Pain under Left Rib Cage:16 Causes & When to See a Doctor

In this article, we will explore 18 of the most common causes of left rib cage pain and explain what each one feels like. This can help you figure out when it’s time to call a doctor versus when you can safely wait it out.

⚠️ Important: This article provides general information only. Not intended as medical advice. Consult your doctor before trying any remedies.

Key Organs in the Left Upper Quadrant

• Spleen: Located just under the diaphragm, tucked behind the stomach. Its primary functions include filtering blood, storing blood cells, and playing a role in the immune system.
• Stomach: The major digestive organ that receives food from the esophagus. A significant portion of the stomach is in the left upper quadrant.
• Pancreas: A gland situated behind the stomach, extending from the left to the right side of the abdomen. It produces digestive enzymes and hormones like insulin.
• Left Kidney: Although largely in the posterior abdomen, the upper pole of the left kidney can contribute to pain perceived in the front left rib area.
• Left Adrenal Gland: Sits atop the left kidney.
• Part of the Large Intestine (Colon): Specifically, the splenic flexure (a bend in the colon) and part of the descending colon are in this area.
• Left Lung and Diaphragm: The lower part of the left lung is protected by the rib cage, and the diaphragm muscle separates the chest cavity from the abdominal cavity.
• Heart: While primarily central, the apex (tip) of the heart points towards the left, and cardiac issues can sometimes manifest as pain in this region.
• Muscles, Nerves, and Bones: The intercostal muscles between the ribs, the ribs themselves, and the nerves running along them can also be sources of pain.

16 Common Causes of Pain Under Left Rib Cage

1. Pancreatitis

Pancreatitis is an inflammation of the pancreas, an organ nestled behind the stomach, primarily in the left upper quadrant. It plays a critical role in digestion by producing enzymes and regulating blood sugar with hormones like insulin and glucagon.

Usually, the most common cause of pancreatitis is excessive alcohol intake, though it can also be triggered by gallstones, high triglycerides, certain viral infections (like mumps), cystic fibrosis, or particular medications (e.g., some diuretics or corticosteroids).

• Symptoms: Nausea, vomiting, fever, rapid pulse, and tenderness when touching the abdomen.
• What it feels like: Pancreatitis often causes an intense, persistent pain under the left rib cage that can radiate to the back. The pain may worsen significantly after eating or drinking, especially fatty foods.
• Treatment: You should see a general physician or gastroenterologist. Treatment typically involves hospitalization for IV fluids, pain medication, and antibiotics if an infection is present. In severe cases, surgery might be necessary. Diet changes, such as avoiding fatty foods and alcohol, are crucial for preventing future flares. Oral enzyme supplements may be recommended by your doctor. Recent guidelines emphasize individualized pain management and early enteral nutrition to improve outcomes.

2. Gastritis

Gastritis refers to the inflammation of the stomach lining. It can be acute (sudden and severe) or chronic (long-term).

Common causes include infection with Helicobacter pylori bacteria, excessive alcohol consumption, regular use of NSAIDs (non-steroidal anti-inflammatory drugs like ibuprofen), stress, and autoimmune reactions.

• Symptoms: Nausea, vomiting, indigestion, bloating, loss of appetite.
• What it feels like: Gastritis often presents as a burning, aching, or gnawing pain under the left rib cage, which can sometimes extend to the upper abdomen. The pain may worsen or improve with eating.
• Treatment: A general practitioner or gastroenterologist can diagnose gastritis. Treatment focuses on reducing stomach acid through proton pump inhibitors (PPIs) or H2 blockers, antibiotics for H. pylori infection, and avoiding irritants like alcohol, NSAIDs, and spicy foods. Lifestyle adjustments, such as eating smaller, more frequent meals and managing stress, are also beneficial.

3. Splenomegaly (Enlarged Spleen)

The spleen, located just under the left rib cage, is part of the immune system, filtering blood and storing white blood cells and platelets. Splenomegaly means the spleen has become enlarged.

This condition is often a symptom of an underlying problem, such as infections (mononucleosis, malaria), liver disease (cirrhosis), certain blood cancers (leukemia, lymphoma), or autoimmune diseases.

• Symptoms: Fatigue, easy bleeding, frequent infections, fullness after eating only a small amount.
• What it feels like: An enlarged spleen can cause a dull ache or a feeling of fullness and discomfort under the left rib cage. The pain may intensify when you take a deep breath or if the spleen is severely enlarged and presses on other organs.
• Treatment: The primary goal is to treat the underlying cause of the enlargement. This could involve antibiotics for bacterial infections, antiviral medication, or treatments for liver disease or cancer. In rare, severe cases where the spleen ruptures or causes significant problems, surgical removal (splenectomy) might be necessary.

4. Splenic Infarction

A splenic infarction occurs when the blood supply to part of the spleen is blocked, leading to tissue death (necrosis).

This blockage is usually caused by a blood clot (embolism) traveling from another part of the body, often associated with conditions like endocarditis, atrial fibrillation, sickle cell disease, or certain cancers.

• Symptoms: Fever, nausea, vomiting.
• What it feels like: Splenic infarction typically causes sudden, severe, sharp pain under the left rib cage that can sometimes radiate to the shoulder. The pain tends to be constant and may worsen with deep breathing.
• Treatment: This is a serious condition requiring immediate medical attention. Treatment focuses on managing pain, preventing complications, and addressing the underlying cause of the blood clot. This might include anticoagulants, antibiotics, or, in rare cases, surgical removal of the affected part of the spleen or the entire spleen.

5. Diverticulitis

Diverticulitis occurs when small, bulging pouches (diverticula) in the digestive tract become inflamed or infected. While diverticula are most common in the colon’s lower-left side, they can occur anywhere in the colon, and when inflamed in the descending colon, they can cause pain under the left rib cage.

It’s often linked to a low-fiber diet, aging, obesity, and lack of exercise.

• Symptoms: Nausea, vomiting, fever, chills, constipation, or diarrhea.
• What it feels like: Diverticulitis typically causes persistent, cramping, or severe pain under the left rib cage or in the lower-left abdomen. The pain can be constant and tender to the touch.
• Treatment: Treatment often involves antibiotics, a clear liquid diet for a few days to rest the bowel, and pain relievers. In more severe cases, hospitalization for IV antibiotics and fluids, or even surgery to remove the affected portion of the colon, might be required. A high-fiber diet is recommended once the acute phase resolves to prevent future episodes.

6. Irritable Bowel Syndrome (IBS)

IBS is a common disorder that affects the large intestine, characterized by a group of intestinal symptoms that usually occur together. It’s considered a “functional” disorder, meaning there’s no structural problem with the bowel.

The exact cause is unknown, but it’s thought to involve problems with how the brain and gut work together, leading to increased gut sensitivity and changes in gut muscle contractions. Triggers include certain foods, stress, and hormonal changes.

• Symptoms: Abdominal cramping, bloating, gas, diarrhea, constipation (or alternating between both).
• What it feels like: While often associated with lower abdominal pain, IBS can cause generalized abdominal discomfort, including a dull ache or cramping pain under the left rib cage, especially if gas builds up in the splenic flexure of the colon. The pain often eases after a bowel movement.
• Treatment: Management typically involves dietary changes (e.g., low FODMAP diet), stress reduction techniques, probiotics, and medications to relieve specific symptoms like diarrhea or constipation. A doctor can help create a personalized plan.

7. Constipation

Constipation is characterized by infrequent bowel movements or difficulty passing stools. When stool remains in the colon for too long, it can cause various forms of abdominal discomfort.

Common causes include a low-fiber diet, dehydration, lack of physical activity, certain medications, and ignoring the urge to have a bowel movement.

• Symptoms: Straining during bowel movements, hard or lumpy stools, feeling of incomplete evacuation, bloating, and gas.
• What it feels like: Severe constipation can lead to a build-up of gas and stool in the colon, particularly in the splenic flexure (the bend in the colon near the spleen), causing discomfort or a dull, sometimes sharp, pain under the left rib cage.
• Treatment: Increasing fiber intake through diet or supplements, staying well-hydrated, and regular physical activity are key. Over-the-counter laxatives can provide temporary relief, but long-term use should be discussed with a doctor.

8. Angina or Heart Attack

While often thought of as chest pain, heart-related issues can sometimes manifest as pain under the left rib cage or radiating to that area. Angina is chest pain or discomfort caused by reduced blood flow to the heart muscle, while a heart attack occurs when blood flow to a part of the heart is completely blocked, leading to heart muscle damage.

Risk factors include high blood pressure, high cholesterol, diabetes, smoking, obesity, and a family history of heart disease.

• Symptoms: Shortness of breath, sweating, nausea, lightheadedness, pain radiating to the arm, jaw, or back.
• What it feels like: Heart-related pain can be a crushing, squeezing, or heavy sensation. While typically in the center or left side of the chest, it can sometimes be felt as a dull ache or pressure under the left rib cage. This pain often worsens with exertion and may be accompanied by other symptoms.
• Treatment: Angina or a suspected heart attack is a medical emergency. Call emergency services immediately. Treatment depends on the diagnosis and severity, ranging from medications (nitroglycerin, aspirin, beta-blockers) to procedures like angioplasty or bypass surgery.

9. Pericarditis

Pericarditis is an inflammation of the pericardium, the two-layered sac-like tissue that surrounds your heart.

It can be caused by viral infections (most common), bacterial infections, autoimmune diseases (lupus, rheumatoid arthritis), kidney failure, heart attack, or certain medications.

• Symptoms: Fever, weakness, coughing, palpitations, and shortness of breath.
• What it feels like: Pericarditis typically causes sharp, stabbing chest pain that may spread to the left shoulder, neck, or back. It can sometimes be felt as a sharp pain under the left rib cage. The pain often worsens when lying down, breathing deeply, or coughing, and may improve when leaning forward.
• Treatment: Treatment depends on the cause and severity. It often includes anti-inflammatory medications like NSAIDs or colchicine. If a bacterial infection is the cause, antibiotics are used. In severe cases, procedures to drain fluid around the heart may be necessary.

10. Pleurisy (Pleuritis)

Pleurisy is an inflammation of the pleura, the thin layers of tissue that surround the lungs and line the inside of the chest cavity. These layers normally glide smoothly over each other during breathing.

Common causes include viral infections (influenza), bacterial infections (pneumonia), autoimmune diseases (lupus, rheumatoid arthritis), blood clots in the lung (pulmonary embolism), or rib fractures.

• Symptoms: Shortness of breath, dry cough, fever (if infection is present).
• What it feels like: Pleurisy causes a sharp, stabbing pain under the left rib cage or in the chest, which dramatically worsens with deep breathing, coughing, sneezing, or movement. The pain is caused by the inflamed layers of the pleura rubbing against each other.
• Treatment: Treatment focuses on addressing the underlying cause. This might include antibiotics for bacterial infections, antiviral medication for viral infections, pain relievers, and anti-inflammatory drugs. Resting and avoiding activities that aggravate the pain are also important.

11. Pneumonia

Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus, causing cough with phlegm or pus, fever, chills, and difficulty breathing.

It can be caused by bacteria, viruses, or fungi. Risk factors include age, weakened immune system, smoking, and chronic medical conditions.

• Symptoms: Fever, chills, cough with mucus, shortness of breath, fatigue, muscle aches.
• What it feels like: Pneumonia can cause a sharp or stabbing pain under the left rib cage or in the chest, particularly when breathing deeply or coughing. This pain is often due to pleurisy developing alongside the pneumonia.
• Treatment: A doctor will determine the type of pneumonia. Bacterial pneumonia is treated with antibiotics. Antivirals may be used for viral pneumonia, and antifungals for fungal pneumonia. Rest, fluids, and managing symptoms like fever and cough are also crucial.

12. Kidney Stones

Kidney stones are hard deposits made of minerals and salts that form inside your kidneys. They can range in size and can cause significant pain when they move through the urinary tract. While kidney pain is typically in the back or side, a stone in the left kidney can sometimes refer pain to the front, under the left rib cage area.

They are often caused by dehydration, certain diets, obesity, and some medical conditions.

• Symptoms: Nausea, vomiting, blood in urine, painful urination, frequent urge to urinate.
• What it feels like: Kidney stone pain is often described as one of the most severe types of pain. It typically starts suddenly and is characterized by intense, sharp, cramping pain in the back or side, but can sometimes be felt as severe pain under the left rib cage as the stone moves. The pain can come in waves and shift locations.
• Treatment: Small stones may pass on their own with increased fluid intake and pain medication. Larger stones may require medical procedures like lithotripsy (shock waves to break up stones) or surgery to remove them. A doctor can recommend preventive measures to reduce the risk of future stones.

13. Inflammatory Bowel Disease (IBD)

Inflammatory Bowel Disease (IBD) is a term primarily used to describe two conditions: Crohn’s disease and ulcerative colitis. Both are characterized by chronic inflammation of the digestive tract.

The exact cause is unknown, but it’s believed to involve a combination of genetic predisposition, immune system malfunction, and environmental factors.

• Symptoms: Diarrhea (often bloody), abdominal pain, weight loss, fatigue, fever.
• What it feels like: IBD can cause persistent or cramping pain anywhere in the abdomen, including under the left rib cage, especially if inflammation affects the upper parts of the colon or small intestine. The pain is often accompanied by other digestive symptoms.
• Treatment: IBD requires management by a gastroenterologist. Treatment typically involves anti-inflammatory medications, immunosuppressants, biologics, and sometimes surgery to remove damaged sections of the intestine. Dietary changes and stress management can also help.

14. Costochondritis

Costochondritis is an inflammation of the cartilage that connects a rib to the breastbone (sternum). It’s a common cause of chest pain.

The exact cause is often unknown, but it can be triggered by chest injury, strenuous exercise, viral respiratory infections, or physical strain.

• Symptoms: Pain that worsens with deep breaths, coughing, sneezing, or certain movements. Tenderness when pressing on the affected ribs.
• What it feels like: Costochondritis causes sharp, aching, or pressure-like pain that is typically felt on the left side of the breastbone, but can radiate and be felt as pain under the left rib cage. The key characteristic is localized tenderness when you press on the affected joint.
• Treatment: It usually resolves on its own within a few weeks or months. Treatment focuses on pain relief with over-the-counter NSAIDs, applying heat or ice, and avoiding activities that aggravate the pain. In some cases, a doctor might recommend physical therapy or steroid injections.

15. Hiatal Hernia

A hiatal hernia occurs when part of your stomach pushes up through the diaphragm (the muscle separating your abdomen and chest) into your chest cavity.

Causes include increased pressure in the abdomen (coughing, vomiting, straining during bowel movements, heavy lifting), obesity, aging, and certain congenital factors.

• Symptoms: Heartburn, acid reflux, difficulty swallowing, belching, chest pain.
• What it feels like: While many people with small hiatal hernias have no symptoms, larger ones can cause a burning or aching pain under the left rib cage or in the chest, often worsened after eating or when lying down. It can also cause a feeling of fullness.
• Treatment: Treatment focuses on managing symptoms, often with antacids, H2 blockers, or PPIs to reduce stomach acid. Lifestyle changes such as eating smaller meals, avoiding trigger foods, elevating the head of the bed, and losing weight can help. In rare cases of severe symptoms or complications, surgery might be considered.

16. Ovarian Cysts (in females)

While ovarian pain is typically felt lower in the abdomen, large or ruptured ovarian cysts on the left ovary can sometimes cause referred pain or discomfort that is felt higher up, even under the left rib cage, due to nerve pathways and pressure on surrounding structures.

Ovarian cysts are fluid-filled sacs that develop on an ovary. Most are harmless and resolve on their own, but some can cause pain, especially if they rupture, bleed, or twist (torsion).

• Symptoms: Pelvic pain, bloating, irregular periods, pain during intercourse, nausea, vomiting (if ruptured or twisted).
• What it feels like: A ruptured or large ovarian cyst can cause sudden, sharp, severe pain under the left rib cage (if on the left side) or lower abdomen. If the ovary twists (torsion), the pain can be excruciating and accompanied by nausea and vomiting.
• Treatment: Often, small, asymptomatic cysts are monitored. Pain can be managed with over-thecounter pain relievers. If a cyst is large, persistent, causing severe symptoms, or suspected of being cancerous, surgical removal may be recommended.

When to See a Doctor for Pain Under the Left Rib Cage

While many causes of pain under the left rib cage are benign and resolve with rest or simple home remedies, some indicate serious underlying conditions that require immediate medical attention.

• Sudden, Severe, or Crushing Chest Pain: Especially if it spreads to your arm, jaw, back, or shoulder, as this could indicate a heart attack.
• Shortness of Breath or Difficulty Breathing: Any new or worsening breathing difficulties alongside pain.
• Dizziness, Lightheadedness, or Fainting: These can be signs of serious internal bleeding or a cardiac event.
• Rapid Heart Rate or Palpitations: An unusually fast or irregular heartbeat coupled with pain.
• Cold, Clammy Skin or Excessive Sweating: Signs of shock.
• Sudden, Intense Pain after Trauma: If you’ve had an injury to your left side, severe pain could indicate a ruptured spleen or a fractured rib, causing organ damage.
• Severe Pain with Fever and Vomiting: This combination can point to serious infections like acute pancreatitis, severe kidney infection, or a ruptured organ.
• Coughing up Blood or Bloody Vomit: Clear signs of internal bleeding from the respiratory or digestive system.
• Black, Tarry Stools or Bloody Stools: Indicates bleeding in the digestive tract.
• Inability to Move or Severe Pain with Movement: Suggests significant injury or inflammation.

Never ignore severe, sudden pain under the left rib cage, especially if it’s accompanied by shortness of breath, dizziness, or chest tightness. These are critical warning signs that require immediate medical evaluation.