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It isn't hypochondria to be concerned about a lump you can move under your right (or left, for that matter) rib cage. If you can see and feel it and other people can, too, it's definitely not all in your head. Only a doctor who gives you a physical exam can diagnose this health concern, but there are some diagnoses you can either rule out quickly or be ready to hear:

  • The most common cause of pain and swelling under the rib cage is injury. It's possible to damage your ribs or the abdominal tissues that lie beneath them without even noticing. However, injuries of this kind usually heal on their own in a few weeks even if you don't go to a doctor. If the problem just won't go away, it's probably not an injury.
  • A combination of dehydration and constipation can cause fecal impaction, which causes a lump you can feel under your rib cage. Treat the constipation and dehydration, and the lump goes away.
  • Irritable bowel syndrome can cause pain under the ribs, but won't cause a mass to form under the rib cage. Crohn disease and ulcerative colitis are also painful, but don't cause a lump you can feel.
  • Severe gas (relieved by severe flatulence) can cause a "moving bubble" under the rib cage. This will be temporary.
  • An abdominal aortic aneurysm (often referred to as a AAA, or Triple-A) is a medical emergency. If you have an expanding AAA, chances are you are going to insist on seeing a doctor right away. They can be intensely painful. There will be sudden, severe, and constant lower back, flank, groin, and/or abdominal pain, unless you lose consciousness first. If you feel a mass under your rib cage, it will be pulsating. Sometimes AAA presents with intense pain, but no palpable mass. The condition can occur at any age but is most common in people who have atherosclerosis and over the age of 65. If the aneurysm is not repaired, it is fatal more often than not, but the condition is very rare before the age of 50.
  • Gallbladder attacks from gallstones cause a dull but intense pain under the right side of the rib cage. The attack usually occurs an hour or two after a fatty meal, as the liver releases bile to dissolve the fats from the meal. The bile builds up behind the stones and the pressure becomes painful. The pain is intense under the right rib cage after taking a deep breath. There is usually sweating and nausea and sometimes vomiting, but neither bowel movement nor vomiting relieves the pain. One of the sad ironies of managing gallstones is that you can have your gallbladder removed and still get gallstones, just in the bile duct, not in the no-longer-existent gallbladder. About 20 percent of the population eventually has to have gallbladder surgery, but seldom before the age of 50. The problem can occur, however, even in teenagers.
  • Various kinds of tumors can occur under the rib cage.  About one person in 100 will develop a kind of fatty tumor known as a lipoma. These tumors are perfectly round, and they are benign. They develop in your body fat, and don't turn into an invasive cancer. About one person in 100 develops a lipoma, which can occur at any age. On the other hand, a cancer in your connective tissue underneath your rib cage, on either side, can develop into a liposarcoma, which is a cancer that starts out as connective tissue and transforms itself into cancerous fat. These cancerous tumors are not round and are relatively hard to identify with MRI or CT scans. They can occur in children and teens, but they most commonly are diagnosed after age 50.
  • Colon cancer on the right side under the rib cage usually causes diarrhea. Colon cancer on the left side usually causes bowel obstruction and "constipation." By the time you can feel a colon cancer tumor, the disease has progressed, so go to a doctor and get a diagnosis to rule out this serious but treatable disease.

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