Diaphragm Pain: Causes & How to Treat it | GetWellGo

Diaphragm Pain Causes

Diaphragmatic pain may result from a range of conditions from mild to severe. The diaphragm is a big, dome-shaped muscle and is responsible for facilitating the process of breathing. Pain in this region may result from muscular, respiratory, gastrointestinal, or systemic causes. These are the most frequent causes:

Muscular Causes

• Muscle strain or overuse
• Trauma or injury
• Hiatal hernia

Respiratory Causes

• Pleuritis (pleurisy)
• Pulmonary embolism
• Pneumonia or bronchitis

Gastrointestinal Causes

• Acid reflux (GERD)
• Gallbladder disease
• Pancreatitis

Neurological Causes

• Phrenic nerve irritation or damage
• Referred pain from spinal issues

Other Causes

• Endometriosis
• Autoimmune conditions
• Tumors or cancer

Diaphragm Pain Treatment

Treatment of pain in the diaphragm varies with the cause. Following is an analysis by causes and their usual treatment:

Muscular Strain or Injury

Cause: Overexertion, heavy lifting, vigorous coughing

Treatment:

• Rest and stay away from strenuous activity
• Heat or ice application to minimize inflammation
• Pain medication available over-the-counter (e.g., ibuprofen, acetaminophen)
• Gentle stretching or physical therapy if persistent

Hiatal Hernia

Cause: A part of the stomach protrudes through the diaphragm

Treatment:

• Dietary adjustments (stay away from large meals, don't lie down after meals)
• Proton pump inhibitors (PPIs) or H2 blockers to decrease acid
• Surgery (for severe cases or when complications such as strangulation arise)

Acid Reflux (GERD)

Cause: Irritation of the diaphragm due to stomach acid

Treatment:

• Dietary modification (avoid spicy/fatty food, caffeine, alcohol)
• Medications: antacids, PPIs, or H2 blockers
• Weight control and sleeping with the head elevated

Respiratory Conditions (such as Pleurisy, Pneumonia, Pulmonary Embolism)

Treatment:

• Pleurisy/Pneumonia: Antibiotics (if caused by bacteria), rest, anti-inflammatories
• Pulmonary Embolism: Emergency treatment with anticoagulants (blood thinners), oxygen, or hospitalization

Gallbladder or Pancreas Problems

Cause: Gallstones, pancreatitis

Treatment:

• Low-fat diet
• Pain-relieving medications
• Hospitalization in acute cases
• Surgery (e.g., gallbladder removal for chronic stones)

Phrenic Nerve Irritation or Spinal Causes

Treatment:

• Physical therapy
• Anti-inflammatory drugs
• Nerve blocks (in some instances)
• Surgery (if caused by tumor or spinal compression)

Endometriosis Affecting the Diaphragm

Treatment:

• Hormonal treatment (birth control, GnRH agonists)
• Laparoscopic removal of endometrial tissue
• Management of pain (NSAIDs)

Diaphragm Pain Symptoms

Diaphragm pain symptoms may differ with the underlying condition but typically encompass pain or feeling in the upper abdomen, lower chest, or near the ribs. The following is a listing of common diaphragm pain symptoms:

Common Symptoms of Diaphragm Pain

• Piercing or burning pain beneath the rib cage (particularly when inhaling deeply)
• Upper abdomen or lower chest tightness or pain
• Pain upon breathing, coughing, sneezing, or laughing
• Shortness of breath or trouble taking deep breaths
• Pain that gets worse when lying down or leaning forward
• Referred pain in the shoulder or neck (particularly if phrenic nerve is implicated)
• Hiccups or excessive belching
• Tenderness in the upper part of the abdomen

Diaphragm Spasm Relief

Diaphragm spasms—involuntary muscle contractions of the diaphragm—can be uncomfortable and at times painful. They can have the sensation of hiccups, sudden cramps, or constriction in the chest or upper abdomen. The relief is determined by the cause, but here are some general strategies:

Immediate Relief for Diaphragm Spasms

Breathing Techniques

• Slow, deep breathing through the nose and out the mouth can settle the diaphragm.
• Pursed-lip breathing (breathe in through the nose, breathe out slowly through pursed lips) may reduce muscle tension.

Stretching and Posture

• Gentle stretches of the upper body or side bending can loosen tension in the diaphragm region.
• Standing erect or lying on your back with bent knees can relieve tension.

Hydration

• Dehydration is a cause of muscle cramps, including the diaphragm.
• Drink slowly lukewarm water to relax spasms, particularly if brought on by eating or GERD.

Warm Compress

• Place a warm compress or heating pad on the upper abdomen or lower chest to relax the muscle.

Diaphragm Pain when Breathing

Diaphragm pain on breathing is usually an indication of irritation, strain, or inflammation affecting the diaphragm or the surrounding structures. The pain of this kind tends to be crampy, pulling, or sharp and exacerbates with sneezing, coughing, or deep breaths.

Widespread causes of Diaphragm Pain While Breathing

Pleuritis (Pleurisy)

• Inflammation of lung lining
• Symptoms: Painful diaphragm or chest, gets worse with coughing or deep breathing

Diaphragmatic Strain or Muscle Cramp

• From heavy exercise, prolonged coughing, or heavy lifting
• Symptoms: Stabbing or aching pain on inhalation, tenderness to touch

Pulmonary Embolism (PE)

• A blood clot in the lungs that causes pleuritic pain
• Symptoms: Sudden severe pain, shortness of breath, fast heart rate (medical emergency)

Pneumonia or Lung Infection

• Irritates tissues close to the diaphragm    
• Symptoms: Fever, cough, chest/diaphragm pain, tiredness

Hiatal Hernia or GERD

• Part of stomach bulges through the diaphragm; acid reflux irritates it
• Symptoms: Pain on breathing or eating, heartburn, tightness in the chest

Phrenic Nerve Irritation

• The nerve supplying the diaphragm can be irritated by trauma, tumor, or surgery
• Symptoms: Hiccups, pain in the shoulder, difficulty breathing deeply

Trauma or Blunt Injury

• Blunt injury or car accident involving the ribcage or upper abdomen
• Symptoms: Localized pain, particularly on breathing or movement

Diaphragm Pain after Eating

Diaphragm pain after a meal is typically brought about by pressure or irritation of the diaphragm by digestive or anatomical problems. The pain may have a sensation of upper abdominal or lower chest pain, tightness, cramping, or even referred shoulder pain in a few instances.

Common Diaphragm Pain After Eating Causes

Hiatal Hernia

• A portion of the stomach bulges through the diaphragm into the chest.
• Symptoms: Pain or pressure in upper abdomen or chest after eating, heartburn, bloating, worse when lying down.

Gastroesophageal Reflux Disease (GERD)

• Stomach acid irritates the diaphragm and esophagus.
• Symptoms: Burning, pain after eating, regurgitation, sour taste in mouth.

Overeating or Eating Too Rapidly

• Causes the stomach to expand and push against the diaphragm.
• Symptoms: Fullness, upper abdominal discomfort, shortness of breath or hiccups.

Gallbladder Problems (e.g., Gallstones)

• Pain may radiate to the diaphragm area after consuming fatty meals.
• Symptoms: Nausea, right upper abdominal pain, pain beneath the right ribcage or shoulder.

Food Intolerances or Bloating

• Gas or bloating caused by specific foods (such as dairy, beans, carbonated beverages) can push on the diaphragm.
• Symptoms: Cramping, bloating, belching, constricted chest or pressure on the diaphragm.

Pancreatitis

• Inflammation of the pancreas will cause pain in the upper abdomen after eating.
• Symptoms: Sudden, severe pain extending to the back or diaphragm, nausea, vomiting.

Diaphragm Pain During Pregnancy

Diaphragmatic pain in pregnancy is quite prevalent, particularly between the second and third trimester, and tends to be secondary to mechanical compression by the enlarging uterus, but it is also related to hormonal or gastrointestinal changes. Though usually innocuous, distinction needs to be made between normal aching and presentation of a pathologic process.

Common Reasons Behind Diaphragm Pain in Pregnancy

Expansion of the Uterus

• During pregnancy, when the uterus enlarges, it presses against the diaphragm.
• Symptoms: Pressure or aching under the ribs, which worsens on sitting or after meals.

Shortness of Breath

• The diaphragm is compressed, restricting lung expansion.
• Symptoms: Mild shortness of breath, soreness of the ribs or diaphragm, particularly on lying down.

Digestive Problems (e.g., GERD, Bloating)

• Hormonal shifts (rise in progesterone) relax muscles, resulting in acid reflux or bloating.
• Symptoms: Burning, fullness, gas, and upper abdominal or diaphragm pain following meals.

Round Ligament or Musculoskeletal Strain

• As posture varies, muscles of support (such as around the diaphragm) can become strained.
• Symptoms: Pain or burning near ribs, exacerbated by motion or deep breathing.

Gallbladder Sluggishness or Gallstones

• Hormones of pregnancy can slow gallbladder movement.
• Symptoms: Pain after fatty foods, beneath right ribs, possibly referred to back or shoulder.

Diaphragm Pain at Night

Night pain in the diaphragm can be particularly uncomfortable and disrupts sleep. This kind of pain tends to be associated with posture, digestion, or pressure from organs inside the body when lying down.

Diaphragm Pain and Back Pain

Diaphragm pain and back pain can be a symptom of many different conditions, from musculoskeletal to gastrointestinal or organ-related. The diaphragm and the muscles surrounding it have shared nerve pathways with the muscles of the back, so pain from one location may be referred to another.

Diaphragm Pain and Shortness of Breath

Diaphragm pain accompanied by shortness of breath can be alarming and may indicate a range of medical conditions, from benign to life-threatening. Paying attention to the unique details of the pain and shortness of breath can assist in determining the cause. Below is a summary of typical causes and what to look out for:

Common Causes of Diaphragm Pain and Shortness of Breath

Pulmonary Embolism (PE)

• Cause: A lung blood clot that may lead to diaphragmatic pain and difficulty breathing.
• Symptoms: Acute sharp pain in the chest, breathing difficulties, dizziness, increased rate of heart beat, cough (potentially bloody).

Pleuritis (Pleurisy)

• Cause: Pleural inflammation (the pleura is the membrane surrounding the lungs), leading to pain that intensifies with respiration.
• Symptoms: Piercing, stabbing pain in the chest or diaphragm, worsened by deep breaths, coughing, or sneezing. You might experience shortness of breath from pain or pleural effusion (fluid accumulation).
• Treatment: Anti-inflammatory drugs, pain relief, and treatment of the underlying cause (e.g., viral infection).

Pneumonia

• Cause: Lung infection that can cause pain in the diaphragm, particularly with breathing.
• Symptoms: Cough, fever, chills, stabbing chest or diaphragm pain, and shortness of breath.
• Treatment: Antibiotics (if bacterial), rest, and fluids.

Diaphragmatic Hernia

• Cause: A hole or tear in the diaphragm that causes abdominal organs to protrude into the chest cavity, usually resulting in difficulty breathing and pain.
• Symptoms: Upper chest or abdominal pain, trouble breathing, acid reflux, or discomfort after meals.
• Treatment: Surgery may be needed to fix the hernia.

Gastroesophageal Reflux Disease (GERD)

• Cause: Acid reflux can irritate the diaphragm and cause discomfort in the chest or upper abdomen, which may feel like pain with shortness of breath.
• Symptoms: Burning sensation in the chest (heartburn), pain after eating, difficulty swallowing, and occasional breathlessness due to irritation.
• Treatment: Antacids, proton pump inhibitors, and lifestyle changes (e.g., avoiding large meals, not lying down after eating).

Anxiety or Panic Attacks

• Cause: Panic or anxiety attacks may result in both diaphragm discomfort (usually due to muscle tension) and shortness of breath (because of hyperventilation or fast breathing).
• Symptoms: Chest or diaphragm tightness, inability to catch your breath, rapid heart, sweating, and sense of impending doom.
• Treatment: Relaxation techniques, breathing exercises, and counseling or therapy for the control of anxiety.

Heart Issues (e.g., Angina or Heart Attack)

• Cause: Decreased blood circulation to the heart may result in referred pain to the diaphragm or chest, usually related to shortness of breath.
• Symptoms: Pain in the chest, ache radiating to the arm, back, or jaw, lightheadedness, nausea, and respiratory distress.

Rib or Musculoskeletal Injury

• Cause: Fracture to the ribs, muscles, or cartilage surrounding the diaphragm may produce pain that worsens with respirations.
• Symptoms: Sharp or tender pain when breathing or moving, effort to breathe deeply.
• Treatment: Rest, ice, pain medication, and potentially physical therapy if muscles are strained.