Extreme Rib and Back Pain

By Dr. Gerard M. DiLeo

Q: Since about week 29, I have been having extreme pain in the middle of my back during the night. It feels as though my ribs are going to pop through my back! When my husband rubs them or if I reach around to push on them, the pain takes my breath away. A hot shower and moving around makes the pain slowly go away. It only happens at night while I am sleeping. I usually wake up at around 3am in tears because I can barely move. My doctor thought it was gastrointestinal and suggested I take some Pepcid before bed. This did nothing. It really feels like my rib cage is expanding to the point where my ribs are going to pop out. Have you heard of anything like this before?

A: It certainly is an unusual presentation. If you were a question on my OB final exam, I suppose I'd answer it something like this: The different possibilities would include: 1. muscle strain of the paraspinous muscles due to a lousy mattress...or 2. costochondritis-inflammation of the cartilaginous joints of the ribs to your vertebrae, provoked by using your accessory breathing muscles (intercostal) to breathe, since laying down makes your diaphragm less able to move air for you...or, 3. a condition called hydronephrosis of pregnancy, in which laying down, especially flat, allows the weight of your pregnant uterus to partially block drainage from your kidneys, backing the urine up and causing mid-back pain. Of these, I'd put most emphasis on kidney pain, which should be relieved by laying on your side when you recline. If that doesn't help, it's more than likely the mattress.

Dr. Gerard M. DiLeo

Obstetrics and Gynecology
Dr. Gerard M. DiLeo is a board certified obstetrician-gynecologist who has been in private practice since 1981 and has served as Chief of the Medical Staff at Lakeview Regional Medical Center in greater New Orleans. Dr. DiLeo's new book The Anxious Parents' Guide to Pregnancy is now available.

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