Can You Break a Rib From Coughing? Yes, and Here’s What to Do

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If you have bronchitis or a particularly nasty cold, you know that the cough can be brutal. And it's common to experience rib pain while coughing. But if your pain is severe - and always in the same spot - you might worry that your rib could be broken. But the good news is that most of the time, this is just a strain on the rib cage. Still, some people are at higher risk for a break in the bone. So it helps to know if it could be a broken rib - and what you can do about it.

Is it possible to break a rib from coughing too much?

Yes, it's possible to break a rib from coughing. When you cough, it creates a significant amount of force in your chest. This force is absorbed by the rib cage and its surrounding muscle. So if your cough is severe enough - and your bones are weaker than normal - this force can actually break a rib.

It's not common to break a rib while coughing. People are more at risk if they:

• Have osteoporosis or osteopenia (low bone density)

• Have other chronic bone problems (like osteogenesis imperfecta)

• Take long-term steroids (which often leads to low bone density)

• Are extremely frail or have been very sick for a long time

• Are female and have had a chronic cough lasting 3 weeks or more

In one study, 85% of people who fractured a rib from coughing had been coughing for at least 3 weeks. Of them, 65% had low bone density or osteoporosis. And 78% of them were female. So, females with low bone density and cough lasting longer than 3 weeks are by far the most likely to experience this problem.

People who don't have any of these conditions usually don't break ribs from coughing. It's more likely that a strained muscle or bruised rib is causing their rib pain from coughing. The rib cage has small muscles between the ribs, called the intercostal muscles. A severe or prolonged cough puts a lot of strain on these muscles, which can cause them to tear or get inflamed. This can also be quite painful.

How do I know if my rib is broken?

It's not always easy to tell the difference between a broken and bruised rib, though sometimes there are clues.

The most definitive way to tell if your rib is broken is with a special rib X-ray or with a CT scan.

But these tests are not necessary for the vast majority of people. According to Dr. Lindsay Remy, an orthopedic surgeon in Bristol, Tennessee, these tests "do not change the treatment, which is treating the symptoms until they improve." She explains that while most people want to know if their rib is broken, "there is no benefit to getting the extra tests."

Both bruised and broken ribs can lead to similar symptoms:

• Bruising or discoloration over the rib

• Tenderness over a specific area of your rib

• Discomfort when you take in a deep breath

• Difficulty lying on the affected side of your body

• Extreme discomfort with coughing or sneezing

But there are some additional signs that suggest your rib is broken, such as:

• The rib appears to be sticking out at a different angle than usual.

• The area over the rib feels bubbly or crunchy.

• One rib is moving in a different direction than the others when you breathe in and out.

• There's severe pain when you take a deep breath in.

How do you treat a bruised rib vs. a broken rib?

The main treatment for an injured rib is to treat the pain. This is especially important so you can continue to breathe normally.

Pain control

Broken and bruised ribs are painful. So, you may need a combination of pain treatments. These might include:

• Over-the-counter (OTC) pain medication, such as ibuprofen and/or acetaminophen. Make sure to clear any OTC medications with your primary provider first, especially if you have a history of kidney problems or are on any other medications.

• OTC lidocaine patches, applied to the painful area.

• Ice on the affected rib area. You can do this hourly while you are awake, for 15 minutes at a time. Cover the ice with a paper towel or washcloth to avoid burning your skin.

• Propping yourself up at nighttime or adjusting your position so that you can't roll onto the painful side in your sleep.

• Bracing against a pillow if you need to cough or sneeze.

Dr. Remy wants people to remember that the pain is only temporary. "Once the ends of the bones start to stick together with early healing tissue (around the 2-week point), the pain should be much less," she said.

She recommends OTC medicines as the safest option, which are enough for most people. You may need prescription medications for a short time "if you can't get your pain adequately controlled to take full breaths," she said.

It's particularly important that you be able to take full breaths.

Breathing

When you have a broken or bruised rib, you want to make sure to inhale and exhale as deeply as possible. This is to prevent developing pneumonia or fluid in the lungs.

The body naturally wants to protect itself from pain. So, you'll probably be tempted to take shallow breaths. But this doesn't allow your lungs to expand or deflate properly, leading to an increased risk of pneumonia.

Many people use an incentive spirometer - a device you breathe into to help expand your lungs - to encourage deep breathing and prevent lung problems.

Activity modifications

In addition to pain medication and breathing exercises, there are a few changes you can make in your day to day to help your ribs heal:

• Limit strenuous activity - like running or jumping - until your rib pain has improved. Walking and lower-impact activities are fine as long as they don't worsen rib pain.

• Avoid heavy lifting, especially pushing or pulling. If it hurts, don't do it and ask someone to help you.

• Even though you may be resting a bit more than normal, don't stay in bed all day. Laying flat makes it harder for your lungs to fully expand, and increase your risk for infection or fluid in the lungs.

• When you are in bed, find a position that's comfortable and helps you breathe. For many people, this means avoiding laying on the painful side. Also, try propping yourself up a bit with a few pillows. This will help you breathe better

How long will it take for my broken rib to heal?

In most cases, rib fractures take 6 to 8 weeks to heal in healthy adults. However, some rib fractures may take as long as 3 months to heal. Bruised ribs usually heal more quickly, but they can still take 6 weeks to resolve. In most cases, there's no need to get an X-ray to confirm the bones are healing.

You can assume your ribs are healed when you:

• Can perform all your normal activities without chest or rib discomfort

• Can breathe deeply in and out repeatedly, with no pain

• Can cough, sneeze, and laugh without pain

When should I get medical care for a broken rib?

If you're concerned you have a broken rib, keep a close watch for any of these serious symptoms:

• Abdominal pain

• Vomiting blood

• Blood in your stool or urine

• Difficulty breathing

• Coughing up blood

• New or worsening chest pain

• New fever

If you experience any of these, get medical attention right away. These can be signs that you have a more serious rib fracture, have damage to your organs (such as lungs, liver, or kidneys), or have developed pneumonia.

How to prevent a broken or bruised rib

If you're already starting to experience rib pain from coughing, there are ways you can help prevent worsening pain or a broken rib:

• Take a cough suppressant. There are a lot of OTC cough medicines to choose from. Look for one that contains dextromethorphan, as this specifically works as a cough suppressant.

• Brace your chest with your hand or a pillow. When coughing - or doing other painful activities - press your hand or small pillow where you feel the pain. This will help support the area, and lessen the force it absorbs from the cough.

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