Rib Pain Due to Coughing: Causes and Medical Management

There are twelve pairs of ribs arranged in curves in the rib cage around the chest, which primarily function as a protection for the vital organs within the rib cage. Ribs can be classified as true ribs (the first seven pairs attached to the breastbone), false ribs (the next three pairs that attach to the last pair of true ribs) and floating ribs (attached only to the spine at the back and not to the breastbone).

The ribs join at the breastbone, at the spine or to true ribs with the help of connective tissue, which is a cartilage. There are important structures like the heart, lungs and surrounding tissues within the ribcage, which makes the ribs more prone to pain and discomfort.

Rib pain can be a common symptom due to various causes related to the ribs or to the structures under the rib cage. Rib pain can be particularly felt on coughing as the underlying and surrounding structures are involved in the coughing mechanism and may move while coughing. Rib pain due to coughing can be sharp, dull, acute or long standing and may differ in its presentation.

Pain in ribs can be due to different causes ranging from mild overstrained muscles to serious lung conditions. Some of the causes of rib pain on coughing include:

Costochondritis is the inflammation of the cartilage which joins the ribs to other bony structures. Due to various reasons like overstretching, strong jerking movement or forceful movements of hands during work, sports, lifting or other activities, the cartilage can get inflamed. Inflammation may also occur after certain viral infections.

The inflamed ribs give rise to pain in the rib cage area and local tenderness may also be felt on touching or pressing. As the cartilage helps in movement of ribs during breathing, such movements can cause pain along with discomfort on movement of arms. Sneezing and coughing can put more stress on the inflamed cartilage causing more pain in the ribs.

Injuries due to fall, muscle strain or accidents can cause damage to the ribs, muscles and surrounding tissues. Excessive and forceful coughing too can sometimes cause rib damage. Ribs can get bruised, cracked or fractured and cause severe pain in the affected area. Movements of the rib cage while coughing tend to worsen the rib pain and discomfort.

Joint conditions that affect the bones, joint or the cartilage can cause pain in the ribs. The bones may become brittle in osteoporosis; while degenerative conditions like osteoarthritis and other forms of arthritis can affect the ribs and their cartilage. These can cause rib pain, which can increase on coughing due to excess movement and strain.

Most of the conditions related to the lungs show symptoms of cough, hence respiratory conditions need special attention when rib pain is associated with cough and the pain aggravates on coughing. The lungs are surrounded by a structure called pleura, which is a membranous lining. The pleura can get inflamed (pleurisy) or there can be accumulation of fluids in between the lining. This can give rise to severe pain under the ribs on breathing and coughing.

Certain infections or cancers affecting the lungs too can cause cough, painful breathing and pain in the chest or under the ribs on coughing. These conditions need proper examination and appropriate treatment to avoid complications.

Precise diagnosis can be made after physical examination and appropriate investigations depending on the clinical history.

Treatment of rib pain due to coughing should begin at the earliest based on the diagnosis. In cases where breathing or coughing is extremely difficult and painful in the ribs, immediate medical help should be sought.

In case of injuries like bruised ribs, cracked or fractured ribs causing pain on coughing, complete rest along with pain and anti-inflammatory medications may be advised. Ice packs to the affected area may be advised to facilitate healing.

Bandages to treat rib pain due to coughing may not be used as they can restrict breathing; hence following medical advice is essential. Joint conditions causing pain in the ribs on coughing may require specific treatment to be taken in time. Nutritional deficiencies like calcium or vitamin D should be corrected as required.

Coughing can worsen the pain in the ribs, hence necessary treatment and prevention to manage cough need to be considered. Any lung conditions that are primarily causing rib pain on coughing should be thoroughly investigated and treated. Some conditions may last for a longer period, hence it is important to follow physician’s advice, continue with the given treatment and regular check-ups.

Rib pain on coughing can arise due to variety of reasons varying in their degree of intensity and severity. In case rib pain due to coughing is present, it is advisable to seek medical opinion at the earliest to identify the problem and begin with apt treatment.