The ribs enclose many organs, so rib pain from coughing, breathing, sneezing or laughing can have a variety of causes, including pulmonary, musculoskeletal and cardiac issues that range in severity. Read more below to learn what may be causing your rib pain from coughing, breathing, sneezing, or laughing, and how your doctor may treat it.
5 most common cause(s)
Rib pain that gets worse when breathing, coughing, or sneezing explained
The 24 ribs of the rib cage and the muscles of the chest wall enclose and protect various organs of the upper body, including the lungs and the heart.
Although damage to the ribs can produce pain, rib pain most often originates from organs in the chest such as the lungs or heart. When the components of the chest or lungs become injured or inflamed, the pain may be felt most in the rib/chest wall. This is known as referred pain, or pain felt not at the site of origin.
Characteristics
Some types of referred pain from the lungs or heart can manifest in the rib area and worsen with actions such as breathing, coughing, sneezing or laughing. The pain may feel sharp, stabbing or burning and may also be associated with symptoms including:
- Fever
- Shortness of breath
- Upper respiratory infection symptoms: These include a cough, congestion, and a runny nose.
The pain can be sudden and intense thus a serious cause for concern. It is important to get medical attention immediately as this type of pain can signal serious underlying conditions that require prompt assessment and treatment.
Why can breathing, coughing, or sneezing increase rib pain?
Since the ribs enclose so many organs, rib pain that gets worse when breathing, coughing, sneezing or laughing can have a variety of causes. These causes can be most easily grouped into the following categories.
Pulmonary
The lungs are in closest proximity to the ribs/chest wall and are often the most common cause of rib pain associated with exhalation or inhalation. The medical term for such pain is pleurisy or pleuritic chest pain. Pleuritic pain relates to large tissues, called pleura, that separate the lungs from the chest wall. One layer of pleura wraps around the lungs and the other layer of pleura lines the chest wall. Under normal conditions, the layers slide or glide against each other smoothly during inhalation or exhalation. However, certain conditions can cause inflammation or irritation of the pleura causing friction. As a result, the two pleural layers rub against each other like sandpaper, causing pain during any activities or movements that cause expansion of the lungs such as coughing, sneezing, laughing and basic breathing. Many types of conditions can cause such irritation, including:
- Inflammation: Inflammatory pathogens such as viruses, bacteria, and fungi can infect the pleura and cause pleuritic pain in addition to symptoms such as a cough, fever, and congestion. A primary infection of the lung itself such as in pneumonia can also spread to the pleura and cause pleuritic pain.
- Obstruction: Chronic or acute obstruction to the vessels of the lungs, especially in the form of a blood clot (embolism) can result in sudden shortness of breath and pain worsened with inhalation or exhalation.
Musculoskeletal
The muscles, bones, skin and soft tissues of the chest wall can also become inflamed or injured, resulting in rib pain that worsens with specific activities.
- Overuse: Physical activity that is strenuous and puts stress on the muscles of the chest, such as pushups or weightlifting, can result in soreness that can worsen with taking deep breaths or laughing or sneezing.
- Inflammation: Inflammation to the cartilage that attaches the ribs to the sternum can result in a condition called costochondritis. Costochondritis results in pain and tenderness around the ribs that can be exacerbated with taking deep breaths or coughing.
- Traumatic: Direct injury to the chest wall can result in damage such as a fractured rib or torn muscles that may present as rib pain that worsens with inhalation or exhalation.
Cardiac
Similarly to the lungs, damage or inflammation to the heart can also result in distinctive pleuritic pain that comes on suddenly and is felt primarily over the front of the chest. A sac called the pericardium surrounds the heart; see an image of the pericardium here. Inflammation of the pericardium is known as pericarditis and similar etiologies such as infection, trauma, systemic inflammatory conditions, etc. can cause it [8].
This list does not constitute medical advice and may not accurately represent what you have.
Chronic costochondritis (chest wall syndrome)
Costochondritis is an inflammation of the cartilage that connects a rib to the breastbone. Pain caused by costochondritis may mimic that of a heart attack or other heart conditions.
Rarity: Uncommon
Top Symptoms: rib pain, chest pain, chest pain that is worse when breathing, rib pain when moving, pain when pressing on the chest
Urgency: Phone call or in-person visit
Viral pneumonia
Viral pneumonia, also called "viral walking pneumonia," is an infection of the lung tissue with influenza ("flu") or other viruses.
These viruses spread through the air when an infected person coughs or sneezes.
Those with weakened immune systems are most susceptible, such as young children, the elderly, and anyone receiving chemotherapy or organ transplant medications.
Symptoms may be mild at first. Most common are cough showing mucus or blood; high fever with shaking chills; shortness of breath; headache; fatigue; and sharp chest pain on deep breathing or coughing.
Medical care is needed right away. If not treated, viral pneumonia can lead to respiratory and organ failure.
Diagnosis is made through chest x-ray. A blood draw or nasal swab may be done for further testing.
Antibiotics do not work against viruses and will not help viral pneumonia. Treatment involves antiviral drugs, corticosteroids, oxygen, pain/fever reducers such as ibuprofen, and fluids. IV (intravenous) fluids may be needed to prevent dehydration.
Prevention consists of flu shots as well as frequent and thorough handwashing.
Rarity: Uncommon
Top Symptoms: fatigue, headache, cough, shortness of breath, loss of appetite
Urgency: Primary care doctor
Rib bruise or fracture
Broken or bruised ribs are usually caused by a fall or a blow to the chest, although occasionally this can happen due to severe coughing. With a broken rib, the pain is worse when bending and twisting the body.
You can safely treat this condition on your own. Breathing will be painful, but it is important to avoid taking shallow breaths or not coughing to avoid the pain as this can raise your risk of developing a chest infection. You can look after yourself by taking over-the-counter pain medication, applying an ice pack to the chest, resting periodically (especially if your work involves a lot of physical labor), and holding a pillow against the chest if you needs to cough.
Rarity: Uncommon
Top Symptoms: rib pain that gets worse when breathing, coughing, sneezing, or laughing, rib pain from an injury, sports injury, rib pain on one side, injury from a common fall
Symptoms that always occur with rib bruise or fracture: rib pain from an injury
Urgency: Primary care doctor
Pleurisy
Pleurisy is an inflammation of the pleura, the protective membranes which surround the lungs and line the inner chest cavity.
The inflammation is most often caused by a viral, bacterial, or fungal infection, such as influenza or pneumonia; by some medications; or by a rib fracture.
Symptoms include sharp, "pleuritic" pain in the chest, back or shoulders that gets worse with deep breathing, sneezing, or coughing; shortness of breath due to shallow breathing in an effort to ease the pain; and sometimes fever and/or cough.
Sudden, intense chest pain during breathing is a medical emergency. Take the patient to the emergency room or call 9-1-1.
Diagnosis is made through patient history; physical examination; and imaging such as x-ray, CT scan, or ultrasound. In some cases, a needle is used to withdraw fluid from the pleura for testing.
Treatment involves addressing the underlying cause, such as prescribing antibiotics for a bacterial infection. Over-the-counter pain relievers can be used, along with supportive care in the form of rest, fluids, and good diet.
Rarity: Uncommon
Top Symptoms: shortness of breath, muscle aches, fever, cough with dry or watery sputum, rib pain that gets worse when breathing, coughing, sneezing, or laughing
Urgency: Primary care doctor
Normal occurence of chest pain
Sometimes chest pain is not a sign of a heart attack. The following symptoms are usually typical of more benign conditions:
If the pain is brief, like a short shock, and subsides right away, it is most likely from an injury such as a broken rib or pulled muscle in the chest.
Sharp pain in the chest that improves with exercise is probably from acid reflux or a similar condition, and will be eased with antacids.
A small, sharp pain anywhere in the chest that actually feels worse on breathing is probably from a lung inflammation such as pneumonia or asthma.
An actual heart attack involves intense, radiating chest pain that lasts for several minutes; worsens with activity; and is accompanied by nausea, shortness of breath, dizziness, and pain in the arms, back, or jaw. Take the patient to the emergency room or call 9-1-1.
If there is any question as to whether the symptoms are serious or not, a medical provider should be seen as soon as possible.
Rarity: Common
Top Symptoms: chest pain, rib pain
Symptoms that always occur with normal occurrence of chest pain: chest pain
Symptoms that never occur with normal occurrence of chest pain: being severely ill, shortness of breath, fainting, severe chest pain, crushing chest pain, excessive sweating, nausea or vomiting
Urgency: Phone call or in-person visit
Bronchitis
Bronchitis is an inflammation of the bronchial tubes, the tiny airways in the lungs.
Acute bronchitis, or "chest cold," comes on suddenly and is caused by the same virus that causes the flu or the common cold. Chronic lasts at least three months and recurs over two years. It is caused by cigarette smoking and/or exposure to other pollutants.
Other risk factors are weakened immune system and gastric reflux (heartburn.)
Symptoms include cough with clear, greenish, or yellowish mucus; fatigue; mild headache; body aches; shortness of breath; low-grade fever; chest discomfort.
Acute bronchitis can lead to pneumonia. Chronic bronchitis is a form of chronic obstructive pulmonary disease (COPD) and requires medical treatment.
Diagnosis is made with chest x-ray and sputum test.
Acute bronchitis lasts 7 to 10 days and needs good supportive care – rest, fluids, and over-the-counter pain relievers. Antibiotics do not work against viral illness.
Chronic bronchitis is treated with lifestyle changes – especially smoking cessation – and an inhaler or other lung medication.
Flu shots, frequent handwashing, and not smoking are the best prevention.
Bacterial pneumonia
Bacterial pneumonia is an infection of the lungs caused by one of several different bacteria, often Streptococcus pneumoniae. Pneumonia is often contracted in hospitals or nursing homes.
Symptoms include fatigue, fever, chills, painful and difficult breathing, and cough that brings up mucus. Elderly patients may have low body temperature and confusion.
Pneumonia can be a medical emergency for very young children or those over age 65, as well as anyone with a weakened immune system or a chronic heart or lung condition.
Complications may include organ failure and respiratory failure. Take the patient to the emergency room or call 9-1-1.
Diagnosis is made through blood tests and chest x-ray.
With bacterial pneumonia, the treatment is antibiotics. Be sure to finish all the medication, even if you start to feel better. Hospitalization may be necessary for higher-risk cases.
Some types of bacterial pneumonia can be prevented through vaccination. Flu shots help, too, by preventing another illness from taking hold. Keep the immune system healthy through good diet and sleep habits, not smoking, and frequent handwashing.
Rarity: Common
Top Symptoms: fatigue, cough, headache, loss of appetite, shortness of breath
Symptoms that always occur with bacterial pneumonia: cough
Urgency: In-person visit
Atypical chest pain
Atypical chest pain describes the situation when someone's chest pain is unlikely to be related to heart or lung disease. There are many other possible causes that could explain chest pain, like sore chest wall muscles or psychological factors like stress and anxiety.
It looks like your chest pain is atypical, however further testing might be needed. Therefore, you should schedule an appointment within two days with your primary care physician who can coordinate these further tests. These will likely include a stress EKG (electrocardiogram), which is a readout of the heart's electrical activity during exercise.
Rarity: Common
Top Symptoms: chest pain, shortness of breath
Symptoms that always occur with atypical chest pain: chest pain
Symptoms that never occur with atypical chest pain: fever
Urgency: Primary care doctor
Acute costochondritis (chest wall syndrome)
Acute costochondritis is also called anterior chest wall syndrome. It is an inflammation of the flexible cartilage that connects each rib to the breastbone.
Costochondritis is caused by excessive coughing or by straining the upper body, as with weightlifting. It is a common occurrence and is seen in children, teenagers, and adults.
Symptoms include a sudden, sharp, aching pain anywhere in the chest wall, especially near the breastbone where it connects to the ribs. The pain gets worse with deep breathing or with almost any movement.
Any sort of chest pain should be seen by a medical provider, especially if the person is over 35 and/or has had any cardiopulmonary symptoms. Heart attack symptoms can be mistaken for costochondritis in some cases.
Diagnosis is made through physical examination. X-rays or CT scans may be done to rule out any other causes for the pain.
Treatment involves rest along with over-the-counter, nonsteroidal anti-inflammatory drugs. Injection of corticosteroid medication to ease pain and inflammation is occasionally done.
Treatment for rib pain that gets worse when breathing, coughing, or sneezing
Treatment of pleuritic pain is very dependent on the cause, making it of utmost importance to get prompt medical attention.
The goals of treatment for many causes of pleurisy are to alleviate pain and resolve inflammation. Depending on the specific cause, your healthcare provider may prescribe the following medications:
- Pain medication: Medications such as aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) are often used to combat both the pain and inflammation associated with many of these conditions. Another anti-inflammatory medication colchicine, more often used to treat gout, can also be used to treat pericarditis.
- Antibiotics: If the pleuritic pain is associated with bacterial infection, your healthcare provider will prescribe antibiotics targeted to the specific pathogen.
There are many causes of lung or heart inflammation such as pulmonary embolism (PE) or myocardial infarction (heart attack) that require emergency intervention such as medications to dissolve clots (thrombolytics) or thin the blood (anticoagulant).
FAQs about rib pain that gets worse when breathing, coughing, sneezing, or laughing
Is pain that worsens when I laugh, sneeze, cough or breathe life-threatening?
Never ignore such symptoms because pleuritic pain can be a symptom of seriously life-threatening conditions such as a pulmonary embolism. Get emergency treatment immediately especially if you experience additional symptoms such as shortness of breath, calf or thigh pain/ swelling or have a history of blood clots in the leg.
If my pleuritic pain is due to a musculoskeletal etiology, is there anything I can do at home to help my symptoms?
You can try doing stretching exercises that target the chest and its muscles like yoga or Tai Chi. Putting a heating pad or ice pack on the painful area periodically may also help relax and ease your pain.
How is costochondritis treated?
Often, costochondritis is self-limiting, meaning it goes away without treatment; however, over-the-counter medications such as Tylenol or ibuprofen can provide pain relief.
How long will my symptoms of pleuritic chest pain last?
The duration of symptoms depends on the specific cause. For example, irritation of the pleura by a viral infection is self-limited and not treated with antibiotics. Most often, once the viral infection resolves, the inflammation and pleuritic pain will also resolve. Make sure to talk with your physician about your specific symptoms and possible duration.
Why does my rib pain worsen when I take a deep breath?
When the lining of the lungs (the pleura) becomes inflamed, this causes a condition called pleuritis sharp chest pain that worsens during breathing. The pleura is divided into two thin layers. One layer wraps around the lungs and the other layer lines the inner chest wall. Breathing causes the lungs to expand and the inflamed pleura rub against each other, causing pain during inhalation and exhalation.
Questions your doctor may ask about rib pain that gets worse when breathing, coughing, sneezing, or laughing
- Do you have a cough?
- Any fever today or during the last week?
- How would you explain why your chest hurts?
- Did you have any cold-like symptoms in the past week or two?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
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References
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- Scivoletti-Polan NA, Valentino DJ, Rosenberg SB, Cowan SW, Soiferman EI. A 65-Year-Old Man with Shortness of Breath, Pleuritic Chest Pain, and Recurrent Pneumonia. The Journal of American Osteopathic Association. 2010;110:733-736. JAOA Link
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- Costochondritis: What You Need To Know. American Family Physician. 2009 Sep 15;75(10):1. AAFP Link
- Imazio M. Patient Education: Pericarditis (Beyond the Basics). UpToDate. Updated December 1, 2017. UpToDate Link