Right Side Pain Under Ribs (Towards Back): 6 Causes Explained In-detail.

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Pain on the right side under ribs towards the back may arise from the right kidney, liver, ascending colon, lung, pleura, muscles, or bone. Each has its distinct type of pain.

Possible causes of right side pain under ribs (towards the back):

  • Muscle strain of the right abdominal wall muscles.
  • Rib fractures or diseases.
  • Right kidney pain (right loin pain).
  • Liver inflammation, abscess, or tumor.
  • Gallbladder stones, or inflammation.
  • Gastrointestinal (ascending colon) pain.
  • Pleurisy (inflammation of the membrane around your lung).
  • Right lung pneumonia.
  • Others.

1. Muscular pain.

The muscles of our abdominal wall and their tendons can get strained or inflamed.

Causes:

  • Sudden awkward movement leading to muscle strain.
  • Being overweight.
  • Trama (often blunt) to the muscle at the right side under ribs (towards your back).
  • Repeated heavy lifting.
  • Lack of physical exercise.
  • Prolonged sitting on low-quality chairs.
  • Frequent sleep on a low-quality mattress or any hard surface.
  • Vigorous workout.

Possible muscles that cause right side pain under the ribs (towards the back) are:

  • The right external oblique muscle.
  • The right internal oblique muscle.
  • The right latismuss dorsi msucle.
  • The right transversus abdominis muscle.

Symptoms:

  • Aching, stabbing or shooting in character. 
  • The pain is almost always related to movement (worsens when you move or bend your body).
  • Also, you may feel more pain at specific postures. 
  • The pain is not related to eating or bowel movement. However, it can increase with straining during defecation.
  • Tenderness is felt when you press on the affected area.

Learn more about muscle strain symptoms and treatments.

2. Bone (rib) pain.

You may feel right ribs pain just under the ribs. The pain can be towards the back or the front of your right side. 

The bones and cartilage of your rib cage are frequent sources of such pain.

The causes are either trauma or bone diseases. The list of possible causes is below.

Causes:

  • Trauma to the rib cage: it may cause fracture or broken rib.
  • Rib bone diseases such as osteoporosis (more common if you are female and older age).
  • Rarely, Tumors affecting the rib (The ribs are one of the common sites of tumor metastasis).

Symptoms:

  • Pain may be sharp, aching, or dull.
  • Tender on touching the right lower rib ridge.
  • Pain is often constant. 
  • Pain worsens when you breathe or move.
  • The onset of pain can be related to trauma to the right side.
  • If the rib is broken or fractured, The pain is often extreme with severe tenderness over the affected rib.
  • With osteoporosis, You may have bone pain elsewhere in your body.

See your doctor if you have a history of significant trauma or if you think you have osteoporosis. Learn more about osteoporosis here.

3. Right Kidney pain.

The right kidney and the right ureter lies in the right side below the ribs towards the back.

Renal colics are one of the most likely causes of pain in this site. 

The renal colic is distinguishable from muscular pain and colon pain by:

  • it is more intense, comes and goes in waves of severe renal colic.
  • It is neither related to movement nor food.

Causes:

  • Right kidney or right ureteric stones.
  • Kidney infection.
  • Kidney inflammation.
  • A large renal cyst.
  • Rarely, kidney trauma or kidney cancer.

Symptoms:

  • Sudden onset of intense pain in the right side below the ribs towards the back (right loin pain).
  • The pain may spread to the back, the groin, or the right side of your abdomen.
  • Pain lasts from minutes up to a few hours. It tends to come and go (recurrent).
  • The pain completely resolves between the attack.
  • NOT related to eating, bowel movements, posture, nor movement.
  • Severe cases are associated with nausea and vomiting.
  • Frequently, you may experience painful urination, bloody or turbid urine.

Learn more about renal colic.

4. Colon (gas) Pain.

Different colon conditions and diseases can localize on the right side. Ascending colon pain

 Causes:

  • Trapped gas in the ascending colon.
  • Overeating of gas-producing foods.
  • Food intolerances as lactose intolerances.
  • Infections (gastroenteritis).
  • Irritable bowel syndrome.
  • Inflammatory bowel disease.
  • Colon cancer.
  • Diverticulitis.

We previously discussed ascending colon pain in this article

Symptoms:

  • The more common site of ascending colon is the front rather than the back of the right side. However, the pain can be towards the back of the right side. 
  • The pain is in the form of colics or cramps that comes and goes.
  • Often related to eating gassy foods. 
  • With irritable bowel syndrome, pain can be triggered by stress and anxiety.
  • The pain is associated with bloating, changes in bowel habits, and stool form. 
  • The pain may improve with defecation.

5. Gallbladder pain.

The gallbladder lies in the upper right quadrant of your abdomen. It is attached to the liver and helps store bile until it is released into your digestive tract. 

Causes:

  • Gallstones, gravels, or mud inside the gallbladder.
  • Inflamed gallbladder (cholecystitis), often due to its obstruction by a stone at its neck.
  • Rarely, tumors of the gallbladder.
  • Functional gallbladder disease.

Symptoms:

  • The primary site of gallbladder pain is the upper right abdomen.
  • However, the pain spreads to the upper middle part of the abdomen (epigastric area). It also spreads to the right side below the ribs and towards the back. 
  • The pain commes in attacks (gallbladder attack). Often, it is related to heavy meals and fatty foods.
  • The gallbladder colic starts suddenly, gradually increases in intensity, and lasts about 10-30 minutes. 
  • The attack may last longer, and it recurs after partial resolution.
  • The onset of pain is often associated with severe nausea. Sometimes, vomiting also occurs.
  • A milder form of right side pain under the ribs (towards the back) every now and then is common with chronic calcular cholecystitis. 

Most gallbladder conditions are easily diagnosed via abdominal ultrasonography.

If your symptoms are consistent with gallbladder disease, call your doctor to get diagnosed. 

MORE: 5 Mimics of Gallbladder Pain (Biliary Colic): Gastroenterologist Explains.

6. Liver pain.

The liver lies under the diaphragm and ribs in the right upper part of your abdomen. Painful liver conditions can lead to right side pain under the ribs (towards the front and the back).

Causes:

  • Liver inflammation (acute hepatitis).
  • Liver cancer.
  • Enlarged liver (as with fatty liver).
  • Large liver cysts or vascular malformation.
  • Liver congestion (in people with advanced heart diseases).
  • Trauma to the liver.

Symptoms:

  • The pain is often continuous, dull aching.
  • The usual site of pain is the right upper quadrant of your abdomen. 
  • The pain may spread to the right side under the ribs towards your back.
  •  

7. Pleura and lung pain.

Diseases affecting the right lung and its cover (the pleura) may cause right side pain.

Causes:

  • Inflammation of the right lung (right lobar pneumonia): viral, bacteria, or others.
  • Inflammation of the right pleura (pleurisy).
  • Rib trauma or fractures may also lead to pleurisy.
  • Right lung or pleural cancer (less common).
  • Certain medications may induce pleurisy.
  • Right pulmonary artery embolism (rare).

Symptoms:

  • Pleurisy pain characteristically worsens with respiration (with breathing in and out).
  • The pain greatly increases with coughing.
  • Associated symptoms as shortness of breath, cough, and expectoration are often present.
  • Fever may also present.

Learn more about pleurisy and pneumonia.

CAUTION: pleurisy and Pneumonia, can be a result of Covid-19. Call your doctor immediately if you have respiratory symptoms. Learn More.

8. Others (less frequent):

  • Fibromyalgia.
  • Supra-renal gland tumors (benign and malignant).
  • Portal vein thrombosis.
  • Painful skin lesions or lumps on the right side of your trunk or back.
  • And others,

When to see a doctor:

See a doctor when the right side pain is associated with:

  • Prolonged, undiagnosed attacks of pain.
  • The pain has started after trauma or injury.
  • Extreme or intolerable pain.
  • Fever.
  • Vomiting.
  • Weight loss.
  • Significant shortness of breath.
  • Bloody urine or stool.