The diaphragm, or thoracic diaphragm, is a dome-shaped sheet of muscle that separates the chest from the abdomen. It is the primary muscle that the body uses when breathing.
The diaphragm moves downward so the lungs can fill with air during inhalation. It then moves upward again during an exhalation, causing the lungs to empty.
People may sometimes feel pain or discomfort in their diaphragm, although in some cases it is possible that the pain is coming from a different, nearby body part.
In this article, we discuss the most common causes of diaphragm pain and how to treat them.
There are many potential causes of diaphragm pain, or pain that feels similar, including:
Heavy impact or a surgical procedure can injure the diaphragm. The resulting pain may be intermittent or constant.
Some types of trauma can tear the diaphragm muscle. This is a severe condition called a ruptured diaphragm, which a CT scan or thoracoscopy can diagnose.
- abdominal pain
- breathing difficulties
- chest or shoulder pain
- heart palpitations
The body respires continuously, so the diaphragm is always moving and a tear will not be able to heal on its own. Surgery is therefore essential to repair the muscle.
2. Musculoskeletal problems
Trauma, twisting movements, and excessive coughing can all strain the rib muscles, which can cause a pain similar to diaphragm pain. The pain of broken ribs can also resemble diaphragm pain.
Treatment options include:
- over-the-counter (OTC) pain relievers, such as ibuprofen (Advil) or naproxen (Aleve)
- ice therapy for the first 72 hours
- heat therapy after the first 72 hours
- breathing exercises
- physical therapy
Fractured or broken ribs tend to heal on their own within 6 weeks, but the following treatments may alleviate symptoms during this time:
- avoiding strenuous activities
- using ice therapy
- taking OTC pain relievers
- having anesthesia shots around the nerves near the ribs
- doing breathing exercises
In the past, people used compression wraps for broken ribs, but these can hinder deep breathing and increase the risk of pneumonia. Doctors, therefore, no longer recommend them.
3. Intense activity
Breathing hard during strenuous physical activity can cause the diaphragm to spasm, resulting in a sharp or tight pain.
The pain is usually severe enough to interfere with breathing. Many people feel as though they are unable to inhale fully and comfortably. Symptoms will worsen if the activity continues.
If diaphragm pain occurs during exercise, it is best to take a break until the spasms stop. A proper warm-up routine may prevent this type of pain from developing.
4. Gallbladder disease
Gallbladder disease is an umbrella term for several conditions. Pain in the gallbladder can feel similar to diaphragm pain so people may confuse the two.
Other symptoms of gallbladder disease include:
- changes in urinary or bowel habits
- chills or fever
- yellowing of the skin and whites of the eyes (jaundice)
Most cases of gallbladder disease occur as a result of inflammation and irritation of the gallbladder walls (cholecystitis). Other gallbladder problems include gallstones, bile duct blockage, and cancer.
The treatment for gallbladder disease will depend on the exact form of the condition. Options may include medications to manage pain, anti-inflammatory drugs, or surgery to remove the gallbladder.
Lifestyle changes that may prevent or manage gallbladder disease include:
- losing weight slowly and steadily (if overweight)
- managing diabetes and other health conditions
- exercising regularly
- quitting smoking
- limiting alcohol intake
5. Hiatal hernia
A hiatal hernia occurs when part of the upper stomach pushes through an opening in the bottom of the diaphragm.
The opening (known as the hiatus) allows the esophagus to pass through the diaphragm muscle to connect to the stomach.
Smaller hiatal hernias are not usually cause for concern.
Many people remain unaware that they even have one as they have no symptoms.
However, larger hiatal hernias can cause symptoms such as:
- acid reflux
- black or bloody stools
- chest or stomach pain
- difficulty swallowing
- regurgitation of food into the mouth
- shortness of breath
Medication is the most common treatment to manage hiatal hernias. The following lifestyle changes can also help to control symptoms:
- eating several small meals rather than three larger ones
- avoiding fatty or acidic foods and other items that trigger heartburn
- eating meals at least 3 hours before bedtime
- quitting smoking
- maintaining a healthy weight
- elevating the head of the bed by 6 inches to prevent acid reflux overnight
If a hiatal hernia is very large or causes severe symptoms, surgery may be necessary.
As a pregnancy progresses, the uterus expands and pushes the diaphragm upward. This action compresses the lungs and makes breathing more difficult. It can also cause mild pain or discomfort and shortness of breath.
These symptoms are no cause for concern and will resolve after giving birth.
However, it is important to consult a doctor if the following symptoms occur:
- intense or constant pain
- a persistent cough
- severe breathing difficulties
Pleurisy refers to inflammation of the pleura, which is the layer of tissue on the inner side of the chest cavity surrounding the lungs.
It causes sharp chest pain when breathing, along with shortness of breath. Pleurisy can, in some cases, also lead to coughing and fever. Pain can sometimes affect the shoulders and back as well.
Treatment involves taking medications to control the pain and to treat the underlying condition. Possible associated conditions that may require treatment include infections, autoimmune disorders, and sickle cell disease.
Bronchitis is the inflammation of the lining of the bronchial tubes, which transport air to and from the lungs. Bronchitis may be acute (short-term) or chronic (long-term).
Bronchitis causes chest pain that people may mistake for diaphragm pain. Other symptoms include:
- a cough
- shortness of breath
- thick, colored mucus
Acute bronchitis typically develops from a cold and will go away on its own within a week or so. Cough medicine and pain relievers may ease symptoms until the infection clears up.
Chronic bronchitis requires medical attention. Treatment options include inhalers, anti-inflammatory medications, and pulmonary rehabilitation to help the person breathe more easily.
Pneumonia is an infection that causes inflammation of the air sacs in the lungs. The cause may be bacterial, viral, or fungal. Symptoms include:
- breathing difficulties
- chest pain
- a cough with phlegm or pus
Some cases of pneumonia can be life-threatening, especially in young children, older adults, and those with other health problems.
Treatment aims to heal the infection and prevent complications. Treatment options include antibiotics, cough medicine, and pain relief. Hospitalization may be necessary in some cases.
10. Other possible causes
Less common causes of diaphragm pain include:
Heart surgery or radiation treatments may also cause pain that resembles diaphragm pain.
The outlook for people with diaphragm pain depends on the underlying cause of this symptom. Those who experience diaphragm pain from exercise, for example, will get relief once they rest.
People with a ruptured diaphragm may take much longer to recover though. Recovery will depend on the type of trauma and any other injuries that it caused.
People with long-term conditions that cause diaphragm pain, such as chronic bronchitis and most hiatal hernias, can alleviate symptoms using medications, lifestyle changes, and other medical treatments.