Ulcerative colitis (UC) may cause a person to experience pain or discomfort, which can occur under the ribs.

UC is one of the two main types of inflammatory bowel disease, the other being Crohn’s disease. UC causes inflammation and damage to the large intestine, also known as the colon.

Pain in the abdomen is a common symptom associated with UC. At times, the pain may seem to start under the ribs.

Sometimes, a comorbid condition — one existing at the same time as UC — may be the underlying cause of this pain.

UC can cause pain to start under the ribs. The two most common sites of pain are the rectum and the lower left area of the abdomen.

When a person has UC, abdominal pain is not something to ignore. Some research suggests that up to one-third of people with UC experience abdominal pain even during periods of remission, when their symptoms disappear or reduce significantly.

Additionally, abdominal pain may indicate the start of a UC flare. The pain may be due to side effects from medications, scar tissue or lesions, or a complication of surgery.

It is possible that some people may feel abdominal pain more under the ribs. This can be either referred pain or pain from the condition itself.

What else could cause the pain?

Pain under the ribs may be a result of UC itself or of the condition’s effects on the body. Pain may also be due to one or more comorbid conditions.

Possible reasons for pain under the ribs include:

  • Bladder infection: A urinary tract infection can cause pain in the lower back near the ribs, a burning sensation when urinating, and a frequent need to urinate.
  • Appendicitis: Appendicitis can cause sudden, severe abdominal pain that often moves to the right lower abdomen. This is an emergency situation that needs immediate medical care.
  • Intercostal muscle strain: Intercostal muscle strain, or costochondritis, happens when the muscles between the ribs become strained or overstretched.
  • Pancreatitis: The main symptom of pancreatitis is pain in the upper abdomen that may spread to the back.
  • Liver or kidney issues: Certain UC medications can affect the liver or kidneys. Doctors should monitor both organs’ health during treatment and make adjustments to help keep them functioning well.

Other possible causes of pain under the ribs include:

  • heart issues, such as heart attack
  • bruised or broken ribs
  • gastrointestinal issues, such as heartburn, acid reflux, and indigestion
  • gallstones

Pain under the ribs due to UC can feel different for each person.

Some people may develop short-term (acute) pain, while others may experience long lasting (chronic) pain.

According to a 2021 research review, in as many as one-third of people with UC, the start of pain in the abdomen indicates that a flare-up of UC symptoms is about to occur.

People living with UC describe pain under their ribs in a variety of ways, including:

  • a burning sensation
  • sharp or stabbing pain
  • a feeling like a muscle cramp in the abdomen

Because there are many possible causes of pain under or near the ribs, some of which require emergency treatment, a person should consider seeing a doctor if they develop new or worsening pain.

UC is an inflammatory disease. This means that the immune system mistakenly attacks healthy tissue in the large intestine.

Over time, inflammation can lead to stress and damage to the tissue of the colon.

In addition to causing pain or discomfort, UC can put a person at risk of other health concerns, such as growth issues (in children), anemia, or colorectal cancer.

Even with UC treatment, people can experience UC flare-ups — periods when symptoms return. A person should talk with their doctor or other healthcare professional to plan for what they should do when a flare-up occurs.

Beyond regular treatment for UC, several methods may help relieve pain associated with UC. According to a 2023 review, people might try any of the following options for pain management:

  • cognitive behavioral therapy
  • acupuncture
  • brain or nerve stimulation
  • exercise, such as yoga or physical therapy
  • over-the-counter or prescription pain medications, such as acetaminophen or opioids
  • other medications and substances, such as antidepressants, anticonvulsants, and cannabis

The review authors state that people with UC should avoid the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen. These medications can cause discomfort in the digestive tract and lead to conditions such as ulcers.

The authors also note that special diets may or may not work for people living with UC. Current studies do not fully support the use of one special diet over another. Additionally, a diet that works for some people, such as a high fiber diet, may make symptoms worse in others.

A person should consider speaking with a member of their treatment team about ways to manage pain. A healthcare professional who is familiar with the person and their condition may have additional recommendations to help them manage pain.

UC can cause pain under the ribs. Many people with UC experience abdominal pain, and this pain may indicate that a flare-up is starting.

However, pain under the ribs may have other underlying causes. Some causes, such as gallstones or pancreatitis, require emergency medical treatment. A person should consider seeing a doctor or seeking emergency care if they develop pain in new areas or if other symptoms accompany the pain.

Managing UC pain often involves continuing to manage the condition with medications as well as medical and complementary interventions, such as acupuncture, physical therapy, and exercise. A person may want to discuss pain management with their treatment team to get recommendations for their unique situation.