Enlarged Spleen: Symptoms and What to Do

Where the spleen is and what it does

The spleen sits in the upper left of the abdomen, behind the stomach and under the lower ribs. It is normally about the size of a fist (around 11 to 12 cm long) and cannot usually be felt. It filters old and damaged red blood cells, stores white blood cells and platelets, and helps fight certain bacteria.

When it enlarges, it pushes down and forward below the rib edge, toward the belly button.

Symptoms of an enlarged spleen

Many people have no symptoms. When present they include:

• Fullness, discomfort or pain under the left ribs, sometimes a dragging feeling
• Early satiety: feeling full after eating very little, because the spleen presses on the stomach
• Pain in the left shoulder tip, from irritation of the diaphragm
• Tiredness and paleness if the spleen is destroying red cells
• Easy bruising or bleeding if it is trapping platelets
• Frequent infections if white cells are low

Symptoms of the underlying cause are often more noticeable: fever and sore throat in mononucleosis, jaundice and swelling in liver disease, or night sweats, weight loss and swollen glands in lymphoma.

Common causes

For the full range of causes, how size is graded and how splenomegaly is investigated and treated, see splenomegaly.

Why the spleen can rupture

An enlarged spleen extends below the protection of the ribs, and its capsule is stretched thin. A blow to the left side, a fall, or contact sport can tear it, and rarely it ruptures on its own, particularly in mononucleosis. A ruptured spleen (spleen injury) bleeds into the abdomen and can be life-threatening. Signs are sudden left upper belly pain, left shoulder pain, dizziness, fainting and a racing pulse.

What to do if you have an enlarged spleen

1. See a doctor to find the cause. Expect blood tests and an ultrasound.
2. Avoid contact and collision sports, heavy lifting and activities with a risk of falls or blows to the belly until your doctor says it is safe. After mononucleosis, this is usually at least 3 to 4 weeks from the start of symptoms, sometimes longer.
3. Wear a seat belt correctly across the hips and chest.
4. Eat smaller, more frequent meals if you feel full quickly.
5. Avoid alcohol if liver disease is a possible cause.
6. Seek emergency care for sudden severe left-sided pain or signs of bleeding.

How doctors check the spleen

A doctor feels and taps the upper left abdomen while you breathe in. An ultrasound measures spleen size and checks the liver and blood flow. Blood tests include a full blood count and blood film, liver tests, and tests for mononucleosis and other infections. Further tests depend on the findings.

Frequently asked questions

What are the first signs of an enlarged spleen?

Often there are none. The first signs may be a feeling of fullness or discomfort under the left ribs, feeling full after small meals, or tiredness. Many enlarged spleens are found during an exam for another illness, such as mononucleosis.

What does an enlarged spleen pain feel like?

It is usually a dull ache, pressure or dragging feeling in the upper left abdomen, sometimes spreading to the left shoulder. It may be worse with deep breaths. Sudden, sharp, severe pain, especially after an injury, can mean rupture and needs emergency care.

Can an enlarged spleen go back to normal?

Yes, often. When the cause is treated or resolves, such as mononucleosis or another infection, the spleen usually returns to normal size over weeks to months. When the cause is long-term, such as cirrhosis or a blood disorder, it may stay enlarged.

Can I exercise with an enlarged spleen?

Gentle walking is usually fine. Avoid contact sports, heavy lifting and activities with a risk of falls or blows to the belly until your doctor confirms the spleen has returned to a safe size, because an enlarged spleen can rupture.