When living with primary biliary cholangitis (PBC, previously called primary biliary cirrhosis), it can be hard to pinpoint where your pain is coming from. Inflammation and swelling from PBC often lead to liver pain. But when the pain spreads, it can feel a lot like muscle pain. How can you tell the difference?

This article will discuss the common signs of liver pain and how they compare to muscle pain. It will also cover how to tell the difference and when you should talk to your doctor. Luckily, your doctor can help you find ways to manage your pain and discomfort.

Liver Pain With PBC: What Are the Signs?

Your liver is the largest internal organ in your body. It sits right below your rib cage on the right side. People living with PBC have inflammation in the small bile ducts within the liver. This is because PBC is an autoimmune liver disease that overactivates your immune system.

The bile ducts carry a digestive substance called bile. Long-term inflammation eventually leads to fibrosis (scar tissue buildup) and obstruction of bile flow. Eventually, you develop permanent liver damage. At this time, there’s no way to reverse the damage done by PBC.

Liver pain usually occurs in the upper right part of the abdomen. Sometimes, the pain also spreads to the back or shoulder blades. Some people experience dull, achy pain, whereas others may notice sharp pain. The pain may also come and go over time.

Members of myPBCteam Experience Liver Pain With PBC

Everyone experiences liver pain from PBC differently. The inflammation and swelling may cause dull, achy pain near the liver. Others may experience more discomfort if they put pressure on their abdomen. One member of myPBCteam shared, “I get pain if I’m cooking and my liver touches the counter.”

Another myPBCteam member asked others about their symptoms, “Sometimes I feel a hardening in the liver area and a dull pain feeling, especially when I eat. I’m just wondering if anyone else feels something similar?” Another member replied, “I haven’t experienced this while eating but have dull pain at times in this area.”

Pain After a Liver Biopsy

A liver biopsy is a key part of diagnosing PBC. This test helps rule out other conditions — including liver cancer and hepatitis. A liver biopsy involves taking a small piece of liver tissue to look at under a microscope. Doctors insert a long, thin needle into the liver to collect the sample. One of the most common complications after a liver biopsy is pain.

Most people have mild pain that can be controlled with over-the-counter pain relievers. However, some myPBCteam members have experienced more severe problems: “Anyone have really bad pain after your liver biopsy? I ended up in the ER and missed a week of work.” If you have pain or discomfort after your biopsy that can’t be controlled with medication, be sure to talk to your doctor.

Muscle Pain With PBC: How Does It Feel Different?

If you’ve ever pulled or strained a muscle, you know how uncomfortable it can feel. Muscle pain along the upper right abdominal area or your back can feel a lot like liver pain. If you have PBC, you may be concerned about confusing the two symptoms.

There’s a wide spectrum of muscle pain that changes depending on the location and cause. One common cause is muscle strain or overuse, which causes small tears in the muscle tissue that need time to repair themselves.

If you’ve recently worked out or injured your back or abdominal muscles, you might notice some new pain and tenderness. Cleveland Clinic notes that sore muscles in one specific body area are usually related to strain or an injury. Other questions doctors use to confirm or rule out muscle pain include:

• Does the pain get better or worse with movement?
• Do you have pain in other areas of your body?
• Do you have other symptoms, like joint pain or weakness?
• Did the pain start suddenly, or has it gotten worse over time?
• How does the pain feel? Is it a dull ache or a sharp, stabbing pain?

Remember that liver pain from PBC can also radiate into the back and shoulders. Other causes of pain in these areas include:

• Strained ligaments and muscles from exercise or heavy lifting
• Arthritis affecting joints in the spine or lower back
• Injured discs or cushions between bones in the spine

Telling the Difference Between Liver and Muscle Pain With PBC

It can be difficult to pinpoint where your pain is coming from on your own. Remember that liver pain from PBC is usually isolated to the upper right part of your abdomen. However, it can spread to your back and shoulder blades. You’ll likely have other PBC symptoms alongside your pain, including:

• Edema (swollen legs, ankles, and feet)
• Pruritis (itchy skin)
• Varices (swollen veins in your abdomen and esophagus)
• Ascites (fluid buildup in your abdomen)
• Xanthomas (high cholesterol levels and fatty deposits under your skin)

You should report new liver pain and any other PBC symptoms to your doctor. You may have a PBC flare-up or other liver problems.

Muscle pain usually develops after an injury or strain. It typically hurts the most near the affected muscle. For example, if you lift a heavy object and your back hurts the next day, it’s likely a muscle problem. Most cases of muscle pain resolve on their own. However, you should talk to your doctor if your pain lasts more than a few days or if it continues getting worse.

Managing Liver Pain From PBC

Pain and discomfort from PBC not only affect your liver but your entire body as well. Treating your PBC helps relieve your symptoms and improve your overall quality of life. Doctors use a few different approaches to manage pain with PBC.

Many PBC treatments relieve symptoms by improving bile movement through the inflamed ducts into the small intestine. Getting the backed-up bile out of the liver eases inflammation.

Liver pain from PBC may be related to jaundice as well. Jaundice causes yellowing of the skin and eyes. This happens when the liver can’t properly break down a yellow waste product called bilirubin. Making healthy choices can take some stress off your liver to relieve pain from jaundice and PBC. Eliminating alcohol and eating a diet high in fruits and vegetables may help.

Managing Muscle Pain

Mild cases of muscle pain go away on their own with time. In the meantime, you can take extra steps to relieve your symptoms. Examples include:

• Taking over-the-counter pain medications, like ibuprofen or aspirin
• Avoiding exercise and strenuous activities so muscles can rest
• Applying heat or cold therapy to treat inflammation, pain, and stiffness
• Stretching and massaging muscles to encourage blood flow and relieve tension

Find Your Team

On myPBCteam — the social network for people living with primary biliary cholangitis and their loved ones — members come together to ask questions, give advice, and share their stories with others who understand life with PBC.

Have you experienced liver pain while living with PBC? Did you mistake it for muscle pain? How did you treat your symptoms? Share your experience in the comments below, or start a conversation by posting on your Activities page.