Rib pain: causes, rib pain in pregnancy and when to get help

Tommy's says some people have pain or discomfort in their ribs in late pregnancy. This may be because your ribcage is pushed out to make room for your growing baby. It may feel worse if your baby is doing some strong kicks or your baby's head is bumping against your ribcage, as in the breech position.

Tommy's also says that pain below the ribs can be a sign of a serious condition called pre-eclampsia, and the NHS lists pain below the ribs among its symptoms. Other symptoms include a severe headache that does not go away with simple painkillers, vision problems such as blurred vision or seeing flashing lights, vomiting, sudden swelling of the face, hands or feet, feeling very unwell, and heartburn that does not go away with heartburn medicines.

The NHS says any of these symptoms can be serious and need to be checked immediately, and that pre-eclampsia is most likely from 20 weeks of pregnancy onwards but can happen at any point, including after the baby is born. If you are pregnant, call your maternity unit if you have the number, or NHS 111 if you cannot. If you have recently given birth, call your maternity unit or 111.

Rib pain is a symptom rather than a diagnosis. The ribs form a cage around the heart and lungs, joined to the breastbone at the front by cartilage and to the spine at the back, and covered by muscles and nerves. Pain in this area can come from the bones, the cartilage, the muscles between the ribs or from organs beneath them.

The NHS describes several distinct conditions that cause it. Broken or bruised ribs are usually caused by a fall, a blow to the chest or severe coughing. Costochondritis is inflammation where the ribs join the breastbone in the middle of the chest. The NHS chest pain page also lists chest sprain or strain after chest injury or exercise, heartburn, anxiety or panic, chest infection, pleurisy and shingles among common causes.

Because the chest also holds the heart and lungs, rib pain is never assessed by location alone. The NHS advises that you should always get medical advice if you get unexplained chest pain that does not go away.

The NHS lists strong pain in the chest area, particularly when you breathe in or cough, swelling or tenderness around the affected ribs, sometimes bruising on the skin, and feeling or hearing a crack if a rib is broken. It says ribs cannot be easily splinted or supported like other bones, so they are usually left to heal naturally and there is often no need for an X-ray. Most heal within 2 to 6 weeks.

Self-care advice from the NHS includes using painkillers such as paracetamol or ibuprofen gel (or tablets if needed), holding a covered ice pack to the ribs regularly in the first few days, resting, breathing normally and coughing when you need to, holding a pillow against the chest when coughing, walking around and moving the shoulders, taking slow deep breaths regularly, and sleeping more upright for the first few nights. It advises not lying down or staying still for a long time, not straining or lifting heavy objects, not doing exercise that worsens pain and not smoking.

The NHS says costochondritis can cause sharp pain in the front or side of the chest that may be worse when you move your upper body, lie down, breathe deeply or press on the middle of the chest or the ribs. It is not always known what causes it, but it has been linked to a chest injury, repetitive upper body movements such as lifting, coughing a lot, and infection.

It usually gets better on its own over time, from a few weeks to several months. Painkillers that help with inflammation, such as ibuprofen, may be recommended, and if there is very bad pain that does not improve a steroid injection or local anaesthetic may be offered. The NHS stresses that it is important to get chest pain checked to rule out other more serious conditions.

The NHS chest pain page gives a guide to how different causes can feel, while warning not to self-diagnose and to see a GP if you are worried.

The NHS says to call 999 if you get sudden pain or discomfort in your chest that does not go away, which can feel like squeezing, pressure, burning or indigestion; if pain spreads to the left or right arm, neck, jaw, stomach or back; or if you have chest pain and feel sweaty, sick, light-headed or short of breath. These could be signs of a heart attack. The costochondritis page adds chest pain with difficulty breathing, a fast heartbeat or coughing up blood, which could be a pulmonary embolism, and sudden chest or back pain that feels like something tearing inside with shortness of breath.

After a rib injury, the NHS says to call 999 or go to A&E if the injury was caused by a serious accident, shortness of breath is getting worse, chest pain is getting worse, there is pain in the tummy or shoulder, or you are coughing up blood, because a broken rib may have damaged something else such as the lung, liver or spleen. It advises an urgent GP appointment or NHS 111 if pain has not improved within a few weeks, you are coughing up yellow or green mucus, or you have a very high temperature or feel hot, cold or shivery, since you might need stronger painkillers or antibiotics for a chest infection.

• Sudden chest pain, pressure or tightness, or pain spreading to arm, neck or jaw.

• Chest pain with breathlessness, sweating, sickness or light-headedness.

• Coughing up blood.

• Worsening breathlessness or pain after a rib injury.

• Pain in the tummy or shoulder after a rib injury.

A clinician will ask what happened, where and when the pain is and what makes it worse, and will examine the chest wall and listen to the heart and lungs. Because other conditions can mimic rib pain, a clinician may arrange further tests where heart or lung problems are possible. The NHS says an X-ray is often not needed for simple broken or bruised ribs.

The NHS chest pain page gives a guide to patterns: pain that starts after a chest injury or exercise, may worsen when you breathe in and eases when you rest the muscle suggests a strain; pain that is worse when you breathe in with coughing up yellow or green mucus and a high temperature suggests infection or pleurisy; and a tingling feeling followed by blisters suggests shingles. It warns not to self-diagnose and to see a GP if worried.

For injuries and costochondritis the main aims are pain control, gentle movement and clearing the lungs, as the NHS advice above shows. The NHS links being able to breathe normally and cough when you need to with clearing mucus and preventing chest infections, so controlling the pain well enough to do so is part of recovery.

Pain that has not improved in a few weeks, that returns repeatedly, or that is associated with other symptoms should be reviewed, and the GP can consider other causes and arrange imaging or referral.

On the NHS, rib pain is usually handled by a pharmacist or GP, with NHS 111, urgent treatment centres and emergency departments for injuries or red flags.

Private urgent care or physiotherapy is available for convenience and speed. Neither route changes the safety rule: new, severe or worsening chest pain with breathlessness should be treated as an emergency.