Can SIBO Cause Pain Under Ribs? Understanding the Connection

If you've been experiencing mysterious pain under your ribs and struggling with digestive issues, you might be dealing with Small Intestinal Bacterial Overgrowth (SIBO). This condition, characterized by excessive bacteria in the small intestine, can manifest in surprising ways—including that persistent discomfort beneath your ribcage. Let's explore the connection between SIBO and rib pain, and what you can do about it.

What Exactly Is SIBO?

Small Intestinal Bacterial Overgrowth occurs when bacteria that normally reside in the large intestine migrate upward and colonize the small intestine in excessive numbers. Unlike the large intestine, which is designed to house trillions of bacteria, the small intestine should maintain relatively low bacterial counts to optimize nutrient absorption and digestion.

When bacterial populations grow out of control in the small intestine, they interfere with normal digestive processes. These bacteria ferment carbohydrates prematurely, producing gases and other byproducts that can lead to a constellation of uncomfortable symptoms—including that mysterious pain under your ribs.

The delicate balance of the small intestine can be disrupted by numerous factors, creating the perfect environment for bacterial overgrowth. Common contributors include decreased stomach acid (often from long-term use of acid-reducing medications), prior intestinal surgeries, structural abnormalities of the digestive tract, or impaired motility due to conditions like diabetes or hypothyroidism. Even stress and certain medications can alter gut function enough to set the stage for SIBO development.

What makes SIBO particularly challenging is its ability to create a vicious cycle. Once established, the bacterial overgrowth can damage the intestinal lining and the very mechanisms that would normally prevent its occurrence. This damage to the brush border enzymes and microvilli can lead to malabsorption issues, further feeding the problematic bacteria and perpetuating the condition if not properly addressed.

Types of SIBO

SIBO typically comes in three main varieties, each with slightly different symptoms. Hydrogen-dominant SIBO often causes diarrhea and more acute digestive distress. Methane-dominant SIBO (sometimes called IMO or Intestinal Methanogen Overgrowth) typically leads to constipation and slower gut motility. The third type, hydrogen sulfide SIBO, is associated with sulfurous gas, rotten-egg smelling flatulence, and can cause more inflammatory symptoms.

Understanding which type you might have is important, as treatment approaches can vary depending on the dominant gas being produced by the bacterial overgrowth.

The Connection Between SIBO and Rib Pain

That nagging pain under your ribs isn't just in your head—it's a legitimate symptom that many SIBO sufferers report. But why does bacterial overgrowth in your intestines cause pain in your rib area? Several mechanisms explain this connection.

Gas Pressure and Bloating

The most direct cause of rib pain in SIBO is excessive gas production. When bacteria ferment carbohydrates in the small intestine, they produce hydrogen, methane, or hydrogen sulfide gases. These gases create pressure and distension in the intestines, which can push against surrounding organs and the ribcage itself.

This pressure is often most noticeable on the right side under the ribs, where the liver is located, or on the left side, near the stomach and spleen. The pain may feel sharp, dull, or like a persistent ache that worsens after meals—especially those containing fermentable carbohydrates that feed the bacterial overgrowth.

Referred Pain Patterns

Another explanation for rib pain in SIBO involves referred pain patterns. The intestines share nerve pathways with other areas of the body, including the chest and rib areas. Inflammation or irritation in the small intestine can trigger nerve signals that your brain interprets as pain in the rib region, even though the actual problem originates in the digestive tract.

This phenomenon explains why many people with SIBO initially worry they're experiencing heart or lung problems when the true culprit is intestinal bacterial overgrowth.

Organ Inflammation

SIBO can also cause inflammation that affects nearby organs. For instance, bacterial overgrowth may impact liver function or irritate the gallbladder, both of which sit in the right upper quadrant beneath the ribs. Similarly, SIBO-related inflammation can affect the stomach or pancreas, creating pain that radiates to the left or central rib areas.

Other Common SIBO Symptoms

While rib pain might be what brought you to this article, SIBO typically presents with a cluster of digestive symptoms that extend beyond localized discomfort. Recognizing these associated symptoms can help confirm whether SIBO might be behind your rib pain.

Digestive Disturbances

The hallmark symptoms of SIBO include bloating that worsens throughout the day, excessive gas, abdominal distension, and irregular bowel movements (either diarrhea, constipation, or an alternating pattern). Many people notice their symptoms intensify after consuming certain carbohydrates, particularly those high in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols).

These digestive symptoms occur because bacteria in the small intestine interfere with normal digestion and absorption processes. When carbohydrates that should be broken down further along the digestive tract are fermented prematurely in the small intestine, the resulting gas and byproducts create uncomfortable symptoms.

Systemic Effects

SIBO doesn't just affect digestion—it can have wide-ranging effects throughout the body. Many sufferers report fatigue, brain fog, headaches, joint pain, and skin issues like rosacea or eczema. These systemic symptoms occur because bacterial overgrowth can damage the intestinal lining, allowing inflammatory compounds and bacterial byproducts to enter the bloodstream and affect distant body systems.

The connection between gut health and overall wellness becomes particularly evident in SIBO cases, where addressing the bacterial overgrowth often resolves seemingly unrelated symptoms throughout the body.

Diagnosing SIBO

If you suspect SIBO might be behind your rib pain and digestive symptoms, proper diagnosis is essential. Several testing methods can help confirm whether bacterial overgrowth is present in your small intestine.

Breath Testing

The most common diagnostic tool for SIBO is the breath test, which measures hydrogen and methane gases in your breath after consuming a test sugar solution. Since humans don't produce these gases (only bacteria do), elevated levels indicate bacterial fermentation is occurring. The timing of the gas rise helps determine whether the fermentation is happening in the small intestine (indicating SIBO) or in the large intestine (which would be normal).

While breath testing isn't perfect, it provides a non-invasive way to assess whether bacterial overgrowth might be contributing to your symptoms. Some specialized clinics now also offer hydrogen sulfide testing, which can identify the third type of SIBO that standard tests miss.

Managing SIBO and Relieving Rib Pain

Addressing SIBO typically requires a multi-faceted approach that combines eliminating the bacterial overgrowth, healing the digestive tract, and preventing recurrence. Here's how to tackle each aspect:

Dietary Modifications

Diet plays a crucial role in managing SIBO symptoms, including rib pain. Many practitioners recommend temporarily reducing fermentable carbohydrates that feed the bacterial overgrowth. Low-FODMAP diets, specific carbohydrate diets (SCD), or SIBO-specific food plans can help reduce bacterial fermentation and the resulting gas production that contributes to rib pain.

While navigating these dietary changes, many people find that digestive enzyme supplements can make a significant difference in their comfort levels. Professional-grade enzyme complexes, like Casa de Sante's Low FODMAP Certified Digestive Enzymes, provide targeted support for breaking down proteins, carbohydrates, and fats. With 18 specialized enzymes including dual protease complexes and alpha-galactosidase for FODMAP support, these supplements can help reduce the digestive burden while you're working to address the underlying SIBO.

Antimicrobial Treatments

Reducing the bacterial overgrowth typically requires either prescription antibiotics (like Rifaximin) or herbal antimicrobials with proven efficacy against intestinal bacteria. These treatments aim to bring bacterial populations back into balance, reducing the fermentation and gas production that contributes to rib pain and other symptoms.

The choice between pharmaceutical or herbal approaches often depends on the severity of your case, your healthcare provider's expertise, and your personal preferences. Both approaches have shown effectiveness in clinical studies, though some cases may require multiple treatment rounds.

Motility Support

SIBO often develops due to impaired motility—the wave-like contractions that move contents through the digestive tract. The migrating motor complex (MMC) is particularly important, as it creates a cleansing wave between meals that helps prevent bacterial buildup in the small intestine.

Supporting healthy motility through prokinetic agents, stress management, and proper meal spacing (allowing 3-4 hours between meals) can help prevent SIBO recurrence. For those with digestive sensitivities, incorporating a comprehensive enzyme blend can further support this process by ensuring food is properly broken down and moves efficiently through the digestive tract.

When to Seek Medical Attention

While SIBO is a common cause of rib pain associated with digestive symptoms, it's important to recognize when your symptoms might indicate something requiring immediate medical attention.

Red Flags

Seek prompt medical care if your rib pain is severe, accompanied by fever, occurs with shortness of breath, or if you notice unexplained weight loss. These could indicate conditions requiring urgent intervention, such as pneumonia, pulmonary embolism, or even cardiac issues.

Similarly, if you experience severe abdominal pain, especially if it's accompanied by vomiting or signs of dehydration, don't assume it's just SIBO—get medical help to rule out more acute conditions like appendicitis, gallbladder inflammation, or intestinal obstruction.

Living Well with SIBO

Managing SIBO is often a journey rather than a quick fix. Many people find that combining conventional treatments with supportive strategies leads to the best outcomes for controlling symptoms like rib pain and preventing recurrences.

Incorporating digestive enzymes before meals can make a significant difference in daily comfort. Professional-strength enzyme blends that include specific enzymes for protein breakdown (like the dual protease complex in Casa de Sante's formula) along with carbohydrate and fat-digesting enzymes provide comprehensive support. For those with FODMAP sensitivities—common in SIBO—enzymes containing alpha-galactosidase offer particular benefit by helping break down troublesome carbohydrates before they can feed bacterial overgrowth.

Beyond supplements, stress management, adequate sleep, and gentle movement all contribute to digestive health and can help prevent the conditions that allow SIBO to develop or recur. By addressing SIBO comprehensively, that nagging pain under your ribs can become a thing of the past, allowing you to return to comfortable, confident living.