slowly.
• Avoid spicy and greasy foods, caffeinated and carbonated drinks, and alcohol, as these can irritate your stomach.
• Quit smoking.
• Try to manage stress with techniques such as meditation.
• If you think that a medication is causing indigestion, talk to your doctor about taking a different drug that may be easier on your stomach.

Pro Tip

Some patients think the longer they have symptoms, the worse it must be. While any time you have symptoms lasting more than 2 weeks you should discuss it with your doctor, it does not necessarily mean your symptoms are more life threatening. —Dr. Chandra Manuelpillai

3. GERD

Symptoms

• Heartburn
• Regurgitation of acidic/sour material
• Chest pain
• Difficulty swallowing
• Sore throat
• Hoarse voice

Gastroesophageal reflux disease (GERD) is when acid in the stomach travels back up the esophagus and causes symptoms. It is a very common disorder and reported in up to 28% of the population in North America.

Everyone has some amount of reflux but it usually does not cause bothersome symptoms. There is a muscle in between the esophagus and stomach, the lower esophageal sphincter (LES), that helps to prevent food or acid from going back up. When the LES is weakened, acid can travel up the esophagus more easily and cause symptoms.

Treatment can include lifestyle modifications, over the counter medications for milder symptoms, or prescription medications for more severe symptoms. Lifestyle modifications include changing what you eat, like fatty or spicy food, and avoiding triggers that worsen your reflux symptoms. Weight loss and not smoking are also important lifestyle modifications.

OTC medications include antacids like Tums or Milk of Magnesia or Pepto-Bismol. Prescription medications include histamine 2 receptor antagonists (h3RA) or proton pump inhibitors (PPI). These medications decrease the amount of acid produced in the stomach, which helps to decrease symptoms. PPIs are prescribed for more severe symptoms.

4. Ulcer

Symptoms

• Pain in the upper abdomen, including below the ribs
• Bloating
• Inability to tolerate fatty foods
• Heartburn
• Nausea

An ulcer is a sore that develops in the stomach (peptic ulcer) or small intestine (duodenal ulcer). The sores form when the acids that help digest your food eat away at the lining of either organ.

Some ulcers develop due to a chronic infection of H. pylori, a type of bacteria. It’s not known how H. pylori infections spread, but it may happen through close contact (such as kissing), water, or food.

Other ulcers are caused by regularly using certain medications. Nonsteroidal anti-inflammatories (Advil, Aleve, indomethacin) are the most common culprits.

Treatment depends on what caused your ulcer. If it’s due to H. pylori, you’ll be prescribed antibiotics. If a medication you take caused your ulcer, your doctor will likely lower your dose or switch you to a different medication. They may also recommend medications that block or reduce the amount of acid your body produces.

5. Gastritis

Symptoms

• Pain in your upper abdomen that may get better or worse when you eat
• Nausea
• Vomiting
• A feeling of fullness in your upper abdomen after eating

Gastritis is an inflammation of the lining of your stomach. It may occur suddenly (acute gastritis) or gradually (chronic gastritis).

The causes of gastritis are the same as those of ulcers: H. pylori infection or regular use of certain medications. Drinking too much alcohol can also cause gastritis.

Treatment is similar to that of ulcers. If your gastritis was caused by drinking alcohol, you may need to cut down on or stop drinking.

6. Pneumonia

Symptoms

• Difficulty breathing that may worsen when you’re active
• Sharp chest pain that is worse when inhaling and coughing
• Shortness of breath
• Fatigue
• Fever and chills
• Nausea
• Vomiting
• Diarrhea

Pneumonia is an inflammation of the lungs. It is caused by a bacterial or viral infection. Pneumonia may be mild or life-threatening. It is most serious in infants, young children, people older than age 65, and people who have a weak immune system.

If you think you have pneumonia, see your doctor.

Treatment depends on the type of pneumonia you have. Antibiotics are used to treat bacterial pneumonia but not viral pneumonia. Your doctor may also recommend treating your symptoms with cough medicine and fever and pain relievers like ibuprofen or acetaminophen.

Bacterial infections often improve within a few days of starting antibiotics. However, it may take weeks or months to fully recover from both bacterial and viral pneumonia.

7. Gallbladder disease

Symptoms

• Pain in the right upper abdomen
• Pain that worsens when you breathe in, press on the right side of your upper abdomen, and after you eat fatty foods
• Nausea and/or vomiting
• Fever and/or chills
• Yellowing of skin and whites of eyes
• Dark urine
• Clay-colored stools

Conditions that affect the gallbladder cause pain under the ribs on your right side because that is where the gallbladder is located. The gallbladder stores bile, which is necessary for digestion.

Gallstones are a common cause of gallbladder pain. These stones may be as small as a grain of sand or as large as a golf ball. You may develop just one gallstone or several at the same time.

It isn’t clear why gallstones occur. It may be that your gallbladder has a problem releasing bile. Or your bile may contain too much cholesterol or a chemical called bilirubin.

Sometimes gallstones don’t cause any symptoms. Sometimes, when the gallstones are blocking your gallbladder from releasing bile, they cause pain in the right upper belly right under the ribs. You may also have nausea or vomiting. It is often worse after eating.

If the gallstone remains stuck, you may develop an infection called cholecystitis. This causes inflammation of the gallbladder. If cholecystitis is untreated, it can cause life-threatening problems such as gallbladder rupture and severe infections.

The treatment of gallstones depends on how severe your symptoms are and how often they occur. If the pain is mild and occurs only occasionally, treatment may be as simple as taking pain medication and avoiding fatty foods.

If you get symptoms often or your symptoms are severe, you may need to have surgery to remove your gallbladder. If your gallbladder becomes infected, you will need to be admitted to the hospital for antibiotics, IV fluids, and pain medications. You’ll likely have to have your gallbladder removed as well.

Pro Tip

The ribs are a very important structure in our body. They protect multiple of our vital organs including those in our chest wall, such as the heart and lungs, as well as those in the upper abdomen including the diaphragm, stomach, liver, gallbladder, and spleen. —Dr. Manuelpillai

8. Splenic or hepatic flexure syndrome

Symptoms

• Sharp pain or cramps under the left or right side of the ribs
• Pain that worsens when inhaling
• Bloating
• Constipation
• Increased gas
• Belching

Splenic and hepatic flexure syndromes are caused by trapped gas or stool in your intestines. Flexures are areas of the intestine that make sharp turns.

Splenic flexure syndrome occurs when gas or stool become trapped in the splenic flexure. This is in the upper left part of your abdomen (over your spleen). In hepatic flexure syndrome, the gas or stool is trapped in the hepatic flexure (over the liver). This is located in the upper right part of your abdomen.

Splenic and hepatic flexure syndrome are not dangerous, but they can be extremely painful.

They can be treated with over-the-counter pain and gas-relief medications. Constipation can be treated with laxatives if necessary. Stretching that affects the abdomen, like certain yoga poses, may also help you release the gas. The best way to prevent them is to avoid gas-producing foods such as beans, broccoli, and dairy products.

9. Side stitch

Symptoms

• Sharp and/or crampy abdominal pain, usually on the left or right side

Side stitches usually occur when you’re exerting yourself, such as when you run.

The cause of side stitches is unknown. Experts think it may be related to not drinking enough, drinking sugary drinks, or eating too much or too soon before you exercise. You may also experience a side stitch if your abdomen and/or diaphragm are irritated.

You can relieve the pain of side stitches by resting, stretching, and drinking water.

10. Pulmonary embolism

Symptoms

• Difficulty breathing that may worsen when you’re active
• Chest pain
• Coughing that may produce blood
• Fast heartbeat

A pulmonary embolism (PE) is a blood clot in a blood vessel in the lungs. PE blocks blood flow to your lungs and lowers the level of oxygen in your blood. The lungs may become damaged.

These clots usually don’t form in the lungs. Instead, they develop in the lower leg, then break off and travel through your blood vessels to your lungs. Blood clots in the leg are called deep vein thrombosis (DVT). People with DVT may also have leg pain and swelling.

PE and DVT are life-threatening conditions. If you have symptoms, you should call 911 or go to the ER immediately.

Treatment depends on the severity of the clot. A large, life-threatening clot may require surgery or clot-dissolving medications called thrombolytics. Less dangerous clots can be broken up by your body with the help of blood-thinning medications called anticoagulants.

Other possible causes

There are other conditions that may also cause pain below the ribs, but it is usually not one of the main symptoms:

• Heart attack (pain is usually in the chest but may be in upper abdomen)
• Kidney stones
• Appendicitis

When to call the doctor

• Symptoms don’t improve after 1 week

Dr. Rx

The more details you include, the easier it is to determine the cause of your symptoms. So make sure you include the location of your pain and if it seems to move or radiate to another location, pain description (sharp, dull, burning, pressure, etc), how long it lasts, when it occurs (after eating, with exertion, etc), if anything makes it better or worse, and any associated symptoms. —Dr. Manuelpillai

Should I go to the ER for pain below the ribs?

You should go to the ER if you have the following:

• Sudden severe abdominal pain
• Uncontrolled vomiting
• Unable to eat or drink
• Vomiting blood or a substance that looks like ground coffee
• Coughing up blood
• Bloody or black diarrhea
• Dizziness or confusion
• Blue lips or nail beds
• Heart palpitations
• Chest pain
• Upper abdominal pain that radiates to the jaw, neck, or arm
• Upper abdominal pain with dizziness, sweating, chest pain, or difficulty breathing
• Fever with yellowing of the skin and whites of eyes

Treatments

At-home care

• If the pain is from a digestive issue like indigestion, over-the-counter antacids and other acid blockers can help.
• If the pain is from constipation, lifestyle changes like eating more fiber, drinking more water, and exercising can help. Use of over-the-counter stool softeners can provide additional relief.
• Avoid certain foods that are likely to cause gas and/or irritate your stomach, such as fatty and spicy foods.
• Limit your use of medications that can lead to ulcers (if that’s not possible, ask your doctor if you can switch to a different medication).
• Gentle stretching or light exercise may help to alleviate pain and reduce muscle tension. However, be sure to avoid any activities that may exacerbate the pain.
• Apply heat or ice: Depending on the cause of the pain, applying heat or ice to the affected area may help to reduce pain and inflammation. You can use a heating pad, warm towel, or ice pack for 10-20 minutes at a time, several times a day.
• Practice deep breathing: Taking slow, deep breaths can help to relax the muscles in the area and may help to alleviate pain.

Chandra Manuelpillai, MD.

Assistant Professor, Department of Emergency Medicine at Boston University School of Medicine

Dr. Manuelpillai is a board-certified Emergency Medicine physician. She received her undergraduate degree in Health Science Studies from Quinnipiac University (2002). She then went on to graduated from Rosalind Franklin University of Medicine and Sciences/The Chicago Medical School (2007) where she served on the Executive Student Council, as well as was the alternate delegate to the AMA/ISMS-MSS G…

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Rib pain or pain in the chest wall that feels like it comes from a rib may be caused by traumatic injury, muscle strain, joint inflammation, or chronic pain, and ranges in severity. Rib cage pain can be associated with bruising, difficulty taking a deep breath, joint pain, and more. Read more below to learn what may be causing your rib pain and when to seek treatment.

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Rib pain on both sides can be caused by inflammation of the cartilage known as acute costochondritis (chest wall syndrome), atypical chest pain, or normal occurrence of chest pain. Read on below for more information on causes and relief options.

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Symptoms, Causes, Treatment, and More

Your left ribs protect the organs that sit below them, like your heart and your stomach. Pain in this area can be caused by injury, infection, or an underlying condition.

If you have pain in your chest, you might worry about a serious condition, such as a heart attack. While it’s true that pain under your left ribs can be a heart attack symptom, discomfort in that area is not always related to your heart.

Depending on the cause, left rib pain might feel sharp and stabbing, or dull and aching. For many people, pain in this area is due to a benign (not harmful), treatable cause. But if you’re having chest pain, it’s best to see a doctor or healthcare professional to make sure it’s nothing serious.

Read on to learn about possible causes of left rib pain, diagnosis, and treatments.

Chest pain can sometimes signal a medical emergency, such as a heart attack. If you’re feeling pain in your left ribs, it’s best not to ignore it.

Heart attack symptoms include:

• pain, discomfort, or a heavy feeling in your chest, usually in the middle or on the left side
• pain or discomfort in your neck, jaw, shoulders, arms, back, or above your belly button
• shortness of breath
• sweating
• fatigue
• nausea and vomiting
• lightheadedness or dizziness
• fast or irregular heart rate

If you think you could be having a heart attack, call 911 or local emergency services right away.

Your rib cage consists of 24 ribs — 12 on the left and 12 on the right side of your body. Their function is to protect your organs that lie beneath them.

On the left side, this includes your heart, left lung, pancreas, spleen, stomach, and left kidney. When any of these organs are infected, inflamed, or injured, pain can radiate under and around your left rib cage. It’s also possible to injure your ribs themselves.

Costochondritis refers to inflammation of the cartilage that attaches your ribs to your breastbone. This condition doesn’t always have a clear cause. It can happen for several reasons, such as:

• an infection
• an injury
• severe coughing

Costochondritis causes a sharp, stabbing pain that’s usually felt on the left side of your rib cage. It may get worse when you cough, sneeze, or press on your ribs.

A forceful blow or injury to your chest is the most common cause of bruised or broken ribs.

If you have a bruised rib, you’ll usually feel pain in your chest that’s worse when you inhale or move.

When a rib is broken, the pain is likely to be severe. It may make you feel like it’s hard to breathe in all the way. Broken ribs can sometimes cause serious complications, such as:

• a collapsed lung
• injuries to your blood vessels or organs, such as your spleen
• flail chest, which is a medical emergency that happens when you have many fractures in your ribs

Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are two different digestive conditions. The causes of IBS and IBD aren’t fully known.

IBS and IBD both cause persistent, long-term pain in your abdomen, which is the area from your chest down to your hips. It’s possible for IBS or IBD to cause pain under your left ribs. These conditions also cause digestive symptoms, such as constipation, diarrhea, and gas.

Symptoms may come and go. IBS symptoms tend to improve after you have a bowel movement. IBD is a more serious condition that causes physical changes to your intestines. A doctor can see these changes using imaging tests.

Your pancreas is a gland located near your small intestine, on the left side of your belly. It makes insulin, which your body uses to turn sugar into energy. It also releases digestive juices into your small intestine to help break down food you’ve eaten.

Pancreatitis refers to inflammation of your pancreas. It can have many causes, including:

• injury
• long-term heavy alcohol use
• gallstones

Pain caused by pancreatitis can happen suddenly (acute pancreatitis), or it can slowly get worse over time (chronic pancreatitis). Additional symptoms of pancreatitis include:

• fever
• fast heart rate
• nausea
• vomiting
• weight loss
• jaundice

It’s important to treat pancreatitis to prevent serious complications.

Your spleen also sits in the left side of your body, near your rib cage. This organ is an important part of your immune system. It produces white blood cells that fight infection, and it processes other parts of your blood.

An enlarged spleen, also called splenomegaly, can cause symptoms such as:

• pain or discomfort
• bloating
• feeling full after eating only a small amount of food

Several things can cause an enlarged spleen, including:

• viral infections, such as mononucleosis
• bacterial infections, such as syphilis
• parasitic infections, such as malaria
• blood diseases
• liver diseases

Sometimes, your spleen can rupture, usually as a result of trauma. It’s a medical emergency, and you should get medical attention immediately.

If your spleen ruptures, the area might feel tender when you touch it. In addition to pain, other signs and symptoms can include:

• low blood pressure
• dizziness
• blurry vision
• nausea

More rarely, a splenic infarct happens when a portion of your spleen necrotizes or “dies.” This happens when the blood supply is lowered or stopped, usually as a result of an injury or conditions that affect your blood.

Gastritis refers to inflammation of the lining of your stomach, which is also near the left side of your rib cage.

It doesn’t always cause symptoms, but possible symptoms include:

• pain in your upper abdomen
• feeling full after eating only a small amount of food
• nausea
• vomiting

The causes of gastritis include:

• Helicobacter pylori infection
• frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs)
• long-term, heavy alcohol use

Your kidneys are part of your urinary tract. They’re located on either side of your spine, but when they become inflamed or infected, the pain can radiate to the front of your body. When your left kidney is involved, you might feel pain near the left side of your rib cage.

Kidney stones are hardened calcium and salt deposits that form into stones. They can cause a cramping pain as they move out of your kidneys and make their way toward your bladder. In addition to pain in your left rib cage, kidney stones can also cause:

• an urge to urinate, with little urine coming out
• bloody or cloudy urine
• pain in your side that radiates to the front of your body

Kidney infections occur when bacteria from your urinary tract make their way into your kidneys. This usually happens due to a bladder infection. Additional symptoms of a kidney infection can include fever and nausea.

If you’re having symptoms of a kidney problem, it’s important to see a doctor. You can get a diagnosis and start any treatment that may be needed.

Your heart is surrounded by a fluid-filled sac called the pericardium. Pericarditis refers to inflammation of this sac. This can cause a dull ache or a stabbing pain that’s usually worse when you’re lying down. Pericarditis can also cause a high fever.

Researchers aren’t sure why it happens, but it often occurs after you’ve had a viral infection.

Pericarditis can lead to complications if it is not treated.

Pleurisy happens when the tissue that surrounds your lungs becomes inflamed. Causes of pleurisy include:

• pneumonia
• blood clot in your lung
• injury
• cancer that has spread from another part of your body to the tissue surrounding your lungs
• cancers that specifically affect the tissue surrounding your lungs, such as mesothelioma

Pleurisy on your left side may cause pain under your left rib cage, but the main symptom is a sharp, stabbing pain when you breathe. Be sure to see a doctor if you experience any intense chest pain while breathing.

To figure out what’s causing pain in your left rib cage, a doctor will give you a physical exam that includes feeling the affected area. This will help them check for any signs of swelling or inflammation that might be caused by conditions such as costochondritis.

If they suspect the pain could be due to a heart problem, a doctor might use an electrocardiogram to measure the electrical activity in your heart. This will help to rule out any serious underlying condition.

Next, they may take blood, stool, or urine samples for testing. Analyzing these results can alert a doctor to signs of kidney problems, pancreatitis, or gastritis.

If the cause of your rib cage pain still isn’t clear, you may need an imaging test, such as:

• ultrasound
• CT scan
• X-ray
• endoscopy

This will give a doctor a better view of your bones, organs, and tissues.

What kind of doctor should I see for left rib pain?

There are many possible causes of pain around your left rib cage. A primary care doctor can usually help you determine the cause. If needed, they can refer you to a specialist, such as an orthopedic doctor who treats bones, muscles, and joints.

If you need help finding a primary care doctor, you can browse doctors in your area through the Healthline FindCare tool.

If you think you could be having a heart attack or other medical emergency, call 911 or your local emergency services right away.

Treating your left rib cage pain depends on what’s causing it. If it’s related to any type of inflammation, a doctor will likely recommend you take NSAIDs to lower your pain and swelling. In some cases, you may need an antibiotic to clear up a bacterial infection.

Bruised ribs will likely heal with rest, as will broken ribs, if there are no complications.

In rare cases, you may need surgery. For example, if a kidney stone is too large to pass through your body on its own, a doctor may need to surgically remove it.

Given the number of organs in the upper left part of your body, it’s not uncommon to feel pain under the left rib cage. It may be caused be an easily treatable condition.

But if you have pain in this area that’s severe, worsens over time, lasts more than 24 hours, or is associated with any of the serious symptoms above, you should get medical treatment immediately to rule out any underlying conditions.

Pain and heaviness in the left hypochondrium

What is the left hypochondrium

The left hypochondrium is the area of ​​the body that is located on the left under the breast and reaches an average of 10 centimeters in length and width.

The stomach, pancreas, spleen, loops of the small intestine, left lung, heart, kidneys can give pain in this area.

Doctors conditionally divide the abdominal wall into 9 regions: right and left hypochondrium, epigastric region, right and left lumbar region, navel region, right and left iliac region, hypogastric region.

Pain, heaviness or other discomfort in the left hypochondrium can also occur with anemia, diseases of the spine, and as a variant of the so-called radiating (reflected) pain.

In most cases, the doctor can guess the cause of pain in the left hypochondrium by the nature of pain and accompanying symptoms. To confirm the diagnosis, laboratory blood tests are prescribed, as well as ultrasound (ultrasound), radiography, or endoscopic examination.

Varieties of pain in the left hypochondrium

Pain in the left hypochondrium may be sharp, dull, cutting or aching.

Acute pain in the left hypochondrium

Acute or so-called stabbing pain is not always a sign of a serious pathology. This happens if gases accumulate in the splenic angle of the large intestine.

In addition, such pain occurs with acute pancreatitis or injuries of the spleen. In addition to pain, accompanying symptoms can indicate the severity of the condition: vomiting, high fever, chills, increased heart rate and a sharp drop in blood pressure.

With the appearance of stabbing and acute pain in the left hypochondrium, an ambulance should be called immediately.

Acute pain may appear spontaneously or may be due to exercise, changes in body position, alcohol or fatty foods.

Acute pain in the left hypochondrium may indicate pancreatitis – inflammation of the pancreas

Dull pain or heaviness in left hypochondrium

Usually dull pain is characteristic of chronic or gradually developing diseases: pancreatitis, peptic ulcer, some infections. Patients often describe dull pain as heaviness, discomfort, a feeling of fullness in the left hypochondrium.

Such pain should not be ignored. Without treatment, the risk of disease progression and the development of severe complications increases.

Aching pain in the left hypochondrium

Aching pain is more often characterized by patients as mild, exhausting, as if spreading, which can spread to the entire abdomen.

Aching pain does not always have a serious cause. So functional dyspepsia, irritable bowel syndrome or infections that affect the gastrointestinal tract (enterovirus infection, salmonellosis) can manifest themselves.

Cutting pain in left hypochondrium

Cutting pain is characterized by patients as sharp, dagger, localized. As a rule, it comes from a certain organ, for example, an inflamed pancreas in acute pancreatitis.

If there is a cutting pain in the left hypochondrium, you should seek medical advice as soon as possible.

According to the nature of the course, pain in the left hypochondrium can be acute or chronic.

Causes of pain and heaviness in the left hypochondrium

Any pain syndrome begins in the same way: pain receptors of cells in the affected part of the body are excited. It is this excitement that the brain perceives as pain.

The peritoneum, as well as the internal organs, have good innervation (they have many nerve endings and receptors), so any inflammatory processes or organ malfunctions naturally manifest as pain.

In addition, pain can occur when organs are stretched and squeezed by them on the nerve endings of neighboring tissues. This happens with swelling of tissues after injury or due to stretching of the loops of the intestines by intestinal contents or gases.

Also, pain in the left hypochondrium may have physiological causes. Sometimes it appears after overeating, intense sports, during pregnancy. As a rule, this is not dangerous: pain and heaviness go away on their own when a person returns to the usual rhythm of life.

Pain on the left often has physiological causes: overeating, pregnancy or active sports

Diseases in which there is pain in the left hypochondrium

The most common diseases that lead to pain in the left hypochondrium include:

• pancreatitis,
• peptic ulcer of the stomach and duodenum,
• pathologies of the spleen,
• abdominal injuries,
• lung diseases,
• myocardial infarction,
• intercostal neuralgia.

In case of myocardial infarction, a person experiences severe pain in the region of the heart, radiating to the left arm or hypochondrium

Pancreatitis

Pancreatitis is inflammation of the pancreas.

There is acute and chronic pancreatitis. The first appears suddenly and is characterized by acute sharp pain in the left hypochondrium and the center of the abdomen. The second one develops gradually. In chronic pancreatitis, pain does not always occur, but only after overeating or alcohol abuse. As a rule, patients describe it as aching.

In addition to severe pain, acute pancreatitis may present with the following symptoms:

• nausea,
• diarrhea,
• high temperature,
• yellowing of the skin and whites of the eyes,
• rapid heartbeat.

People with chronic pancreatitis may lose weight for no reason, they may develop oily stools with an unpleasant odor.

Peptic ulcer of the stomach and duodenum

Peptic ulcer of the stomach and duodenum is a disease in which defects (ulcers) form in the stomach, as well as in the upper parts of the duodenum.

The first sign of a stomach ulcer is usually a burning pain in the left hypochondrium and upper abdomen, which is especially strong on an empty stomach and is slightly relieved after eating or taking heartburn medications.

Burning pain in the left hypochondrium and upper abdomen is one of the symptoms of peptic ulcer disease

Common symptoms of gastric and duodenal ulcers:

• fullness in the abdomen,
• bloating,
• belching,
• nausea,
• frequent feeling of hunger.

Pathologies of the spleen

Spleen is an organ that is located on the left just below the ribs. Its main function is to deposit blood. Platelets accumulate in the spleen, which, if necessary, are released into the bloodstream and close the damaged vessels. In addition, old erythrocytes are destroyed in it and immune cells – lymphocytes – are formed.

The spleen is like an oval about 12 cm long and not more than 8 cm wide

The most common pathologies of the spleen, in which it can hurt in the left hypochondrium:

• abscess,
• spleen injury,
• splenomegaly.

Abscess , or suppuration of the spleen, may develop after infectious diseases (endocarditis, typhoid fever, and others). As a rule, the abscess resolves on its own, but while healing is in progress, aching or dull pain may be felt in the left side.

Injury to the spleen dangerous organ rupture. This can happen due to a blunt blow to the side, such as in a car accident or during a fight. A ruptured spleen can lead to pain shock and death.

Splenomegaly is a condition in which the spleen is enlarged.
One of the causes of splenomegaly can be infectious mononucleosis, the causative agent of which is the Epstein-Barr virus. Also, other infections can be the culprits of splenomegaly: parasitic, viral, bacterial.

Cirrhosis, some types of anemia, autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus) can also lead to splenomegaly.

Enlargement of the spleen in size is usually accompanied by aching pain and a feeling of fullness in the left hypochondrium.

Abdominal injuries

Abdominal injuries are potentially life-threatening injuries that may be accompanied by massive internal bleeding. Such injuries can be open (eg, stab or cut wounds) or closed (internal bruising from a car accident or impact).

As a rule, pain in severe abdominal injuries is acute and is caused by the accumulation of blood between the tissue of the internal organs.

An abdominal injury, accompanied by a sharp deterioration in well-being, is an indication for urgent hospitalization and emergency surgical treatment.

Diseases of the lungs and pleura

Pleuropneumonia is an inflammation of the lungs and pleura caused by a viral, bacterial or fungal infection.

The main symptoms of pleuropneumonia are shortness of breath, chest pain, excruciating cough, fever. In some patients, pleuropneumonia is manifested by dull pain in the left hypochondrium.

In general, the disease is mild and successfully treated with a course of antibacterial, antiviral or antifungal drugs. In rare cases, severe complications develop, such as respiratory failure.

Myocardial infarction

Myocardial infarction (heart attack) is a condition in which the heart suddenly stops receiving blood (partially or completely).

Most often, a heart attack occurs due to atherosclerosis – the accumulation of cholesterol plaques in the walls of blood vessels. Sometimes plaques rupture, and blood thickens around them – blood clots form, which can block the artery. Because of this, not enough blood and oxygen will flow to the heart, so its tissues will begin to die.

Despite the fact that a heart attack is an acute condition, its symptoms develop gradually (over several hours, days or even weeks).

Common symptoms of a heart attack:

• severe pressing pain in chest;
• pain on the left under the ribs, in the neck, jaw, back;
• shortness of breath;
• weakness;
• dizziness;
• cold sweat;
• nausea or vomiting.

If you suspect a myocardial infarction, you should immediately call an ambulance.

Intercostal neuralgia

Intercostal neuralgia is a condition when a person experiences acute burning or shooting pain in the area to which the intercostal nerve is responsible for sensitivity.

Intercostal nerves entangle each rib like threads and attach to the spine and sternum

As a rule, pain in intercostal neuralgia girdles from the back to the abdomen, may disturb constantly or comes in waves, aggravated by deep inspiration, coughing or sharp turns of the body.

Which doctor to contact if there is pain in the left hypochondrium

If there is aching or dull pain in the left side, you should contact a therapist as soon as possible or immediately make an appointment with a specialized specialist who treats gastrointestinal problems – a gastroenterologist.

At the consultation, the doctor will conduct a survey and examination and, possibly, refer you to a narrow specialist – a nephrologist, gynecologist, endocrinologist, surgeon or neurologist.

You should also seek medical advice if:

• pain persists for more than one or two days or worsens;
• in addition to pain, fever, nausea, vomiting or diarrhea;
• people lose weight for no reason;
• weakness appeared, blood pressure decreased.

If there is a sharp acute pain in the left hypochondrium, an ambulance should be called as soon as possible.

In addition, call an ambulance immediately if:

• vomiting of blood or bloody stools;
• pain radiates to chest, neck or shoulders;
• pain accompanied by shortness of breath;
• developed severe bloating.

Diagnosis for pain and heaviness in the left hypochondrium

To distinguish the suspected disease from other similar pathologies and confirm the diagnosis, the doctor may prescribe laboratory and instrumental studies.

Laboratory research methods

To evaluate a patient’s general health, a doctor may order a complete blood count.

Clinical blood test with leukocyte formula and ESR (with microscopy of a blood smear when pathological changes are detected) (venous blood)

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Based on the results of a clinical blood test, one can suspect an inflammatory process, determine its severity and suggest a possible cause.

For the diagnosis of pancreatitis, laboratory tests are used that allow you to evaluate the work of the pancreas, identify violations and start treatment in a timely manner. As a rule, three indicators are determined: the level of glucose, the content of pancreatic amylase and lipase in the blood.

Pancreas

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Also, the doctor may prescribe a coprogram (a comprehensive analysis of feces). The analysis shows how well food is digested under the influence of pancreatic juice. If there are not enough enzymes, fat residues, muscle fibers and other components are found in the feces, which should not normally be present.

Coprogram

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To diagnose gastric and duodenal ulcers, a doctor may prescribe a general and biochemical blood test, a test for C-reactive protein – a marker of the acute phase of inflammation, as well as blood tests for liver enzymes – alanine aminotransferase (ALT) and aspartate aminotransferase (AST).

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Alanine aminotransferase (ALT)

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Aspartate aminotransferase (AST)

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In addition, tests for Helicobacter pylori are mandatory, because depending on whether a person is infected or not, the choice of drugs for treatment will also differ.

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If a perforated ulcer is suspected, your doctor may order a fecal occult blood test to check for bleeding.

Occult blood (FOB Gold), feces, count

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To detect Payr’s syndrome, doctors look at changes in the parameters of a clinical blood test (as a result, there will be a high level of leukocytes, an increase in ESR, a decrease in hemoglobin and red blood cells). In addition, blood tests for creatinine and urea may be ordered.

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Diagnosis of pathologies of the spleen is carried out using a clinical and biochemical blood test: a clinical analysis reveals a significant increase in ESR (more than 20 mm/h), a sharp decrease in the number of red blood cells and hemoglobin. In biochemical – a decrease in the amount of total protein due to albumin, an increase in urea.

The doctor also evaluates the results of the hemostasiogram: in case of pathologies of the spleen, the results will show an increase in blood clotting ability.

Hemostasiogram (Coagulogram)

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To confirm the diagnosis of intercostal neuralgia caused by herpes zoster, PCR tests and tests for antibodies to the causative agent of herpes, the varicella-zoster virus, are prescribed.

Diagnosis using PCR tests allows you to identify the genetic material (DNA) of the virus in the blood, urine or discharge from the rash.

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Antibody tests help clarify the stage of the disease. So, with herpes zoster, an increased titer of antibodies of class G and class M is detected in the blood.

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Instrumental methods of examination

Depending on the nature and localization of pain, different instrumental examination methods are used, including:

• ultrasound examination of the pelvic organs, kidneys, liver;
• computed or magnetic resonance imaging;
• radiography for suspected inflammation of the lungs and pleura;
• endoscopic examinations of the gastrointestinal tract (gastroscopy, colonoscopy).

Treatment of pain in the left hypochondrium

Treatment will depend on the cause of the pain.

For the treatment of pancreatitis , as a rule, drugs are used that reduce the production of hydrochloric acid by the stomach, as well as enzymes, antispasmodics, and for severe pain, analgesics and non-steroidal anti-inflammatory drugs.

The main goal of treating gastric and duodenal ulcers is to reduce the production of hydrochloric acid with the help of drugs (proton pump inhibitors). They block the release of acid in the stomach and help the ulcer heal.

In addition, treatment may be supplemented depending on the cause that provoked the mucosal lesion. As a rule, it includes the destruction of Helicobacter pylori, changing drugs that injure the mucous membrane or reducing the doses taken, the use of healing agents and drugs that reduce the production of hydrochloric acid.

Surgical treatment is used only in severe cases of peptic ulcer, and also if the patient develops complications that cannot be stopped by conservative methods.

The tactics of treating pathologies of the spleen depend on the cause. So, antibiotics are used to treat bacterial infections, and anti-inflammatory and painkillers help relieve pain and stop the spread of inflammation during an abscess.

Treatment of abdominal injuries

The slightest suspicion of rupture of the spleen with blunt abdominal trauma is an indication for urgent hospitalization and emergency surgical treatment.

Treatment of inflammation of the lungs and pleura

In general, pleuropneumonia is mild and is successfully treated with a course of antibacterial, antiviral, or antifungal drugs. In rare cases, severe complications develop, such as respiratory failure, which require hospitalization.

Treatment of myocardial infarction

The main thing is to restore blood flow to the heart. The main ways to do this are to inject drugs into the vein that destroy blood clots in the vessels (thrombolytics) or install a stent (a thin tube that keeps the vessel open). This is done on an emergency basis in a hospital setting.

In severe cases, heart surgery may be required – coronary bypass surgery: the surgeon takes a part of a healthy vessel from the leg, arm, chest or abdomen and attaches it to a blocked artery near the heart. So the blood will be able to bypass the clot along the new vessel.

Treatment of intercostal neuralgia

Treatment of intercostal neuralgia depends on the cause that led to nerve damage. So, for herpes zoster, a course of antiviral drugs is prescribed, and for cancer, surgical removal of the tumor, chemotherapy or radiation therapy.

For unbearable pain that interferes with normal life, the doctor may perform an intercostal nerve block. This helps to anesthetize the affected nerve and bring relief at the same time. Sometimes the blockade relieves pain for several months. Sometimes local anesthetics, such as patches or ointments, are also used.

Treatment of gynecological pathologies

Painkillers and anti-inflammatory drugs are used for treatment. In severe cases, minimally invasive treatment (laparoscopic surgery) or abdominal surgery may be required.

What to do with pain in the left hypochondrium

Any pain is a reason to see a doctor. You can start with a therapist or immediately make an appointment with a specialized specialist who deals with the treatment of gastrointestinal diseases – a gastroenterologist.

In the event of acute pain in the left hypochondrium, it is urgent to call a medical team. Before the ambulance arrives, you should lie down and not take any medications so as not to worsen the condition and not interfere with the correct diagnosis.

Sources

1. Gastroenterology: clinical treatment protocols. 2021.
2. Acute myocardial infarction with ST elevation electrocardiogram: clinical guidelines. 2022.
3. Inflammatory diseases of the female pelvic organs: clinical guidelines. 2021.

Why does the left side hurt under the ribs

Pain in the left side is typical for diseases of the abdominal organs. Sometimes there are cases when pathologies of the lungs, heart and neuralgia can become the cause of pain. To identify the exact cause, instrumental diagnostics is used using ultrasound, x-rays and radio wave studies. Depending on the cause of pain in the left side, appropriate treatment is prescribed. Below, we will talk in detail about the most common pathologies that cause pain. But it is worthwhile to understand that self-diagnosis and self-treatment are likely to only worsen the condition, so you should contact a qualified specialist for help as soon as possible.

• Diseases of the spleen. The spleen is a hematopoietic organ. With inflammation, a rapid increase in the size of the spleen (splenomegaly) is characteristic, and with injuries, there is a high risk of rupture of the organ capsule with heavy bleeding. In diseases of the organ, arching, pressing pain in the left hypochondrium is characteristic, which does not depend on physical activity and food intake.
• Intestinal diseases. Pathology of the small intestine leads to visceral or referred pain in the left side. The tumor of the left part of the colon in the later stages of the disease causes aching pain, which intensifies 2-3 hours after eating. The pain syndrome occurs against the background of weakness, weight loss, aversion to food.
• Diseases of the stomach. Gastritis and gastric ulcer cause pain in the epigastric region and in the left hypochondrium. In the case of gastritis, the pains are stabbing, boring, shooting, worse after eating spicy and fatty foods. Characterized by a feeling of heaviness in the stomach, belching rotten or sour, heartburn, nausea.
• Diseases of the pancreas. Inflammation of the pancreas is called pancreatitis. Chronic pancreatitis causes indigestion and periodic pain in the left side. Characterized by diarrhea, fatty stools with lumps of undigested food, flatulence. Pain of a stabbing, arching, shooting character, occurs 1-1.5 hours after eating. Often the pain syndrome becomes shingles – spasmodic pain squeezes the “ring” of the left and right hypochondrium.
• Muscle disease. Muscle inflammation – myositis may be accompanied by pain in the left side. The pain syndrome is shooting and cramping, aggravated by stretching the muscle fibers while bending in the opposite direction. Dull or burning pain develops when food passes through the esophagus and when the body bends after eating.
• Intercostal neuralgia. Inflammation of the intercostal nerves is commonly called intercostal neuralgia. In most clinical cases, the disease develops with herpes zoster. There is an acute burning pain, which is localized in the left hypochondrium, can spread to the back in the region of the shoulder blades and spine. Discomfort is aggravated by tilting towards the lesion.
• Disease of the left lung. Pain in the left side can appear with left-sided lower lobe pneumonia with involvement of the pleura in the pathological process. There is a cutting, stabbing, boring pain in the region of the left hypochondrium, which intensifies at the height of inspiration. Pneumonia is characterized by fever up to 40 degrees, shortness of breath, weakness, dry or productive cough, wheezing when listening to breathing.