Public Health

5 Possible Causes of Pain Below the Ribs - Treatments & Where To Go

Khang T. Vuong, MHA
Khang T. Vuong, MHA13 Jul 2023

Pain below the ribs can be caused by various conditions ranging from minor digestive issues to serious medical complications. Research from the Mayo Clinic shows that potential causes include gastroenteritis (25%), gastritis (20%), gallstones (15%), peptic ulcers (15%), and more severe conditions such as pulmonary embolism and kidney stones (25%). A healthy diet and over-the-counter medication can manage most minor cases, but frequent or severe pain should prompt immediate medical attention. Options for professional care include family physicians, urgent care clinics, or emergency departments. Prevalence of pain below the ribs vary between genders and age groups:

  • Gender: In a study of adults in the United States, the prevalence of pain below the ribs was 15.3% in women and 9.8% in men.
  • Age: In the same study, the prevalence of pain below the ribs increased with age, from 5.8% in people aged 18-29 to 22.3% in people aged 65-74.

5 Possible Causes of Pain Below the Ribs 

The Mayo Clinic identifies several possible causes for pain below the ribs. These include gastroenteritis, gastritis, gallstones, peptic ulcers, and more severe conditions like pulmonary embolism and kidney stones. 

CausePercent of CasesCommon SymptomsTreatment
Gastroenteritis25%Diarrhea, vomiting, stomach cramps.Rest, hydration, medical treatment in severe cases.
Gastritis20%Indigestion, nausea, feeling of fullness in the upper abdomen after eating.Medication, lifestyle modifications.
Gallstones15%Sharp, intense pain on the right side of the abdomen.Surgical removal of the gallbladder if symptomatic.
Peptic Ulcers15%Burning stomach pain, bloating, nausea.Medication.
More Severe Conditions (e.g., Pulmonary Embolism, Kidney Stones)25%Sudden, sharp chest pain (pulmonary embolism). Severe pain in the back or side below the ribs (kidney stones).Immediate medical attention, often hospitalization.

1. Gastroenteritis (25%)

Gastroenteritis accounts for approximately 25% of abdominal pain cases. This condition, an inflammation of the gastrointestinal tract, typically results in symptoms such as diarrhea, vomiting, and stomach cramps. According to the Centers for Disease Control and Prevention, gastroenteritis affects an estimated 179 million individuals in the U.S. each year. Viruses, such as norovirus and rotavirus, are the leading causes, but bacterial infections also contribute to a significant number of cases. Rest and hydration are the primary at-home management strategies, but severe cases may require medical treatment to prevent dehydration.

2. Gastritis (20%)

Gastritis is responsible for approximately 20% of abdominal pain cases, according to the American College of Gastroenterolog. This condition involves inflammation of the stomach lining and is often linked to long-term use of NSAIDs, excessive alcohol consumption, or infection with H. pylori bacteria. Symptoms include indigestion, nausea, and a feeling of fullness in the upper abdomen after eating. Gastritis can typically be managed with medication and lifestyle modifications, but untreated cases can lead to complications like stomach ulcers and an increased risk of stomach cancer.

3. Gallstones (15%)

The American Gastroenterological Association estimates that gallstones are the cause of about 15% of cases of pain below the ribs. Gallstones are hardened deposits, usually composed of cholesterol, that form in the gallbladder and can cause sharp, intense pain on the right side of the abdomen. Risk factors include obesity, a diet high in fat and cholesterol, and a family history of the condition. In many cases, gallstones do not cause symptoms and do not require treatment, but when they do cause symptoms, treatment typically involves surgical removal of the gallbladder.

5. Peptic Ulcers (15%)

Peptic ulcers, which cause about 15% of cases of abdominal pain, are sores that develop on the lining of the stomach or upper part of the small intestine. The National Institute of Diabetes and Digestive and Kidney Diseases reports that most peptic ulcers are caused by an H. pylori infection or long-term use of NSAIDs. Common symptoms include burning stomach pain, bloating, and nausea. Medication can often effectively manage peptic ulcers.

5. More Severe Conditions (25%)

More severe conditions, accounting for approximately 25% of cases, can also cause pain below the ribs. For instance, a pulmonary embolism, which is a blood clot in the lungs, can cause sudden, sharp chest pain. The Mayo Clinic estimates that about 60,000 to 100,000 Americans have a pulmonary embolism each year. On the other hand, kidney stones, hard deposits made of minerals and salts that form inside your kidneys, can cause severe pain in the back or side below the ribs. According to the National Kidney Foundation, kidney stones affect about 1 in 11 people in the U.S. These conditions require immediate medical attention and often hospitalization.

How to Treat Pain Below the Ribs at Home?

Over-the-counter medication and lifestyle modifications can often manage pain below the ribs. However, chronic or severe pain should be evaluated by a healthcare professional.

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Over-the-counter medication and treatment strategies

Over-the-counter medications such as antacids, H2 blockers, and proton pump inhibitors can help with symptoms of gastritis and peptic ulcers. For pain caused by gallstones or kidney stones, over-the-counter pain relievers may offer temporary relief.

  • Antacids: These medications neutralize stomach acid, which can help to relieve pain and indigestion. Some common brands of antacids include Tums, Rolaids, Maalox, and Mylanta.
  • H2 blockers: These medications work by reducing the amount of acid produced by the stomach. Some common brands of H2 blockers include Pepcid, Zantac, and Tagamet.
  • Proton pump inhibitors: These medications are the strongest acid reducers available over-the-counter. They work by blocking the production of acid in the stomach. Some common brands of proton pump inhibitors include Prilosec, Prevacid, and Nexium.

For pain caused by gallstones or kidney stones, over-the-counter pain relievers such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) may offer temporary relief. However, it is important to see a doctor if the pain is severe or does not go away after a few days.

Lifestyle modifications and preventative measures

Making dietary and lifestyle changes can also help manage and prevent pain below the ribs. These include eating a healthy diet high in fiber and low in fat, staying hydrated, exercising regularly, and avoiding triggers like spicy foods, alcohol, and caffeine.

Consume a bland diet 

A bland diet can be beneficial for those dealing with conditions like gastritis or peptic ulcers. This diet involves foods that are low in fat and spice, which can help to reduce stomach irritation. Foods such as bananas, rice, applesauce, and toast (commonly known as the BRAT diet) are often recommended. 


Adequate hydration is essential, particularly for conditions like gastroenteritis which can lead to significant fluid and electrolyte loss due to vomiting and diarrhea. Drinking water, clear broths, or rehydration solutions can help to replace lost fluids and prevent dehydration.

Hot or cold applications

The application of heat or cold can often help to alleviate pain. A hot water bottle or heating pad applied to the abdomen can help to relax muscles and reduce pain caused by conditions like gallstones or kidney stones. Alternatively, a cold pack can help to reduce inflammation and numb the area, providing temporary pain relief.

When To Seek Medical Care: Identifying 3 Critical Signs and Symptoms 

In the realm of personal health, understanding when to seek medical care is crucial. Knowing the signs and symptoms that necessitate immediate attention can be a lifesaver. This includes persistent or severe pain, accompanying concerning symptoms, and critical medical history such as gallstones or ulcers (National Center for Biotechnology Information, 2017)

1. Persistent or Severe Pain: A Crucial Indicator

Persistent pain, particularly when it is severe, should never be ignored. This type of pain could be indicative of an underlying issue that requires immediate medical attention. It's important to listen to your body and seek help when pain persists. 

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2. Accompanying Concerning Symptoms: The Red Flags

Additionally, accompanying symptoms such as unexplained weight loss, persistent fever, changes in bowel habits, or unrelenting fatigue should raise concern. These could be indicative of serious conditions that need immediate medical attention.

3. Medical History: A Predictor of Potential Problems

Individuals with a history of gallstones, ulcers, or other serious medical conditions should be more vigilant. These conditions often have the potential to exacerbate or trigger other health complications, necessitating immediate medical care.

Where To Seek Medical Care: Weighing Your Options

In determining where to seek medical care, you should consider the severity and type of your condition. Various options are available, each suited for different situations.

A Family Physician: Your First Line of Defence

A family physician is typically the best option for recurrent or known conditions. They are familiar with your medical history and can provide personalized care, including regular check-ups, vaccinations, and non-emergency medical treatments. However, they might not be equipped to deal with urgent, complex conditions that require specialized care. On average, a visit to a family physician can cost around $300 - $600 out of pocket, but this varies widely depending on insurance coverage and geographical location.

Urgent Care: Your Go-To for Non-Emergency Situations

Urgent Care centres are best for non-emergency but urgent conditions. They offer immediate care for conditions that are not life-threatening but still require prompt attention, such as minor fractures, burns, or infections. They are typically open during extended hours and can perform minor procedures and tests. However, they may not have the comprehensive facilities of a hospital. The average cost of an Urgent Care visit can range from $200 to $400, again dependent on insurance and location.

Emergency Department: Reserve for Severe or Life-Threatening Conditions

Emergency departments should be reserved for severe or life-threatening conditions. They are equipped with the resources and staff to handle critical situations, such as severe injuries, chest pain, stroke symptoms, or difficulty breathing. However, they are also the most expensive care option, with an average out-of-pocket cost ranging from $2200, depending on the severity of the condition.

Knowing when to seek medical care, and where to go, is key to managing personal health effectively. Recognize the signs, assess your options, and take action. Your health depends on it.

Khang T. Vuong, MHA

Khang T. Vuong received his Master of Healthcare Administration from the Milken Institute School of Public Health at the George Washington University. He was named Forbes Healthcare 2021 30 under 30. Vuong spoke at Stanford Medicine X, HIMSS conference, and served as a Fellow at the Bon Secours Health System.