Ribcage Pain: causes, symptoms, and when to seek help

Ribcage pain can occur due to various factors, but in most cases, it is not a cause for serious concern. However, there are medical reasons that should be considered to rule out any underlying conditions. Here are some of the potential causes of ribcage pain:

1) Trauma or muscular pain

If you have experienced a traumatic injury to the ribs or have had forceful coughing, you may have bruised or even broken a rib. To manage the pain, it's best to take painkillers as needed and apply an ice pack to the affected area to reduce inflammation. Practicing deep breathing can help ensure proper lung inflation and reduce the risk of developing a chest infection.

Inflammation of the intercostal muscles, the muscles that connect the ribs and expand and contract during breathing, can also lead to ribcage pain. This type of pain usually occurs when taking deep breaths. The treatment options for muscular strains are similar to those mentioned above for broken or bruised ribs.

2) Cardiac pain

Ribcage pain can sometimes indicate a cardiac concern, such as heart failure. Additional symptoms that may accompany cardiac-related pain include:

• Shortness of breath
• Swelling in the feet and legs, which can also spread to other parts of the body
• Unusual fatigue and weakness
• Coughing or wheezing, sometimes with the presence of frothy or blood-stained mucus
• Rapid heart rate

If you experience ribcage pain along with any of these symptoms, it's important to seek urgent medical review through your GP to determine a diagnosis. If the pain is severe and accompanied by symptoms such as radiating pain to the arms, back, or jaw, as well as nausea, shortness of breath, sweating, dizziness, or feeling extremely unwell, it is crucial to seek emergency medical attention at your local Accident and Emergency department or by dialling 999 for an ambulance.

3) Costochondritis

Costochondritis refers to the inflammation of the cartilage connecting the ribcage to the breastbone (sternum). While this condition doesn't lead to long-term complications and typically improves on its own within a few weeks, some individuals may experience relapses. Symptoms of costochondritis include:

• Pain during deep breathing, coughing, or sneezing
• Increased pain when pressure is applied to the chest
• Worsened pain when lying down

The main treatment for costochondritis involves painkillers such as anti-inflammatories. If these medications do not effectively manage your pain or if the condition does not resolve, your GP may explore alternative treatment options.

4) Gallstones

Gallstones are small stones that form within the gallbladder, usually composed of substances like cholesterol. While gallstones often cause no problems and may be asymptomatic, they can trigger a condition known as biliary colic when one of the stones becomes lodged in a duct inside the gallbladder. Pain from gallstones is typically felt in the centre of the abdomen, under the ribs, or on the right-hand side. Certain fatty foods may trigger the pain, and relief may not be achieved by vomiting, bowel movements, or passing gas.

If complications arise from gallstones, such as biliary colic or inflammation of the gallbladder (cholecystitis), you may experience additional symptoms like:

• Jaundice (yellowing of the skin and whites of the eyes)
• Persistent severe pain
• Vomiting
• Fever

Gallstones usually need treatment only if they cause complications. In such cases, surgery to remove the gallbladder using keyhole surgery is typically recommended.

5) Liver diseases

Various liver diseases, including cirrhosis or hepatitis, can affect the liver without presenting symptoms in the early stages. However, as the diseases progress, abdominal pain can occur. Symptoms that may accompany liver disease-related ribcage pain include:

• Nausea
• Jaundice
• Itching of the skin
• Dark-coloured urine
• Pale or clay-coloured stools
• Abdominal pain, often on the right side under the ribs
• Fatigue
• Weight loss
• Frequent or easy bruising or bleeding
• Changes in personality

If you are experiencing abdominal pain along with any of the aforementioned symptoms or if you are concerned about your liver, it is best to contact your GP for a physical review and blood tests. Making positive lifestyle choices can significantly impact liver health, and many liver diseases are preventable.

6) Pancreatitis

Pancreatitis refers to the inflammation of the pancreas, an organ involved in hormone production and digestion. It can manifest as acute or chronic. Acute pancreatitis requires prompt medical attention, as it can make a person feel extremely unwell and be potentially dangerous. The main causes of pancreatitis include gallstones, heavy alcohol use, as well as injury and infection.

Severe pain felt in the upper abdomen just below the ribs is the primary symptom of acute pancreatitis, although other symptoms may be present, such as:

• Fever
• Nausea or vomiting
• Rapid heartbeat
• Swollen abdomen
• Jaundice
• Diarrhoea

If you suspect pancreatitis, it is vital to seek urgent medical assessment through your local Accident and Emergency department or by calling NHS 111, as this condition can be life-threatening.

7) Acid Reflux and stomach ulcers

Heartburn and acid reflux can sometimes cause pain in the chest area, including the ribcage. Stomach acid traveling up the oesophagus is responsible for this discomfort. In addition to heartburn, acid reflux can lead to symptoms such as:

• A sour or unpleasant taste in the mouth
• Bad breath
• Bloating
• Nausea
• Hoarse voice
• Recurring coughs or hiccups

Symptoms of stomach ulcers can be similar. If you suspect you have a stomach ulcer or are struggling with acid reflux, it is best to consult your GP for further investigation. In some cases, a stomach ulcer can perforate and bleed. If you experience any of the following symptoms, seek urgent medical review:

• Vomiting blood
• Sudden intense worsening pain
• Passing black or tar-like bowel movements

8) Inflammatory bowel disease

Inflammatory Bowel Disease (IBD) refers to a group of diseases that cause inflammation in the digestive tract, with ulcerative colitis and Crohn's Disease being the primary forms. While pain from these conditions is usually felt lower in the abdomen, it can occasionally refer to the ribs. Additional symptoms often experienced with IBD include:

• Diarrhoea, sometimes with mucus, blood, or pus
• Abdominal cramping
• Fatigue
• Loss of appetite and unexplained weight loss
• Anaemia
• Mouth ulcers
• Inflammation in other parts of the body

If you are experiencing any of the mentioned symptoms along with rib pain, it is recommended to consult your GP to discuss your symptoms.

9) Appendicitis

Appendicitis occurs when the appendix, a small part of the intestine, becomes infected and inflamed. It requires examination by a GP or emergency doctor and may necessitate surgery. The pain is typically felt in the lower right side of the abdomen. If you experience worsening pain, especially accompanied by fever, nausea, and loose stools, it is crucial to seek an assessment to rule out appendicitis.

It is important to obtain a diagnosis and treatment from your GP for any of these issues. If your symptoms worsen or you experience any of the following, go to the accident and emergency department of your hospital:

• Unbearable pain
• Vomiting blood or passing blood with bowel movements
• Black stools
• Crushing chest pain
• Worsening symptoms that you cannot manage at home

Sources and further reading:

1. Aches and pains – AXA Health
2. Bruised or broken ribs - NHS
3. Heart failure - BHF
4. Costochondritis - NHS
5. Gallstones symptoms - NHS
6. Symptoms of liver disease – British Liver Trust
7. Acute Pancreatitis - NHS
8. Symptoms and causes of pancreatitis - NIDDK
9. Heartburn and acid reflux – NHS
10. Stomach ulcer - NHS
11. About Crohns and Colitis – Crohns and Colitis UK
12. Appendicitis – NHS

Information provided and reviewed by the AXA Health 24/7 health support line for members.