Pain Below the Rib Cage: Causes and Next Steps - Gastroenterology and Hepatology

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Understanding pain below the rib cage can be quite complex, as it can stem from various causes, and the symptoms can vary significantly from person to person. Based on your description, it seems that you have already undergone some important diagnostic tests, including a colonoscopy and an endoscopy, which have ruled out major issues in your gastrointestinal tract. The mild inflammation in your intestines noted during the colonoscopy may be a contributing factor to your discomfort, but it is essential to consider other potential causes as well.

Pain in the area below the rib cage can arise from several sources, including the gastrointestinal system, musculoskeletal issues, or even referred pain from other organs. Since your tests have not indicated any severe problems, it might be worthwhile to explore other possibilities.

1. Gastrointestinal Causes: Even though your tests came back normal, conditions such as gastritis, peptic ulcers, or functional gastrointestinal disorders (like irritable bowel syndrome) can cause intermittent pain. Sometimes, inflammation can persist even after the initial cause has been treated.

2. Musculoskeletal Issues: Pain in the rib cage area can also be related to muscle strain or rib dysfunction. If you've been experiencing any physical stress or have had a recent injury, this could lead to muscle spasms or tension in the abdominal wall, which might explain the "pulling" sensation you feel when you press on the area.

3. Referred Pain: Sometimes, pain can be referred from other organs, such as the kidneys or the pancreas. If there are any underlying issues with these organs, they might manifest as pain in the rib cage area.

4. Nerve-related Pain: Conditions such as intercostal neuralgia, where the nerves running between the ribs become irritated, can also cause sharp, localized pain.

Regarding the "stringy" fibers you feel when you palpate your abdomen, this could be normal muscle tissue or fascia. The abdominal wall is composed of various layers of muscles and connective tissue, and it is not uncommon to feel these structures, especially if you are thin or have low body fat. However, if you notice any unusual lumps or if the pain persists or worsens, it would be prudent to consult a healthcare professional for further evaluation.

Given your ongoing symptoms, it might be beneficial to follow up with a specialist. A gastroenterologist could provide further insights into your gastrointestinal health, while a musculoskeletal specialist or physical therapist could help assess any potential muscle or nerve issues contributing to your pain.
In summary, while your initial tests have ruled out significant gastrointestinal problems, the persistence of your symptoms suggests that further evaluation may be warranted. It is essential to communicate openly with your healthcare provider about your symptoms, including the nature of the pain, any patterns you notice, and how it affects your daily life. This information will be crucial in guiding the next steps in your care.