Pain Under Left Rib Cage

What Can Cause Pain Under the Left Ribs?

Pain under the left rib cage can arise from any organ in the left upper abdomen or chest, spine, or the left ribs themselves. In otherwise healthy people, spleen irritation and gas built in the colon are main causes of pain under the lower left ribs. Pain can be also psychological, for example from neurotic heart, but physical causes have to be excluded first.

Spleen Irritation

During or after running, walking or other physical activities, irritation of the spleen capsule can cause side pain under the lower left ribs. Pain usually goes away after some rest.

Gas in the Colon – Splenic Flexure Syndrome

Gas trapped in the bend of the colon lying near the spleen (splenic flexure) can cause pain in the left upper abdomen or in the left lower chest. Other symptoms and signs of the so called splenic flexure syndrome include:

  • Distension of the upper abdomen, which can be tender to touch or not.
  • Drum-like sound when tapping upper abdomen with the hand
  • Pain in the upper left abdomen when bending or twisting the upper body. Pain is also often triggered by sitting down and relieved by standing up.
  • Constipation, diarrhea, abdominal cramps or excessive gas may be present in persons diagnosed with irritable bowel syndrome (IBS) .

Some people try to get rid of trapped gas by leaning over the back of a chair, or fence. It is important you find a cause of trapped gas, which may be:


Sharp or dull, gnawing pain near the breastbone, affected by deep breathing, cough or moving the upper body may be due to costochondritis (costosternal syndrome). Costochondritis is an inflammation of cartilages that connect the ribs with the breastbone. The exact cause is not always clear, but trauma, fibromyalgia or infection can be included.

Costochondritis may be confused with heart attack. Pain from costochondritis is localized in small area on one or both sidesof the breastbone, and is tender to touch, while pain from heart attack or angina pectoris comes from under the breastbone and is not tender to touch.

Doctor can suspect costochondritis from symptoms and signs found during physical examination; costochondritis is not shown on X-ray of the chest.

Costochondritis usually heals on its own in a week or two. Rest and anti-inflammatory drugs, like aspirin or ibuprofen can help.

Pinched Nerve in the Thoracic Spine

Bulging or herniated disc, osteoporosis, rheumatoid arthritis or spondylitis can result in pinched nerve(s) in the neck or chest part of the spine (from C7 to Th8), which innervate the muscles and skin of the chest wall. Pain, burning, numbness or tingling, usually only on one side of the chest, can be affected by different body positions. Diagnosis is made by CT of the chest spine.

Broken Rib

Broken or fractured rib(s) on the left side causes pain during deep breathing and moving of the upper body. The main cause is trauma. Diagnosis is made by chest X-ray, but still some fractures can be missed since a broken rib may be only a crack in the rib, which does not necessary fall apart in two pieces. Elastic wraps to “immobilize” the chest are not used anymore. Simple cracks heal in a month or two, complicated fractures require surgery. Painkillers are recommended to enable deep breathing without pain.

Herpes Zoster (Shingles)

Shingles is an inflammation of one of the spinal nerves due to reactivation of infection with Herpes zoster (varicella) virus. Burning pain extending as a stripe from the back toward the breastbone, and itchy rash that often appears some days after pain has started, are main symptoms. Shingles heal on its own in few weeks. Painkillers may be needed.

Pleuritis, Pneumonia, Pneumothorax, Lung Cancer…

Inflammation of the lung membrane (pleuritis) on the left side can cause stabbing pain around the lower ribs. Pain is usually affected by deep breath and cough. Pneumonia(bacterial, viral or caused by mycoplasma or other microbes) affecting the left lung can cause cough, left side chest pain and fever.

Pneumothorax is a collapse of the lung (usually on one side only) due to a break in the lung membrane. Pneumothorax may be caused by trauma or can be spontaneous – the later usually affects young skinny males. Vague, not necessary sharp pains around the chest and back, affected by breathing and body movements, are typical. Diagnosis is made by X-ray; treatment is with surgery.

Other lung causes of pain under the left ribs:

  • Tuberculosis or other lung infection
  • Lung cancer
  • Pleural effusion
  • Lung infarct
  • Mesothelioma

Heart Attack and Angina Pectoris

Heart attack causes a sudden pain of various intensity behind the breastbone or slightly to the left. Angina pectoris, is a chronic pain, caused by various heart disorders, and usually triggered by physical effort or stress. Check other heart disorders.

Pancreatitis and Pancreatic Cancer

Pancreatitis or pancreatic cancer may cause pain in the middle or left upper abdomen. Diagnosis is with CT and blood tests.

Spleen Disorders and Enlarged Spleen

Liver disease, systemic lupus erythematosus (SLE), spleen rupture, spleen infarct, infectious mononucleosis, malaria or other infections, lymphoma, leukemia, sickle cell anemia and other blood disorders, or certain (rare) genetic metabolic disorders can cause pain in the spleen.

Other Disorders Causing Pain Under the Left Rib Cage

Other possible causes of pain under the left rib cage include:

  • Stretched or torn muscle or muscle spasm in the chest or abdominal wall
  • Chest or abdominal trauma
  • Gastric ulcer
  • Kidney diseases, including urinary stones in the kidney or left ureter
  • Pericarditis – an inflammation of the heart sac
  • Aneurysm or dissection of abdominal aorta
  • Henoch Schönlein purpura, inflammation of arteries affecting various organs

Related Articles:

About Jan Modric (249 Articles)
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Please note that any information or feedback on this website is not intended to replace a consultation with a health care professional and will not constitute a medical diagnosis. By using this website and the comment service you agree to abide by the comment terms and conditions as outlined on this page

  • jsaunders

    Thankyou for your reply.
    I do get tenderness occasionally.I never feel bloated. No food of whatever kind iritates. Bowel movements have no effect,when I get them.
    You mention gas or something to that nature in the colon? I do feel that is closer to a diagnosis than acid, which other GP,s mention. What would be the best course of action to take now and do I ask for any particular tests?
    If it is what you suggest how is it I feel an improvement on the Lansoprazole?

  • Jan Modric


    lansoprazole helping you speaks for excessive acid secretion in your stomach. This can cause gastritis or peptic ulcer. One of (common) possible causes is an infection with bacterium Helicobacter pylori. Blood and breath test exist, I recommend you to have this.

    You should avoid acidic foods, like fruits, also vitamin C, aspirin or other non-steroid antirheumatic drugs, like ibuprofen…

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  • debra

    have occasional discomfort under bottom of rib cage on left side. yesterday had very sudden and sharp pain lasting only few seconds. not activity related. bowels okay no other medical issues or injury

  • Jan Modric


    what you can do by yourself is to have a low-FODMAP diet trial for a weak or so. Certain foods in certain people can irritate the part of the colon that runs below the rib cage. If this doesn’t help you may visit a doctor.

  • 13592183

    hi,my mother is 58 years old,she is fatty and has pain under left rib after walking

  • Jan Modric


    if her pain is on her side, it may be from the spleen. If this is something new, I recommend her to visit a gastroenterologist. A common cause of pain under left rib cage is also gas built in the large intestine due to certain foods, like oatmeal, that produce a lot of gas.

  • Nics

    Could any associated pain under the lower left ribcage be due to excess alcohol consumption?

  • Jan Modric


    yes, pancreatitis is one such disorder.

  • vlad

    my pain in the lower rib cage started after sneezing in the morning, and now it hurts to the toch and when I cough.

  • Jan Modric


    if the pain will lessen in the next few days, it was probably a stretched or pinched muscle. If pain does not go away, you may visit your doctor.

  • mirandakarey

    I have a pain on the left side right under my rib cage. have had endoscopy and ultra sound but dr said alls well. said it was acute gastritis and that I needed to lose 20 lbs and take nexium for 2 months to keep it at bay. the nexium does help but not always. I have days w/ lots of gas and that sharp pain, sometimes its so bad I can barely get out of bed. My dr did not schedule any kind of follow up. Should I seek a second opinion and ask them to ck something specific?

  • chrishouse

    i have sharp stabbing pain under left lower rib cage. ive had bloodwork,ct scan xrays ultrasounds and nothing. every time the pain starts about every three days i feel almost a flutter like a movement under my ribs then i have to urinate badly. it is always huge blood clots its not menstrual as i no longer have them. i am at the doctors almost every week because of this and im not getting answers or any better. please help me with a starting point.

  • Jan Modric


    in case you also burp excessively, one likely cause of excessive gas and pain in the stomach is infection with Helicobacter pylori (Diagnosis is with a breath test, treatment with antibiotics). Pain below the left ribs can be due to gas built in the colon; common causes are fructose malabsorption (likely, if symptoms would lessen considerably after few days of a low-fructose diet, and intestinal parasites, for example. Other causes include celiac disease, Crohn’s disease and so on.

  • Jan Modric


    blood clots in the urine and upper left abdominal pain strongly speak for a disorder in the left urinary tract (kidney/ureter). Appropriate urine tests should be done in this case, if not already.

  • Jayda

    I have had pressure and some mild pain in my upper left abdomen for several months. Mostly it is just very uncomfortable but it is noticeably worse during certain weeks. The pressure lessens slightly when standing or lying down. Also, it is occasionally tender to the touch about an inch below my left breast where my front meets my side. What could cause something like this?

  • Jan Modric


    it could be gas trapped in the part of the colon where it beds down near the spleen. In this case a low-FODMAP diet might help you:

  • tucker

    I have had pain in my lower left side for a week. I can put my fingertip on my lower front rib to pinpoint it.It comes and goes but sometimes it is sharp lasting only a couple of seconds. Now it seems to make my left arm hurts some. What could it be ??

  • Jan Modric


    do you feel pain in the whole arm (and hand?) or only in shoulder, for example? Is the pain aggravated by body movements?

  • tucker

    pain comes and goes in the shoulder and arm. Body movement has no effect. May go several hours with no pain. Most pain is just under rib cage. Sometimes shooting up to left arm.

  • Jan Modric


    I recommend you to visit a doctor, who can judge is it a pinched nerve in the spine, a heart disorder or something else.

  • mel


    Hey my mom is 50 y/o
    She just recently started having left lower rib pain. she has not fractured her ribs because she hasn’t done any activites. It hurts when she moves her upper body and sometimes when she takes in deep breaths. It feels tender to touch.

  • Jan Modric


    is it her rib cage or abdomen which is tender to touch? Does she feels or appears bloated, does she has excessive gas or change in bowel habit?

  • fryewinda1

    Hello! Just reading the other people health comments made me realize I am not alone! I have been having all kinds of problems soon as I turned 40 years of age and I am 44 now. Well I have been to the doctor for approximately 10 years for a sharp pain or a heart attack like pain on my left side; specialist and monitoring and what nots: lately there has been a pain under my left side that like a inside hurt pain like something is there that shouldnt be there; and it is so irritable: I cant sleep or afraid to sleep I cant move to fast or hold my arm up long (left side) I drop everything and I cant pick up anything that has weight (long as it is lightweight) it hurts that bad

  • Jan Modric


    – Where exactly is the pain?
    – Is the affected area distended, tender to touch, painful during deep breathing?
    – How did the pain appear the first time – suddenly or slowly?
    – Are you constipated or have other bowel-related issues?
    – What is your diet in general, and have you changed the diet when you were 40, or something other stressful has occurred at the time?

  • doctors_doctors

    For several months I have had a bulge type swelling in my upper left quadrant with some burning sensation periodically and down on my left side a bit. My RBC was slightly elevated however they also said I am anemic. CT scan clear, ultrasound showed clear. I dont know what to do, but I am starting to get really scared…

  • Jan Modric


    are you male or female and how old are you? If the bulge is an obviously delimited mass, it could be enlarged spleen. If it is a diffuse abdominal distension, it could be from gas built in the colon. In anemia in a combination with gastrointestinal problem, a bowel bleeding is suspected (confirmed by a stool test for blood). Anemia is also common in vegetarians and in certain small intestinal disorders (celiac, Crohn’s disease). Colorectal cancer is rare before 40 years of age.

  • doctors_doctors

    Thank you for responding, I am female and 35 years old. I am not a vegetarian, ct scan showed no masses,also my spleen was normal. I feel like there is pressure by my left ribs plus the bulge I have had for months. Sometimes the pressure radiates to my back.I am having a colonoscopy on Tuesday, I have been in and out of doctors for several months and I just feel like everyone is guessing. I am getting extremely overwhelmed and very scared- Thank you so much for getting back to me, I really appreciate it!

  • Jan Modric


    if neither ultrasound nor CT have revealed any abnormality, you can assume that the bulge is caused by gas built in the transverse (below the ribs) and descendant part (on the left side) of your colon. There are several possible causes for gas accumulation in the bowel:
    – a food intolerance, like fructose malabsorption, lactose intolerance, celiac disease or irritable bowel syndrome . Few days lasting elimination diet trials can help if you have any of these disorders.
    – intestinal parasites (confirmed by a stool test)
    – Crohn’s disease.

  • doctors_doctors

    colonoscopy- clear yesterday

  • lmds

    Hi there! My fiancee is 37 years old and has been going through testing for 4 years now to find a cause for the extreme chronic pain in his left side. The pain starts at the bottom of his left ribs and can extend all the way to the groin region depending on the day. He has alternating bouts of constipation and diarrhea but constant defecation problems and spends most of every day in the bathroom. Even so, he never feels like he has emptied his bowels. He has experimented with different diets, but hasn’t found anything that really solves the issue. He has had every imaginable gastro test and scan, which all come back normal. One thing that is strange is that his lower left rib sometimes sticks out dramatically and is obviously deformed. He had broken his rib a while back. Is it possible that his rib could be so out of place that it is causing his pain and gastrointestinal problems or am I grasping at straws here? We are just so desperate for a resolution and to get his life back!! Any insight would be GREATLY appreciated! Thank you!

  • Jan Modric


    a doctor could evaluate how deformed his rib is, and maybe some imaging investigation (X-ray, CT) would be needed to see, if the rib is pressing upon the bowel and obstructing it. One explanation could be that gas built in the colon would push the rib out and cause pain both below the ribs and pain that extends toward the groin. Food intolerances that could cause gas built in the colon include celiac disease, fructose malabsorption, lactose intolerance and irritable bowel syndrome. Diet trials for all these intolerances exist.

  • lmds

    thank you so much for such a quick response! could you tell me what Dr. is best to speak to about the rib? Would a neurologist help with that? Also…are you familiar with Splenic Flexure Syndrome? that is something we just came across in our investigating and I am curious if that is the same as IBS or a disorder on its own…

  • Jan Modric


    to speak about the rib, the doctor who has treated his broken ribs would be appropriate. Or it could be an experienced orthopedist or traumatologist. But before that, his primary doctor can examine him and evaluate if the problem is in the rib, or in gas built in the colon. I don’t think a neurologist is the first option here. Splenic flexure syndrome is not yet fully understood, but is often considered as a form or part of IBS. You can read about splenic flexure syndrome in the article above. A low-FODMAP diet may hep in IBS.

  • rita

    my rib cage is extending out more on my left side for the past couple months,don’t look right!!what do you think it might be?

  • jan

    I have been waking up with a stabbing pain under my left ribcage and numbness in one or both arms in the middle of the night. I received a blood transfusion about a week ago because of low iron and have been put on hormone pills to control bleeding.

  • Dr. Chris

    Hi Rita

    You need to see a doctor who can verify that this is not just your perception but an actual abnormality of the rib cage. Your lack of other symptoms makes it difficult to isolate a possible cause, but it is important to remember that conditions affecting the upper abdominal organs on the left side could also be responsible. In addition, disorders with the chest wall as well as conditions affecting the right side of the thoracic cavity could be responsible. You need to see a doctor who will consider further investigations to diagnose a possible cause.

  • Dr. Chris

    Hi Jan

    Your recent procedure could be responsible for your symptoms but you should see a doctor as soon as possible because these symptoms may be related to a cardiovascular condition (heart and blood vessels). A peptic ulcer and acid reflux may also be responsible for these symptoms. Speak to your doctor who can advise you further.

  • Danielle

    Hi, was wondering if you can help me, I am 32 year old female and have pain just under left rib cage, this pain usually comes whilst having deeper breath and is a little tender to touch and getting up from lying down hurts too… Does this sound just like a pinched nerve? Many thanks

  • Dr. Chris

    Hi Danielle

    It could be a pinched nerve but there are various other possibilities that should first be considered. First, this could be related to the chest wall – muscles, ribs or costal cartilages, and even the skin. Then other symptoms may point to a respiratory condition (like pleuritis), gastrointestinal (gastritis, hital hernia, pancreatitis and so on), or even the kidneys or spleen. All of thee may be a possibility and therefore you should see your doctor who can consider further investigation. Considering that the pain is present with movement and the area is tender to touch does make chest wall pain a more likely cause. Without further assessment and other symptoms, it is difficult to comment much further.

  • hurting mom

    Hi doctors_doctors,

    I have been dealing with upper abdominal pain for the past 3 months, there is always a dull pain just below my breast bone, which intensifies after eating but would go back to the dull pain after a couple hours. Over the past week however the pain has become more powerful, and is going through to my back. The only discription that I could give is that it feels like I have a rope tied around me that someone is pulling as hard as they can on. I have had blood work done which came back normal, and an ultrasound which also came back normal. I am getting frustraded with the pain and was wondering if you had any suggestions as to what else could be going on?