Rectus Sheath Pain

Rectus sheath pain refers to discomfort or pain in the rectus sheath, the fibrous covering surrounding the rectus abdominis muscles in the abdomen. This pain can stem from various conditions and injuries, affecting the muscles, nerves, or other tissues in the area.

Types of Rectus Sheath Pain

  1. Acute Rectus Sheath Pain: Sudden onset of pain, often due to an injury or strain.
  2. Chronic Rectus Sheath Pain: Persistent or recurring pain over a long period.
  3. Localized Rectus Sheath Pain: Pain confined to a specific area within the rectus sheath.
  4. Diffuse Rectus Sheath Pain: Pain spread over a broader area within the rectus sheath.
  5. Traumatic Rectus Sheath Pain: Resulting from a direct injury or trauma.
  6. Non-Traumatic Rectus Sheath Pain: Pain without a clear injury, often due to overuse or repetitive strain.
  7. Inflammatory Rectus Sheath Pain: Caused by inflammation in the rectus sheath or surrounding tissues.
  8. Neuropathic Rectus Sheath Pain: Resulting from nerve damage or compression.
  9. Post-Surgical Rectus Sheath Pain: Pain following abdominal surgery.
  10. Referred Rectus Sheath Pain: Pain originating from another part of the body but felt in the rectus sheath.

Causes of Rectus Sheath Pain

  1. Muscle Strain: Overstretching or tearing of the rectus abdominis muscles.
  2. Hernia: Protrusion of an organ or tissue through a weak spot in the abdominal wall.
  3. Trauma: Direct impact or injury to the abdomen.
  4. Post-Surgical Complications: Pain after abdominal surgery due to scar tissue or adhesions.
  5. Overuse: Repetitive activities leading to muscle fatigue and pain.
  6. Infection: Bacterial or viral infections causing inflammation.
  7. Inflammatory Conditions: Conditions like myositis causing muscle inflammation.
  8. Nerve Compression: Pressure on the nerves supplying the rectus sheath.
  9. Fibromyalgia: A chronic condition causing widespread muscle pain.
  10. Endometriosis: Endometrial tissue growing outside the uterus and affecting the abdominal muscles.
  11. Pregnancy: Abdominal muscle strain during pregnancy.
  12. Postpartum Changes: Muscle strain or weakness after childbirth.
  13. Tumors: Benign or malignant growths in the abdomen.
  14. Kidney Stones: Pain radiating from the kidneys to the abdomen.
  15. Gastrointestinal Disorders: Conditions like IBS or Crohn’s disease causing abdominal pain.
  16. Abdominal Aortic Aneurysm: An enlarged area in the lower part of the aorta causing pain.
  17. Liver Disease: Conditions affecting the liver causing referred pain.
  18. Gallbladder Issues: Gallstones or cholecystitis causing referred pain.
  19. Pancreatitis: Inflammation of the pancreas causing abdominal pain.
  20. Constipation: Severe constipation causing abdominal pain and discomfort.

Symptoms of Rectus Sheath Pain

  1. Localized Pain: Pain in a specific area of the abdomen.
  2. Diffuse Pain: Pain spread across a wider area of the abdomen.
  3. Sharp Pain: Sudden, intense pain.
  4. Dull Ache: Persistent, mild discomfort.
  5. Burning Sensation: A burning or stinging feeling.
  6. Tightness: Feeling of tightness or constriction in the abdomen.
  7. Tenderness: Pain when touching or pressing the abdomen.
  8. Swelling: Visible swelling in the abdominal area.
  9. Bruising: Discoloration of the skin due to internal bleeding.
  10. Muscle Weakness: Weakness in the abdominal muscles.
  11. Limited Mobility: Difficulty moving or bending.
  12. Nausea: Feeling of sickness in the stomach.
  13. Vomiting: Expulsion of stomach contents through the mouth.
  14. Bloating: Feeling of fullness or swelling in the abdomen.
  15. Fever: Elevated body temperature indicating infection.
  16. Fatigue: Feeling unusually tired or weak.
  17. Loss of Appetite: Reduced desire to eat.
  18. Constipation: Difficulty passing stools.
  19. Diarrhea: Frequent, loose, or watery stools.
  20. Urinary Symptoms: Painful or frequent urination.

Diagnostic Tests for Rectus Sheath Pain

  1. Physical Examination: Assessing pain, tenderness, and muscle strength.
  2. Medical History: Discussing symptoms, medical history, and recent activities.
  3. Ultrasound: Imaging test to visualize muscles and tissues.
  4. MRI (Magnetic Resonance Imaging): Detailed imaging to assess soft tissues.
  5. CT Scan (Computed Tomography): Detailed cross-sectional images of the abdomen.
  6. X-ray: Imaging to check for fractures or abnormalities.
  7. Blood Tests: Checking for signs of infection or inflammation.
  8. Urine Tests: Analyzing urine for signs of infection or kidney issues.
  9. Electromyography (EMG): Testing muscle electrical activity.
  10. Nerve Conduction Studies: Assessing nerve function and conduction.
  11. Laparoscopy: Minimally invasive surgery to examine abdominal organs.
  12. Endoscopy: Visualizing the digestive tract using a flexible tube with a camera.
  13. Colonography: Imaging test to visualize the colon.
  14. Herniography: Imaging to detect hernias.
  15. Barium Swallow: X-ray imaging of the digestive tract after swallowing barium.
  16. Stool Tests: Checking for infections or blood in the stool.
  17. H. pylori Test: Testing for Helicobacter pylori infection.
  18. Abdominal Angiography: Imaging to check blood flow in abdominal vessels.
  19. Liver Function Tests: Assessing liver health.
  20. Gallbladder Function Tests: Evaluating gallbladder function and detecting stones.

Non-Pharmacological Treatments for Rectus Sheath Pain

  1. Rest: Allowing the muscles to heal by avoiding strenuous activities.
  2. Ice Therapy: Applying ice packs to reduce inflammation and numb pain.
  3. Heat Therapy: Using heat packs to relax muscles and improve blood flow.
  4. Physical Therapy: Exercises and stretches to strengthen abdominal muscles.
  5. Massage Therapy: Relieving muscle tension and improving circulation.
  6. Acupuncture: Using needles to stimulate specific points and relieve pain.
  7. Chiropractic Care: Adjusting the spine and joints to improve alignment.
  8. Yoga: Practicing poses and breathing exercises to improve flexibility and reduce stress.
  9. Pilates: Strengthening core muscles through controlled movements.
  10. Hydrotherapy: Using water exercises to reduce pain and improve mobility.
  11. TENS (Transcutaneous Electrical Nerve Stimulation): Using electrical currents to relieve pain.
  12. Ultrasound Therapy: Using sound waves to reduce inflammation and promote healing.
  13. Biofeedback: Learning to control physiological functions to reduce pain.
  14. Cognitive Behavioral Therapy (CBT): Addressing the psychological aspects of chronic pain.
  15. Mindfulness Meditation: Reducing stress and pain perception through meditation.
  16. Deep Breathing Exercises: Relaxing the body and reducing pain.
  17. Progressive Muscle Relaxation: Tensing and relaxing muscle groups to reduce tension.
  18. Ergonomic Adjustments: Improving posture and work environment to reduce strain.
  19. Supportive Braces: Wearing abdominal supports to reduce strain on muscles.
  20. Compression Garments: Using compression to support muscles and reduce swelling.
  21. Foam Rolling: Using a foam roller to massage and stretch muscles.
  22. Dietary Modifications: Eating a balanced diet to reduce inflammation and support healing.
  23. Hydration: Drinking plenty of water to keep muscles hydrated and healthy.
  24. Herbal Supplements: Using natural remedies like turmeric or ginger for their anti-inflammatory properties.
  25. Essential Oils: Applying oils like lavender or peppermint for their analgesic effects.
  26. Aromatherapy: Using essential oils to promote relaxation and reduce pain perception.
  27. Topical Creams: Applying creams with ingredients like menthol or capsaicin to numb pain.
  28. Home Exercises: Performing exercises and stretches recommended by a physical therapist.
  29. Posture Training: Learning to maintain proper posture to reduce muscle strain.
  30. Lifestyle Changes: Making adjustments like reducing stress and avoiding activities that worsen pain.

Drugs for Rectus Sheath Pain

  1. Acetaminophen (Tylenol): For mild to moderate pain relief.
  2. Ibuprofen (Advil, Motrin): Non-steroidal anti-inflammatory drug (NSAID) for pain and inflammation.
  3. Naproxen (Aleve): NSAID for pain and inflammation.
  4. Aspirin: NSAID for pain and inflammation.
  5. Diclofenac (Voltaren): NSAID for pain and inflammation.
  6. Celecoxib (Celebrex): NSAID for pain and inflammation.
  7. Tramadol (Ultram): Opioid pain reliever for moderate to severe pain.
  8. Codeine: Opioid pain reliever for moderate pain.
  9. Hydrocodone: Opioid pain reliever for moderate to severe pain.
  10. Oxycodone: Opioid pain reliever for severe pain.
  11. Gabapentin (Neurontin): For nerve pain.
  12. Pregabalin (Lyrica): For nerve pain.
  13. Amitriptyline (Elavil): Antidepressant used for chronic pain management.
  14. Duloxetine (Cymbalta): Antidepressant used for chronic pain management.
  15. Lidocaine Patches: Topical anesthetic for localized pain relief.
  16. Capsaicin Cream: Topical cream for pain relief.
  17. Methocarbamol (Robaxin): Muscle relaxant.
  18. Cyclobenzaprine (Flexeril): Muscle relaxant.
  19. Tizanidine (Zanaflex): Muscle relaxant.
  20. Baclofen: Muscle relaxant.

Surgeries for Rectus Sheath Pain

  1. Hernia Repair Surgery: Fixing hernias that cause pain.
  2. Laparoscopic Surgery: Minimally invasive surgery to explore and address abdominal issues.
  3. Abdominal Wall Reconstruction: Repairing and strengthening the abdominal wall.
  4. Nerve Decompression Surgery: Relieving pressure on compressed nerves.
  5. Endometriosis Surgery: Removing endometrial tissue causing pain.
  6. Tumor Removal Surgery: Removing benign or malignant tumors.
  7. Scar Tissue Removal: Removing scar tissue causing pain.
  8. Abscess Drainage: Draining infected fluid collections.
  9. Adhesion Removal Surgery: Removing adhesions causing pain.
  10. Exploratory Laparotomy: Open surgery to diagnose and treat abdominal issues.

Preventions for Rectus Sheath Pain

  1. Proper Lifting Techniques: Using correct techniques to avoid muscle strain.
  2. Regular Exercise: Strengthening abdominal muscles to prevent injuries.
  3. Warm-Up and Stretching: Preparing muscles before physical activity.
  4. Maintaining a Healthy Weight: Reducing strain on abdominal muscles.
  5. Good Posture: Maintaining proper posture to avoid muscle strain.
  6. Ergonomic Workstation: Setting up a comfortable and supportive work environment.
  7. Balanced Diet: Eating a nutritious diet to support muscle health.
  8. Hydration: Drinking enough water to keep muscles hydrated.
  9. Avoiding Repetitive Strain: Taking breaks and avoiding repetitive activities that strain the muscles.
  10. Stress Management: Reducing stress to prevent muscle tension.

When to See a Doctor

  • Severe Pain: If the pain is intense and unmanageable.
  • Persistent Pain: If the pain lasts more than a few days without improvement.
  • Associated Symptoms: If you experience fever, nausea, vomiting, or other concerning symptoms.
  • Post-Injury: If the pain follows an injury or trauma.
  • Post-Surgery: If the pain occurs after surgery and doesn’t improve.
  • Unexplained Pain: If the pain has no clear cause and persists.
  • Swelling or Bruising: If you notice significant swelling or bruising in the abdominal area.
  • Limited Mobility: If the pain restricts your movement and daily activities.
  • Nerve Pain: If you experience numbness, tingling, or nerve-related pain.
  • Weight Loss: If you have unexplained weight loss along with the pain.


Rectus sheath pain can significantly impact daily life, but understanding its causes, symptoms, and treatment options can help manage and alleviate the discomfort. By adopting preventive measures and seeking timely medical intervention, individuals can effectively address rectus sheath pain and improve their quality of life.


Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. Thank you for giving your valuable time to read the article.