IBS vs Non-IBS Pain Under The Left Rib Cage: How To Differentiate (Dr. Farahat).

 

Hi, I am Dr. Farahat, an IBS sufferer and gastroenterologist. Oftentimes, many of my IBS patients get confused about IBS pain.

With all of the IBS unpredictability, Being uncertain about what actually caused your abdominal pain can be quite stressful; especially if your abdominal pain has atypical patterns and locations.

Here, I will provide an in-depth answer all your questions about IBS pain at the upper left abdomen (under the left rib cage):

  • Is pain under the left rib cage a “typical” location of IBS pain? and how common?
  • How does IBS pain under the left rib feels like?
  • When left hypochondrial pain is NOT IBS Pain?
  • Other causes of left rib pain and how to suspect the cause?
  • When to worry, and seek medical attention?

Is Pain under the left rib cage typical for IBS? and How common?

IBS pain can be generalized or localized at any part of your abdomen, it is not common for IBS to localize in the upper left abdomen under the rib cage. According to the journal of Hepatology and gastroenterology, upper left abdominal pain occurs only in 6% of IBS patients.

The most common IBS pain locations are around the umbilicus and the upper part of the abdomen in the middle. Here is a break down of the frequency of abdominal pain according to the site (ref):

  1. Around the umbilicus (belly button) {39%}: it is the most common site of IBS pain.
  2. The upper central part of the abdomen {33%}: the second most common site of IBS pain or discomfort.
  3. The lower central part of the abdomen: {13%}
  4. The lower left part of the abdomen: {7%}
  5. Upper left abdominal pain (under the rib cage): {6%}
  6. Right-sided IBS pain (upper and lower) are the least common IBS pain locations.

Note:

  • IBS can affect more than one location in your abdomen. Some have IBS pain or discomfort allover their abdomen.
  • The above percentages are based on a small study in the “journal of gastroenterology and hepatology”.
    Although it is not a large scale clinical study, it can give you an idea about the common IBS pain locations.

How does IBS pain under the left rib feels like?

Assuming that you are an IBS sufferer, You’re now wondering about the pain under the left rib cage: Is it an IBS pain or something else?

To answer this question, I will try to simply explain the character of IBS pain and how it is different from other causes of pain under the left rib.

The characters of IBS Pain under the upper left abdomen (under ribs):

  • 1. Comes in attacks: the fundamental character if irritable bowel syndrome abdominal pain is the “fluctuating nature”
    Usually, IBS pain comes in waves of flare-ups and remissions. If the pain felt under the left ribs comes and goes over a long period of time, it is suggested to be an IBS pain.
  • 2. Associated with defecation: If the upper left abdominal pain decrease or increases after you poop, this is a feature of IBS pain.
  • 3. Associated with changes in stool frequency: If the onset of pain is associated with a change in the frequency of bowel movements (associated with diarrhea or constipation), then it is IBS pain.
  • 4. Associated with changes in stool form: The onset of  IBS pain is associated with a change in the stool form (associated with loose or hard stools).
  • 5. The IBS pain Character: usually, the IBS pain is “Colicy” in nature. Pain arising from the colon is usually in the form of “Spasms” or “contractions” and relaxation. 
    Also, some IBS patients suffer from just “abdominal discomfort” and not true pain.
    IBS pain is commonly associated with bloating, diarrhea, or constipation.
  • 6. Associated with food: when the left pain under the rib starts after eating (especially high fodmap or gas-producing foods), it is more suggestive for it is IBS pain.
  • 7. Doesn’t awaken you from sleep: functional abdominal pain (including IBS pain) usually doesn’t affect your sleep. If the upper left pain cannot awaken you from sleep, then it is probably an IBS pain.
  • 8. Relieved by IBS medications: another important feature that suggests the upper left abdominal pain is due to IBS is its relation to IBS medications.
    Usually, the IBSpain goes away after you take an antispasmodics or peppermint oil.

When the left pain under the rib is NOT an IBS pain?

After explaining what is IBS pain, now it is time to explain what is NOT IBS pain.

The features and signs listed below, if present, suggests another cause of left hypochondrial pain than IBS.

Some of these causes are of benign and mild nature, others may require you to consult your doctor.

1- Extreme or very severe pain:

Unlike IBS, pain due to inflammation or trauma to any organ in the left hypochondrial area is usually different from the usual IBS pain.

It can occur in the form of severe stabbing pain that increases with movement or respiration.
Example:

Pain from the pancreatitis is very extreme and can cause nausea and vomiting.

2- Pain that is not going away:

IBS pain comes and goes (flare-ups and remissions). Persistent pain for days or weeks, progressively increasing and not related to defecation and food is not an IBS pain.Example:

People with moderate to huge enlargement of their spleen (splenomegaly) may suffer continuous heaviness or pain under the left rib cage, the pain is usually persistent and doesn’t go away.

3- Pain that is related to Movement:

IBS  left abdominal pain doesn’t change in degree (severity) when you move to change the position of your body.

A pain that greatly increases on walking, standing up, bending the body, coughing, or sleeping on one side of the body is not typical for IBS.
Example:

Left rib fracture or trauma can cause left abdominal pain under the rib cage that greatly increases with movement.

4- Pain that awakens you at night:

It is unusual for IBS pain to awaken you after you fall asleep. Pain under the left rib cage is of new-onset and great at night is probably not IBS pain.

5- Associated fever:

Fever is not a symptom of IBS. presence of fever indicates that the left pain under your ribs is not of IBS origin. This is especially important if the onset of left pain is related to the onset of the fever.

6- Associated vomiting:

Left upper abdominal pain and vomiting may reflect actual inflammation of infection inside your gut

For example, severe gastritis or GERD may lead to left abdominal pain under the rib cage and vomiting.

7- Pain that is associated with “Red Flag Signs” of IBS:

  • Blood in stool.
  • The onset of IBS pain after the age of 50.
  • Progressive weight loss (a significant weight loss is a loss of more than 5% of your body weight over 6 to 12 months without obvious cause (ref)).
  • Unexplained fever or anemia.
  • Family history of colon cancer (especially if your age is above 40).

But, Please: Reading an article about your IBS (such as this article) can leave you convinced that there is something worse is happening inside.

So, please bear in mind that the incidence of such serious conditions is rare. It is better to think of the common causes at first (which will be responsible for such pain in more than 99% of the time).

Common causes of left pain under the rib OTHER THAN IBS.

1- Stomach & lower esophagus.

Pain from the stomach is:

  • Upper abdominal pain at the center (Typical location)
  • It can be left abdominal pain under the rib cage.
  • The Pain can radiate into the back.

The character of pain is usually sharp, stabbing, or burning pain. it is usually associated with nausea, GERD, or bloating.

Common gastric conditions that can cause stomach pain under left ribs:

  • Gastritis: acute and chronic.
  • Gastric ulcer.
  • GERD.
  • Functional dyspepsia

Always consider Functional dyspepsia if you continuously experience post-prandial fullness and left pain under the ribs with your IBS.

Functional dyspepsia is of special importance as many IBS patients have associated functional dyspepsia. Actually, this meta-analysis estimates that about 37% of IBS patients suffer from functional dyspepsia.

Functional dyspepsia (also known as indigestion) is a group of symptoms including stomach pain, bloating, nausea, and maybe a loss of appetite.

Unfortunately, no specific test or imaging can diagnose such functional diseases. To be diagnosed with such conditions, only your doctor can do this after the exclusion of any organic diseases. The diagnosis of functional gut diseases is based only on certain clinical criteria. This criterion is created by The “Rome Foundation” for gastrointestinal diseases.

Due to its common association with IBS, consider functional dyspepsia (indigestion) as a cause of left pain under ribs.

2- Other colonic conditions

IBS is not the only condition that may affect your colon. Other diseases or conditions that affect your colon (especially the left or splenic flexure of the colon) & can cause pain under the ribs.

Examples:

  • IBD (inflammatory Bowel Disease) as Crohn’s and Ulcerative Colitis.
  • Trapped wind in the left colonic flexure.
  • Any localized inflammation (colitis), or mass (colon cancer).

Usually, the differentiation of pain is not easy. but with IBD, the condition is more severe and may be associated with Blood in stool, fever, or weight loss.

3- Spleen

The spleen can be a cause of left abdominal pain under the rib cage.

The splenic conditions that can cause pain:

  • Splenomegaly (enlarged spleen): the splenic pain location is left hypochondrial (under left ribs). when the spleen enlarges for any reason, it leads to vague, continuous pain or heaviness (dragging pain). this commonly occurs in people with blood diseases or liver failure (liver cirrhosis).
  • Splenic abscess: the pain from a splenic abscess is usually severe, progressive, and associated with fever.
  • Splenic masses, cysts, or focal lesions: as with lymphomas. this can be asymptomatic or dull left abdominal pain or discomfort.

4- Your abdominal wall & Chest (lower ribs, intercostal muscle, left pleura, and left lung).

This is another very common cause of pain under the left rib cage with IBS. the conditions can be simply of muscular or skeletal origin.

Any bone trauma, bone diseases (especially osteoporosis in females) can lead to vague left abdominal pain just under the rib cage.

Another contributing cause is a persistent or chronic cough. If you have a persistent cough for many days or even years, then subcostal pain can be attributed to cough.

The distinctive features of pain from the musculoskeletal origin are:

  • Related to movement: if the pain increases greatly when you move or change your body position, it may suggest a musculoskeletal origin.
  • History of rib or left side trauma, false movements, or lifting heavyweight.
  • History of osteoporosis, or any bone disease.

5- The pancreas.

Pancreatic pain is very extreme especially with the acute form of pancreatitis. The pain usually occurs in the middle of the body, just under the ribs. But it is sometimes felt on either the left or right side (ref).

Symptoms and signs suggesting pancreatitis:

  • Upper abdominal pain, usually central but it can radiate to the left side under ribs.
  • The pain radiates to the back, partially relieved by leaning forward.
  • severe nausea, and maybe vomiting.
  • the pain feels worse after eating.
  • severe tenderness when touching the abdomen.

6- The kidneys.

The kidney came last in this list because it seldom causes pain under the left rib. Your Kidneys are located in the back of your abdomen.

Typical kidney pain location is in your sides or middle to upper back. Common conditions that cause kidney pain are

  • kidney stones.
  • Kidney gravels (tiny stones).
  • Kidney inflammation (urinary tract infection or glomerulonephritis).

7- Unexplained, Fibromyalgia, and more!

Oftentimes, doctors cannot identify a specific cause of abnormal pain locations with IBS.

IBS can cause pain in “atypical” locations or presentations such as (ref):

  • Back pain.
  • Leg pain.
  • Pelvic pain.
  • Painful urination (intestinal cystitis).
  • Unexplained generalized muscle pains
  • Fibromyalgia.
  • Generalized fatigue and headaches.
  • Chest pains and shortness of breath.

(Source study)

One of the common examples of non-typical IBS symptoms is its association with fibromyalgia.

Fibromyalgia is widespread pain in the muscles, ligaments, and tendons in your body. And the pain under your left rib cage may be one of its symptoms.

Some studies estimates that Fibromyalgia Syndrome (FM) is present in up to 60% of patients with Irritable bowel syndrome (ref).

if you experience pain in “atypical” IBS locations, consider discussing the issue of fibromyalgia with your doctor.