Back pain under the ribs - as a symptom of disease

Back pain under the ribs can be a symptom of various diseases. It is very difficult for a non-specialist to understand such a variety of diseases, so a diagnosis made by oneself often does not coincide with the one given to us by a qualified doctor. And even then, in order to make a final diagnosis, doctors usually do not limit themselves to identifying symptoms, but prescribe additional studies.

What does the localization of pain indicate?

We, not having sufficient knowledge and opportunities, can only assume what the pain under the ribs in the back may be associated with. The exact localization of the pain will tell us about this.

Right side pain

When pain appears in the right side of the back under the rib, you need to remember what organs a person has in this area. To the right of the spinal column, we have: the right lung, the corresponding part of the diaphragm, the liver (its right part), the gallbladder, some part of the stomach, the head of the pancreas, one of the two kidneys. In the absence of compactions in the muscles and ligaments of the back, traumatic foci, episodes of increased load on the back (spine and muscles), as well as diseases of the spine, one can suspect that the cause of the pain is a disease of the internal organs (one of the above).

Pain on the right side of the back under the rib is typical for liver diseases. However, it is important to understand that this organ is weakly innervated and begins to hurt only with severe damage. Pain syndrome of varying intensity is typical for the inflammatory process in the liver (hepatitis), cirrhosis, fatty degeneration of the organ (fatty hepatosis is rarely accompanied by mild pain in the right hypochondrium), tumor processes in the organ. Pain on the right side under the ribs is not associated with damage to hepatocytes (liver cells, its parenchyma), but with the transition of the pathological process to the capsule of the organ, where sensitive receptors are located.

In severe liver diseases, more characteristic symptoms are observed: changes in blood composition, increased bilirubin in the blood and tissues of the patient (jaundice), circulatory disorders, symptoms of intoxication of the body. The pain is constant, but can intensify when pressing on the liver area.

The gallbladder with ducts is located next to the liver. During stagnant processes in the organ, concretions (stones) can form, which are pushed into the bile ducts by bile juice. This process is accompanied by severe pain in the right hypochondrium in front, but can also radiate to the back. The pain is not constant. It subsides when the stone is removed (into the intestines).

Gallstone disease is often accompanied by inflammation of the gallbladder, which can also be infectious. In this case, the pain will also be localized on the right side closer to the lower back, but it can also radiate to the shoulder blade and collarbone. In acute cholecystitis, the pain is strong, piercing, accompanied by hyperthermia, nausea, vomiting. Sometimes, as in liver diseases, the bilirubin level can increase, which is reflected in the color of the skin and whites of the eyes.

If the disease is chronic, the pain is usually moderate, and intensifies only when eating fatty and fried foods, and vomiting occurs. Patients may also complain of belching and a bitter taste in the mouth, not related to eating bitter foods.

Most pathologies of the pancreas are not characterized by pain under the ribs on the right side from behind, i.e. from the back, because most of the organ, with the exception of its head, is located to the left of the spinal column. However, inflammation of the pancreas begins precisely from here, i.e. from the entrance to the duodenum, where the bile ducts also come out. Inflammation of the organ is accompanied by mild or acute pain in the corresponding localization. If only the head of the pancreas is inflamed, then the pain will be localized mainly on the right. With acute inflammation, the pain is severe, almost like with appendicitis, but its focus is located a little higher. Chronic inflammation is characterized by mild pain, appearing with nutritional errors and subsiding after the pancreas has a chance to rest.

Pancreatitis is more characterized by a girdle pain under the ribs and in the back closer to the lower back (after all, the size of the gland is not small, in an adult the length of the organ varies within 15-22 cm). At the same time, patients complain of pain on the left side of the back and abdomen more often than of the right-sided symptom, perhaps because most of the pancreas is located on the left, and we feel reflected pain.

Other symptoms include: heaviness in the stomach after eating 1.5-2 hours, weakness, loss of appetite, change in skin color (it becomes pale or yellowish), pancreatic diarrhea (stool disorder with painful spasms), hyperhidrosis, and sometimes vomiting.

If the pain in chronic pancreatitis becomes permanent, one may suspect oncology, i.e. pancreatic cancer, which usually develops in the head of the organ in people with a hereditary predisposition.

The pancreatic and gallbladder ducts open into the part of the intestine that is commonly called the duodenum. Its walls are not usually damaged by acid, like those of the stomach, but in some pathologies, gastric juice is thrown into the intestine, the mucous membrane of which is not designed for such an aggressive effect. Alkalis in bile and pancreatic juice should extinguish the acid, but this does not happen if the liver, gallbladder or pancreas are dysfunctional, which leads to inflammation of the walls of the initial section of the intestine and the formation of ulcers on it.

The bulb and descending part of the duodenum are located on the right side of the spine and border the liver and right kidney. When these segments are inflamed, there is a nagging pain on the right in the epigastrium, which often radiates to the back, reminiscent of pain in pancreatitis. With an ulcer of the right segments (and they are most often affected) of the duodenum, unpleasant aching pains appear, especially in the evenings and at night (hunger pains), which can radiate to the back and even to the arm. The pain is most often localized in the lumbar and thoracic region, subsiding some time after eating.

The stomach, as part of the digestive tract, is located in the area of the lower ribs, it is not surprising that with diseases of this organ, pain in the back under the ribs may occur. More typical is still pain in the abdomen in front (epigastric), but it can also radiate to the back. This symptom is typical for gastritis, which often occurs in a chronic form, but can also be acute with severe pain in the area of localization of inflammation.

Inflammation of the gastric mucosa also often causes: belching, heartburn, nausea, flatulence, heaviness in the stomach after eating, loss of appetite, and bowel movements.

Back pain also occurs in cases of ulcerative-erosive lesions of the gastric mucosa, which often spreads to the duodenum.

If the ulcer is located on the third of the stomach that is located to the right of the spine or extends to the initial sections of the duodenum, then back pain may also appear on the right. The pain sometimes intensifies, sometimes subsides. During an exacerbation, it has a dagger-like character, forcing the patient to bend at the waist. Severe pain appears when hunger sets in, immediately after eating spicy or hot food, or in stressful situations.

Other symptoms of stomach ulcers include nausea and vomiting (often with blood), belching, heartburn, flatulence, and blood may also appear in the faeces. If the stomach wall is perforated (perforated ulcer), symptoms of peritonitis appear: vomiting, fever, severe aching and sharp pain in the abdomen and back.

The kidneys are a paired organ of the excretory system. One kidney is located on the right, the other on the left. In case of kidney diseases of an inflammatory nature, back pain is one of the most characteristic symptoms. If only the right kidney is affected, then the pain will be localized on the right side. In case of bilateral kidney damage, pain will be felt in both the right and left sides at the back. The intensity of the pain will depend on the severity of the pathological process.

Other symptoms of pyelonephritis (glomerulonephritis) are: fever (in acute cases), swelling of the face and extremities, frequent urination. Urine becomes cloudy and dark. As a result of poor filtration and intoxication of the body, nausea, vomiting, headaches, general weakness, and dizziness appear.

As a result of stagnation in the kidneys, as well as in the gall bladder, stones can form, which are periodically washed out into the ureter with the urine flow. Renal colic is characteristic of kidney stone disease, accompanying the movement of a urinary stone or sand. Pain on the right occurs if the stone comes out of the right kidney. Bilateral colic is a rare occurrence.

The pain associated with kidney stone disease is acute, paroxysmal, and can radiate to the groin and abdomen. The localization of pain constantly changes as the stone moves. It occurs in the area of the lower ribs of the back, moving to the lumbosacral region.

Urolithiasis is also characterized by cloudy urine, but frequent urges to urinate do not always end positively. Often there is a retention of urine in the body and, as a result, edema.

Unlike pyelonephritis, the pain symptom of kidney stones responds well to treatment with antispasmodics. Thermal procedures also relieve pain.

Pain in the right hypochondrium radiating to the back, lower back, and anus may be one of the symptoms of acute appendicitis (inflammation of the cecum). In this case, patients usually experience the most severe pain in the pelvic area in front, but the sensations radiating to the back may be similar to renal colic. Other symptoms may also indicate appendicitis: fever, constipation combined with vomiting, diarrhea with blood, hyperhidrosis, chills, etc. In this case, pressing on the appendix area is less painful than the moment when the hand is suddenly removed.

The similarity of symptoms of appendicitis with renal colic sometimes causes serious complications. By relieving pain with antispasmodics, the patient only complicates the diagnosis of appendicitis, and delay in this case can cost him his life. When an inflamed appendix ruptures, its contents spill into the abdominal cavity, causing inflammation of the peritoneum (peritonitis) - a potentially very life-threatening condition.

With the above-described diseases, back pain under the ribs usually occurs in the lumbar region and lower thoracic region, although in some cases it can radiate to the upper back. If the pain is localized under the ribs in the shoulder blade area, one can suspect diseases of the lower respiratory system (bronchitis, pneumonia, pleurisy).

With bronchitis, back pain under the ribs usually occurs during coughing. It is difficult to say in which part of the back it is felt more strongly. With pneumonia and bronchopneumonia, the localization of pain indicates which part of the respiratory system is affected by the disease. With right-sided damage, the back in the area of the shoulder blades and a little lower will hurt on the right. The pain will also increase with coughing. Often, back pain with this pathology is the only symptom, which complicates the diagnosis and treatment of this dangerous disease.

Back pain under the ribs when inhaling can have different causes. The displacement of the chest bones and the movement of the anterior abdominal wall can increase the pressure on the diseased organ, resulting in pain (or pain intensification). Due to the displacement of the bones, it is at such moments that intercostal neuralgia often makes itself known, the pain in which, especially in the middle parts of the chest below the mammary glands, resembles attacks of angina. But at the same time, there are no symptoms characteristic of heart disease: increased sweating, a feeling of shortness of breath, a feeling of constriction in the chest, shortness of breath, nausea. Breathing problems are explained only by the fact that with a deep breath the pain intensifies (becomes sharp, stabbing), so the person tries to breathe shallowly, which is why there may still not be enough air.

Neuralgia, despite severe pain, does not pose a particular danger to human life, unlike cardiovascular diseases and pleurisy. The latter is an inflammatory pathology and most often acts as a complication of infectious diseases of the respiratory system (pneumonia). In both dry and exudative forms of pleurisy, pain when breathing is one of the characteristic symptoms of the disease, along with shallow, rapid breathing. Painful sensations that force the patient to take a forced position also appear when coughing, hiccupping, or trying to bend in the opposite direction from the lesion. For example, if the inflammation is localized in the right part of the pleura, then sharp pain in the right side of the back occurs when bending to the left.

Aching reflected pain in the back under the right lower rib sometimes occurs in women with diseases of the reproductive system, for example, with an anomaly in the location of the uterus or inflammation of the endometrium, as well as with dysmenorrhea (painful periods), when abdominal pain can radiate to the back, but with less intensity. The right-sided nature of reflected pain may be evidence of an inflammatory process in the right ovary. The back pain is not intense, does not have a clear localization, but is unpleasant in that it causes anxiety and worry, which only worsens the situation.

Pregnant women often complain of back pain under the ribs and in the lower back. In case of pregnancy pathology, we are most often talking about right-sided pain. Although the pain is often caused by fatigue of the spine, which in the lumbar region has to take an unusually strong bend as the fetus grows inside the uterus.

Left side pain

On the left side of the spine in our body are located: the heart, the left lung with the left bronchus extending from it, the left part of the diaphragm, the spleen, the main part of the stomach and pancreas, and the left kidney.

Pain in the left side of the back under the ribs may indicate inflammation of the left kidney or the formation of stones in it, which, when moving through the ducts, cause pain sensations that radiate to the back and side. In women, pain of lesser intensity is noted with inflammation of the left ovary. With severe inflammation, they alternate with acute pain in the abdomen.

Pain in the left side from the back can also be complained by expectant mothers, especially in the later stages. In the early stages, a temporary weak pain symptom (on the right or left) can occur during the penetration of the embryo into the uterus and during placentation, which does not indicate pathology at all. However, such a symptom should not be treated carelessly. Sometimes women who are subsequently diagnosed with an ectopic pregnancy complain of pain in the hypochondrium (on the right or left). Other symptoms of this pathology are brown discharge and quite severe pain in the abdomen below on one side (the localization of the pain indicates the location of the embryo).

The pains with pancreatitis have approximately the same localization on the left. If the inflammation covers not only the head of the pancreas, the pains become encircling. Most often they radiate to the left side of the back, but can also reach the right. In this case, it is very difficult for the patient to determine where exactly it hurts and what kind of pain it is. The intensity of pain with chronic pancreatitis is small, and with acute pancreatitis it becomes stabbing, from the epigastric region gradually descends to the hypochondrium and below, encircling both the abdomen and the back. In this case, neither antispasmodics nor analgesics help to significantly reduce the pain. Other symptoms include: nausea, vomiting, upset stool, severe weakness.

Back pain on the left side under the ribs is often felt by patients with stomach pathologies (inflammation or ulcer). In principle, back pain is not typical for gastritis, especially at an early stage of the inflammatory process. Usually, patients complain of discomfort and pain in the abdomen, belching, nausea, heartburn. Back pain joins these symptoms later, during exacerbations of the disease, which has acquired a chronic course. Chronic diseases tend to weaken the body, so a person develops or worsens other pathologies. These can be diseases of the kidneys, liver, gall bladder. It is quite possible that the pain can be associated with these organs, so they can be either left-sided or right-sided (depending on the location of the diseased organ).

But advanced gastritis (especially with increased acidity of gastric juice) threatens to develop into a stomach ulcer. In this case, the pain becomes much stronger, strictly tied to food intake (hunger pains and those that occur when eating spicy food) and the psycho-emotional state of a person. Back pain is localized in the lumbar region, but can also spread under the shoulder blades. Their intensity is somewhat lower than that of abdominal pain. But when the ulcer perforates, the pain becomes encircling, stabbing, the person cannot find a comfortable position, he begins vomiting blood, and his body temperature rises.

Gastritis and stomach ulcers are diseases that cannot proceed asymptomatically for a long time, so back pain under the ribs in the absence of symptoms from the gastrointestinal tract is unlikely to be associated with inflammatory or erosive-ulcerative processes in the digestive system. Most likely, their cause should be sought in the condition of the kidneys or spine.

Pain in the upper abdomen under the ribs, radiating to the back, is also characteristic of spleen pathologies. Pain usually occurs when the organ is enlarged, which in turn occurs with spleen injuries, lymphoma, leukemia, hemolytic anemia, infectious mononucleosis, hepatic hypertension, endocarditis, lupus erythematosus and some other pathologies. That is, back pain with an enlarged spleen can be a symptom of many diseases that only indirectly relate to this organ. And even a ruptured spleen, which is possible both in a traffic accident and as a result of an enlarged organ, and is accompanied by blue tissue around the navel, requires a thorough study of the causes of the incident.

What can indicate spleen disease, besides back and abdominal pain on the left, increasing with any movement? The appearance of chills, fever, nausea, vomiting can also be symptoms of spleen disease. Sometimes patients note an incomprehensible itch on the body.

Pain on the left side under the ribs in the area of the shoulder blades and slightly below is typical for left-sided pneumonia, which is diagnosed less often than right-sided pneumonia, but has a more severe course, problems with therapy and a high risk of complications, as well as left-sided pleurisy and damage to the diaphragm on the same side. Back pain associated with respiratory pathology is usually tied to the acts of inhalation and exhalation. On inhalation, the pain intensifies, on exhalation it becomes weaker.

Pain in the back under the ribs on the left side may be a symptom of cardiovascular diseases: angina, ischemic heart disease, myocardial infarction, spinal cord stroke. In myocardial infarction, some patients do not experience chest pain in the usual location, but complain of back pain. Most often, this is pain between the shoulder blades (usually on the left), which can radiate to the left shoulder, lower jaw.

Back pain and discomfort that occurs when walking, physical and emotional stress, and immediately subsides after rest, may be one of the symptoms of developing cardiac ischemia. Pain in angina and coronary heart disease is easily relieved with nitroglycerin.

With aneurysm and dissection of the aorta of the heart, pain occurs on the left side of the chest, which can radiate to the groin and occipital region or back.

In case of a spinal cord stroke, pain behind the ribs can be called a precursor of this rare but extremely dangerous disease, which is often a complication of osteochondrosis or intervertebral disc herniation (sometimes a tumor is the cause of a stroke). It is with the exacerbation of the underlying disease that sharp pain in the back is associated in combination with tension in its muscles. If subsequently a person begins to feel weakness and pain in the legs, decreased sensitivity, disorders of the acts of defecation and urination, the occurrence of moving lameness in combination with back pain - these are already alarming symptoms that require a visit to the doctor.

Localization of pain in neurological diseases and spinal pathologies (osteochondrosis, herniated discs, spondylitis, scoliosis, etc.) indicates the area of the affected nerve. But it should be taken into account that excitation can be transmitted along the nerve fiber. Its compression or inflammation are local irritants that increase the sensitivity of the nerve, but the pain signal will be transmitted from neuron to neuron, so the pain can radiate to the neck, limbs, perineum, which makes it impossible to determine by eye exactly where the nerve is damaged.

The nature and intensity of pain

Back pain under the ribs can have not only different causes and localizations, but also vary in intensity. It is clear that severe pain always attracts our attention, although it does not often become a sign of a dangerous disease.

For example, in neurological diseases, the patient usually feels severe pain, because we are talking about the impact on the nerves - the structures responsible for our sensations. However, neuralgia, as a disease of the compressed nerve, is less dangerous than a stomach ulcer, in which back pain is rarely very intense, or myocardial infarction, which manifests itself as discomfort in the back.

Neuralgia and spinal diseases, which often cause pain under the ribs that radiates to the back, are more dangerous not in themselves, but because of their complications, so they also cannot be left to their own devices.

Usually, more information about the pathology is given to us not by the intensity of the pain syndrome, but by its nature. Considering the types of pain, it is not always possible to diagnose a specific disease, but it is possible to determine the nature of the course of the disease. Thus, aching pain in the back under the ribs most often indicates a sluggish inflammatory process. The same pain can also occur with back fatigue, as a result of muscle and spine fatigue, during menstruation and pregnancy.

A dull aching pain on the left side of the back under the ribs can be a harbinger of myocardial infarction or a consequence of another gradually progressing cardiovascular disease. It also occurs with an enlarged spleen, chronic diseases of the stomach, kidneys, osteochondrosis on the eve of an exacerbation, etc. But with relapses of any pathologies, the pain usually changes its character.

Thus, a sharp pain in the back under the ribs can be the result of neuralgia or osteochondrosis (it appears during movement, and is intensified by it), as well as a consequence of an exacerbation of various inflammatory diseases of the internal organs, the passage of stones through the renal or bile ducts, acute infarction, exacerbation of appendicitis, perforation of a stomach ulcer.

A sharp pain in the back under the right ribs is more typical for acute cholecystitis and cholelithiasis, and with cirrhosis of the liver and hepatitis, the patient suffers from a dull aching pain that occurs during physical exertion. With hepatic colic against the background of latent cholelithiasis, the pain again takes on a sharp stabbing character.

Diagnosis of back pain under the ribs is complicated by the fact that with the same disease, pain can have different intensity and character, and the presence of reflected pain does not allow one to accurately determine the location of the diseased organ or structure.