Back pain under the ribs - as a symptom of the disease

, medical expert
Last reviewed: 01.07.2022

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

What is the localization of pain

We, not having sufficient knowledge and capabilities, can only guess what pain under the ribs in the back can be associated with. This will tell us the exact localization of pain.

Right side pain

When pain appears in the right side of the back under the rib, you need to remember which 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 seals in the muscles and ligaments of the back, traumatic foci, episodes of increased stress on the back (spine and muscles), as well as diseases of the spine, one can suspect that the cause of pain is a disease of the internal organs (one of the above).

Pain on the right side of the back under the rib is characteristic of liver diseases. True, you need to understand that this organ is poorly innervated and begins to hurt only with a strong lesion. Pain syndrome of varying intensity is characteristic of the inflammatory process in the liver (hepatitis), cirrhosis, fatty degeneration of the organ (fatty hepatosis is rarely accompanied by unexpressed 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 also noted: changes in the composition of the blood, an increase in bilirubin in the blood and tissues of the patient (jaundice), circulatory disorders, symptoms of intoxication of the body. The pain is permanent, but may increase with pressure on the liver area.

Next to the liver is the gallbladder with ducts. During stagnant processes in the organ, calculi (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 be given to the back. The pain is not permanent. They subside when the stone is brought out (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 scapula and collarbone. In acute cholecystitis, the pain is severe, penetrating, accompanied by hyperthermia, nausea, and vomiting. Sometimes, as with liver disease, the level of bilirubin may increase, which is reflected in the color of the skin and whites of the eyes.

If the disease proceeds in a chronic form, then the pain usually has a moderate strength, increases only with the use of fatty and fried foods, then vomiting also occurs. Patients may also complain of belching and a bitter taste in the mouth not associated with eating bitter foods.

Most pathologies of the pancreas are not characterized by pain under the ribs on the right rear, 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 starts from here, i.e. From the place of entry into the duodenum, where the bile ducts exit. Inflammation of the organ is accompanied by unexpressed or sharp pains of the corresponding localization. If only the head of the pancreas is inflamed, then the pain will be localized mainly on the right. In acute inflammation, the pain is severe, almost like with appendicitis, but its focus is slightly higher. Chronic inflammation is characterized by unexpressed pain that appears with errors in nutrition and subsides after the pancreas has a chance to rest.

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

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

If the pain in chronic pancreatitis takes on a permanent character, oncology can be suspected, i.e. Pancreatic cancer, which usually develops in the head of the organ in people with a hereditary predisposition.

The ducts of the pancreas and gallbladder exit into that part of the intestine, which is commonly called the duodenum. Its walls are not usually damaged by acid, as in the stomach, but in some pathologies, gastric juice is thrown into the intestine, the mucosa of which is not designed for such an aggressive effect. Alkalis in the composition of bile and pancreatic juice should quench the acid, but this does not happen with dysfunction of the liver, gallbladder or pancreas, which leads to inflammation of the walls of the initial intestine and the formation of ulcers on it.

The bulb and the descending part of the duodenum are located on the right side of the spine and border on the liver and right kidney. With inflammation of these segments, aching pain appears on the right in the epigastrium, which often radiates to the back, resembling 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 (hungry 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 passage of the lower ribs, it is not surprising that with diseases of this organ, back pain under the ribs can occur. More characteristic is still pain in the abdomen in front (epigastric), but it may well give 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 inflammation.

With inflammation of the gastric mucosa, there are also often: belching, heartburn, nausea, flatulence, heaviness in the abdomen after eating, loss of appetite, stool disorders.

Back pain also occurs in the case of ulcerative erosive lesions of the gastric mucosa, which often extends to the duodenum.

If the ulcer is located on that third of the stomach, which is located to the right of the spine or extends to the initial sections of the duodenum, then back pain may appear on the right. The pain intensifies, then subsides. When exacerbated, it has a dagger character, forcing the patient to bend at the waist. Severe pains appear during hunger, immediately after taking spicy or hot food, or in stressful situations.

Other symptoms of stomach ulcers are: nausea and vomiting (often with blood), belching, heartburn, flatulence, blood can also appear in feces. With perforation of the stomach wall (perforated ulcer), symptoms of peritonitis appear: vomiting, fever, severe aching and sharp pains in the abdomen and back.

The kidneys are a paired organ of the excretory system. One of the kidneys is located on the right, the other on the left. In kidney disease of an inflammatory nature, back pain is one of the most characteristic symptoms. If only the right kidney is affected, then the pain will also have a right-sided localization. With bilateral kidney damage, pain will be felt both in the right and in the left side from behind. The intensity of pain will depend on the severity of the pathological process.

Other symptoms of pyelonephritis (glomerulonephritis) are: fever (in the acute course of the disease), 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 congestion in the kidneys, as well as in the gallbladder, calculi can form, which are periodically washed out into the ureter with urine flow. For nephrolithiasis, renal colic is characteristic, accompanying the advancement of urinary stone or sand. Pain on the right occurs if the stone comes out of the right kidney. Bilateral colic is rare.

Pain in nephrolithiasis is acute, paroxysmal, can radiate to the groin and abdomen. The localization of pain as the stone moves is constantly changing. It occurs in the region of the lower ribs of the back, moving to the lumbosacral region.

Turbidity of urine is also characteristic of nephrolithiasis, but frequent urge to urinate does not always end positively. Often there is urinary retention in the body and, as a result, edema.

Unlike pyelonephritis, the pain symptom of kidney stones responds well to treatment with antispasmodics. Relieves pain and thermal treatments.

Pain in the right hypochondrium radiating to the back, lower back, anus may be one of the symptoms of acute appendicitis (inflammation of the caecum). At the same time, patients usually experience the most severe pain in the pelvic area in front, but the sensations that radiate to the back can be similar to renal colic. Other symptoms may also indicate appendicitis: fever, constipation in combination with vomiting, diarrhea mixed with blood, hyperhidrosis, chills, etc. At the same time, pressure on the appendix area is less painful than the moment when the hand is sharply removed.

The similarity of the symptoms of appendicitis with renal colic sometimes causes serious complications. Relieving pain with antispasmodics, the patient only makes it difficult to diagnose 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 life-threatening condition.

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

With bronchitis, back pain under the ribs usually occurs during coughing. At the same time, it is difficult to say in which part of the back it is felt stronger. In pneumonia and bronchopneumonia, the localization of pain indicates which part of the respiratory system is affected by the disease. With a right-sided lesion, the back in the area of \u200b\u200bthe shoulder blades and a little lower will hurt on the right. The pain will also increase with coughing. Often, back pain in this pathology is the only symptom, which complicates the diagnosis and treatment of this dangerous disease.

Pain in the back under the ribs when inhaling can have various causes. The displacement of the bones of the chest and the movements of the anterior wall of the abdominal cavity can increase pressure on the diseased organ, resulting in the appearance (or intensification of pain). Due to the displacement of the bones, it is at such moments that intercostal neuralgia often manifests itself, pain in which, especially in the middle sections of the chest below the mammary glands, resembles angina attacks. But at the same time, symptoms characteristic of heart disease do not appear: increased sweating, feelings of lack of air, feelings of pressure in the chest, shortness of breath, nausea. Breathing problems are explained only by the fact that with a deep breath, the pain intensifies (becomes acute, dagger), so the person tries to breathe superficially, which 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). Both with dry and with effusion form of pleurisy, pain during breathing is one of the characteristic symptoms of the disease, along with shallow, frequent breathing. Pain, forcing the patient to take a forced position, also appears when coughing, hiccups, trying to lean in the opposite direction from the lesion. For example, if the focus of inflammation is localized in the right side of the pleura, then a sharp pain in the right side of the back occurs when bending to the left.

Breaking reflected pain in the back under the right lower rib sometimes occurs in women with diseases of the reproductive system, for example, with an abnormal 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 the reflected pain may be evidence of an inflammatory process in the right ovary. At the same time, back pain is not intense, does not have a clear localization, but is unpleasant in that it causes anxiety and anxiety, which only aggravates the situation.

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

Left side pain

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

Pain in the left side of the back under the ribs can indicate inflammation of the left kidney or the formation of stones in it, which, when moving along the ducts, just cause pain that radiates to the back and side. In women, pain of lesser intensity is noted with inflammation of the left ovary. With severe inflammation, they are interspersed with sharp pains in the abdomen.

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

Approximately the same localization on the left has pain in pancreatitis. If the inflammation covers not only the head of the pancreas, the pain becomes girdle. Most often they radiate to the left side of the back, but can also reach the right. At the same time, it is very difficult for the patient to determine exactly where it hurts and what character the pain has. The intensity of pain in chronic pancreatitis is small, and in acute it becomes dagger, from the epigastric region gradually descends to the hypochondrium and below, encircling both the stomach and back. At the same time, neither antispasmodics nor analgesics help to significantly reduce pain. Other symptoms are: nausea, vomiting, upset stool, severe weakness.

Back pain on the left 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 in the development of the inflammatory process. Usually patients complain of discomfort and pain in the abdomen, belching, nausea, heartburn. Back pain joins these symptoms later, with exacerbations of the disease, which has acquired a chronic course. Chronic diseases tend to weaken the body, so a person develops or exacerbates other pathologies. It can be diseases of the kidneys, liver, gallbladder. It is likely that 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 high acidity of gastric juice) threatens to turn into a stomach ulcer. In this case, the pains become much stronger, strictly tied to food intake (hungry pains and those that occur when eating spicy food) and the psycho-emotional state of a person. Pain in the back is localized in the lumbar region, but can also radiate under the shoulder blades. Their intensity is somewhat lower than abdominal pain. But when the ulcer is perforated, the pain becomes girdle, dagger, the person cannot find a comfortable position, he has hematemesis, the body temperature rises.

Gastritis and stomach ulcers are diseases that cannot be asymptomatic 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 and 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 an 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 rupture of the spleen, which is possible both in an accident and as a result of an increase in the organ, and is accompanied by blue tissue near the navel, requires a thorough study of the causes of what happened.

What can indicate diseases of the spleen, in addition to pain in the back and abdomen on the left, aggravated by any movement? The appearance of chills, fever, nausea, vomiting can also be symptoms of spleen disease. Sometimes patients note an incomprehensible itching on the body.

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

Pain from the back under the ribs on the left side can be a symptom of cardiovascular diseases: angina, coronary heart disease, myocardial infarction, stroke of the spinal cord. With myocardial infarction, some of the patients do not experience chest pain in the usual localization, but complain of back pain. Most often, these are pains between the shoulder blades (often on the left), which can radiate to the left shoulder, lower jaw.

Pain and discomfort in the back 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 pectoris and coronary artery disease is easily relieved with nitroglycerin.

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

With a spinal cord stroke, pain behind the ribs can be called the harbingers of this rare but extremely dangerous disease, which often turns out to be a complication of osteochondrosis or herniated discs (sometimes a tumor becomes the cause of a stroke). It is with the exacerbation of the underlying disease that the sharp pain in the back is associated, combined with the tension of its muscles. If subsequently a person begins to feel weakness and pain in the legs, a decrease in their sensitivity, disorders of defecation and urination, the occurrence of moving lameness in combination with back pain - these are already alarming symptoms that require a visit to a doctor.

Localization of pain in neurological diseases and pathologies of the spine (osteochondrosis, herniated discs, spondylitis, scoliosis, etc.) indicates the area of the affected nerve. But it must be borne in mind that excitation can be transmitted along the nerve fiber. Its compression or inflammation are local irritating factors 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 not only have different causes and localization, but also differ in its intensity. It is clear that severe pains always attract our attention, although they do not often become a sign of a dangerous disease.

For example, with 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 a compressed nerve, is less dangerous than a stomach ulcer, in which back pain is rarely of great intensity, or myocardial infarction, which is manifested by discomfort in the back.

Neuralgia and diseases of the spine, in which there is often pain under the ribs, which radiates to the back, are more dangerous not in themselves, but in their complications, so they also cannot be left to chance.

Usually, more information about the pathology is given 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. So, aching pain in the back under the ribs most often speaks of a sluggish current inflammatory process. The same pain can also occur with back fatigue, as a result of muscle and spinal fatigue, during menstruation and pregnancy.

Dull aching pain on the left from the back under the ribs may be a harbinger of myocardial infarction or the result of another gradually progressive cardiovascular disease. It also occurs with an increase in the 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.

So, a sharp pain in the back under the ribs can be either the result of neuralgia or osteochondrosis (appears when moving, it also intensifies from it), and the result of exacerbation of various diseases of the internal organs of an inflammatory nature, the passage of stones through the renal or bile ducts, acute heart attack, exacerbation appendicitis, perforation of gastric ulcer.

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 dull aching pain that occurs during physical exertion. With hepatic colic against the background of latent cholelithiasis, the pain again acquires an acute stabbing character.

Diagnosis of pain in the back 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 you to accurately determine the location of the diseased organ or structure.

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