What Causes Pain Below the Right Ribs?

Pain in the lower right rib area is most commonly due to musculoskeletal strain.

However, first and foremost, organic (visceral) causes must be ruled out. Structures located beneath the right lower ribs include the liver and pleura. Therefore, conditions such as pleuritis or hepatic disorders should be considered. An abdominal ultrasound is recommended to help exclude these possibilities. If the abdominal ultrasound findings are normal and a chest X-ray also shows no abnormalities, the pain beneath the right lower ribs is typically attributable to common musculoskeletal strain-related inflammation. This inflammation may involve the periosteum covering the rib, the fascia overlying the muscles, or the muscle tissue itself. Occasionally, cutaneous conditions—such as herpes zoster—may also cause localized pain.

In general, if visceral pathology and dermatologic causes have been excluded, three primary factors commonly account for right lower rib pain: First, physical strain or poor posture—for example, prolonged sitting with thoracic kyphosis (rounded upper back) and inadequate lumbar or back support; Second, exposure to cold and damp weather; Third, emotional stress—particularly frequent anger or frustration, which may manifest as distending or dull pain. Consider whether any of these three factors apply; addressing them appropriately often leads to symptom relief.