It starts as a dull throb. Or maybe it’s a sharp, stabbing sensation that catches your breath when you twist too fast. You’re sitting at your desk or lying in bed, and suddenly there it is—that unmistakable pain on the right side under ribs. Your mind probably goes straight to the worst-case scenario. Is it my liver? Did I pull a muscle? Is it a gallstone?
Honestly, the right upper quadrant (RUQ) is crowded real estate. You’ve got the liver, the gallbladder, the right kidney, part of the pancreas, and the beginning of the large intestine all tucked under that rib cage. When something hurts there, the body isn't always great at pinpointing the exact source. It’s a bit of a biological guessing game until you look at the specific symptoms accompanying the ache.
The Gallbladder is Usually the Prime Suspect
If the pain feels like a "grip" or an intense pressure that radiates to your right shoulder blade, your gallbladder is likely the culprit. This tiny, pear-shaped organ stores bile. Sometimes, that bile hardens into stones.
Gallstones are incredibly common. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), about 10% to 15% of adults in the U.S. have them. But here is the thing: most people don't even know they have them. They are "silent." The trouble starts when a stone gets stuck in a duct.
That’s biliary colic. It’s a specific type of pain on the right side under ribs that usually flares up about thirty minutes to an hour after you eat a greasy burger or something heavy in fat. It isn't a subtle itch. It’s a deep, boring pain. If you also notice your skin or the whites of your eyes looking a bit yellow—that’s jaundice—you need to see a doctor immediately. That suggests a blockage that the body can't bypass.
Cholecystitis vs. Simple Stones
There is a big difference between a passing stone and cholecystitis (inflammation of the gallbladder). If the pain is constant, accompanied by a fever, and makes you feel nauseous just looking at food, you're looking at inflammation. Dr. Mark Schattner at Memorial Sloan Kettering often notes that gallbladder issues can mimic heart attacks or even simple indigestion, which is why the location is so tricky.
Liver Issues: The Quiet Aches
The liver is a massive organ. It takes up most of the space behind your lower right ribs. Interestingly, the liver itself doesn't actually have pain receptors.
Wait. If the liver doesn't feel pain, why does it hurt?
It’s the capsule. The Glisson’s capsule is a thin layer of connective tissue surrounding the liver. When the liver swells—whether from hepatitis, fatty liver disease, or congestion due to heart issues—it stretches that capsule. That stretching is what you feel. It’s usually a dull, heavy sensation rather than a sharp poke.
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Non-Alcoholic Fatty Liver Disease (NAFLD) is a rising giant in modern health. It’s often asymptomatic for years. You might just feel a vague sense of fullness. But if that pain on the right side under ribs is paired with extreme fatigue or unexplained weight loss, it’s time for a FibroScan or an ultrasound.
The "Side Stitch" and Musculoskeletal Reality
Sometimes it’s just your body being a body.
If you were running or lifting heavy boxes and felt a sharp jab, it’s likely an intercostal muscle strain. These are the tiny muscles between your ribs. They help you breathe. If you strain one, it hurts to cough, hurts to sneeze, and definitely hurts to deep-breathe.
Then there’s the classic "side stitch," officially known as Exercise-Related Transient Abdominal Pain (ETAP). Scientists still debate exactly why this happens. Some believe it's caused by the friction of the abdominal lining (the peritoneum), while others think it's a lack of blood flow to the diaphragm. Either way, it's harmless. It goes away when you stop moving.
Costochondritis
This sounds scary but it's basically just inflammation of the cartilage that connects your ribs to your breastbone. It can cause a sharp pain on the right side under ribs that feels like it’s coming from the bone itself. If you press on the area and the pain gets worse, it’s more likely a rib or muscle issue than an internal organ problem. Organs usually don't "hurt more" when you poke your skin unless the inflammation is very advanced.
When the Lungs Get Involved
The base of your right lung sits right above the diaphragm, which sits right above the liver. If you have pneumonia in the lower lobe of the right lung, the pain can "refer" downward.
This is often called pleurisy—an inflammation of the linings around the lungs.
- Does it hurt more when you inhale?
- Do you have a dry cough?
- Are you running a low-grade fever?
If you answered yes, the pain on the right side under ribs might actually be a respiratory issue disguised as an abdominal one.
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Kidney Stones: The Back-to-Front Attack
Your kidneys are actually located closer to your back than your belly. However, a kidney stone doesn't stay put. When a stone moves from the kidney into the ureter, the pain is legendary. It’s often described as one of the worst pains a human can experience.
While kidney pain usually starts in the flank (your side/back), it frequently wraps around to the front, landing right under the ribs or traveling down toward the groin. If you see blood in your urine or feel a constant "need to go," the issue likely isn't your liver or gallbladder—it’s your renal system.
Digestion, Gas, and the Hepatic Flexure
Gas is the great pretender.
The "hepatic flexure" is the spot where your ascending colon turns a sharp corner to become the transverse colon. This turn happens right under your right ribs. If gas gets trapped in that corner, it can cause surprising amounts of pressure and sharp pain on the right side under ribs.
It’s localized. It’s sharp. Then, you pass gas or have a bowel movement, and it vanishes. Irritable Bowel Syndrome (IBS) or even simple constipation can cause this "trapped gas" sensation.
Fitz-Hugh-Curtis Syndrome
This is a rarer one, but important for women to know. It’s a complication of Pelvic Inflammatory Disease (PID) where inflammation spreads to the lining of the liver. It causes sharp RUQ pain that can be mistaken for gallbladder issues. It’s a reminder that the body is an interconnected web; a problem in the pelvis can end up hurting in the ribs.
Red Flags: When to Head to the ER
Most of the time, this pain is something manageable. But you shouldn't ignore certain signals.
If your pain on the right side under ribs is accompanied by a rigid, board-like abdomen, that's a surgical emergency. It could mean a perforation. If you are vomiting uncontrollably or have a fever over 101°F, don't wait for an appointment.
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Also, watch for the "classic triad" of gallbladder infection: fever, jaundice, and RUQ pain. This is known as Charcot's Triad. It’s a sign of ascending cholangitis, which can be life-threatening if the infection hits the bloodstream.
Actionable Steps for Relief and Discovery
You don't have to just sit there hurting. Here is how to narrow down what’s going on and find some relief.
1. The "Fatty Meal Test"
Pay attention to what you ate before the pain started. If it consistently happens after eating cheese, fried chicken, or heavy oils, your gallbladder is screaming for help. Try a low-fat diet for three days and see if the frequency of the pain on the right side under ribs drops.
2. Physical Palpation
Lie flat on your back. Take a deep breath and press your fingers firmly under your right rib cage as you exhale. If you experience a sudden, sharp catch in your breath—almost like you can't finish the inhale because of the pain—that’s a positive Murphy’s Sign. It’s a classic indicator of gallbladder inflammation.
3. Hydration and Movement
If the pain is gas-related or a minor kidney stone, water is your best friend. For muscular pain, alternating heat and ice works wonders. A heating pad for 20 minutes can relax the intercostal muscles, while ice can bring down inflammation if you’ve actually strained something.
4. Document the Pattern
Before you see a doctor, keep a "pain log" for 48 hours. Is the pain constant or colicky (coming in waves)? Does it move to your back? Does it get better when you sit up or lean forward? Doctors at clinics like the Mayo Clinic use these specific patterns to differentiate between things like pancreatitis (which feels better leaning forward) and gallbladder issues (which don't).
5. Avoid Self-Medicating with NSAIDs Initially
If you think the pain might be your liver or an ulcer, be careful with ibuprofen or aspirin. These can irritate the stomach lining or, in the case of high-dose Tylenol, stress the liver. Stick to rest and light fluids until you have a better idea of the source.
The reality is that pain on the right side under ribs is a symptom, not a diagnosis. Whether it’s a simple muscle pull from a gym session or a gallbladder that’s finally had enough of your Friday night pizza habit, paying attention to the "flavor" of the pain is the first step toward fixing it. Listen to your body—it usually tells you exactly what’s wrong if you know the language.