The diaphragm, also called the thoracic diaphragm, is a large, flat muscle between the chest and the abdomen. This muscle plays an important role in breathing. Pain around the diaphragm feels like pain under the ribs, high in the abdomen, or low in the chest. Sometimes the pain radiates to the back or shoulder.

Pain in this region does not automatically mean that the diaphragm itself is the cause. Around the diaphragm are various organs, muscles, and other structures that can cause similar symptoms.

What is the diaphragm?

The diaphragm forms the separation between the chest cavity and the abdominal cavity. Above the diaphragm lie, among other things, the lungs and the heart. The stomach, liver, and other abdominal organs lie below it.

During inhalation the diaphragm contracts and moves downward. This creates more space in the chest and air flows into the lungs. During exhalation the muscle relaxes and moves upward again.

There are several openings in the diaphragm. The esophagus and important blood vessels pass through these openings from the chest to the abdomen.

What does diaphragm pain feel like?

The symptoms differ per person and depend on the cause. Possible symptoms are:

A stabbing or sharp pain under the ribs.
A feeling of pressure or tightness around the lower chest.
Pain with deep inhalation.
Pain when coughing, sneezing, or laughing.
Pain during movement or sports.
A burning sensation behind the breastbone.
Shortness of breath or difficulty taking a deep breath.
Pain radiating to the back or shoulder.

Pain during breathing does not always directly point to a problem of the diaphragm. The ribs, intercostal muscles, pleura, and organs in the upper abdomen can also cause pain in this area.

Causes of pain around the diaphragm

Muscle overuse

Heavy lifting, frequent coughing, or intensive sports load the muscles around the chest and abdomen. This sometimes causes pain around the lower ribs. The pain increases with deep breathing, twisting, bending, coughing, or tightening the abdominal muscles.

Side stitch during exercise

The exact cause of a sudden sharp pain under the ribs that occurs during exercise is not yet fully known. The medical name for this is exercise-related transient abdominal pain. This is exertion-related transient abdominal pain.

Such a side stitch occurs more often shortly after eating or drinking. The pain usually disappears by slowing down or stopping exercise altogether.

Acid reflux and stomach complaints

Stomach acid that flows back into the esophagus causes a burning or pressing pain behind the breastbone or high in the abdomen. The symptoms increase after eating, when bending forward, or when lying down.

Hiatal hernia

With a hiatal hernia, also called a hiatus hernia, part of the stomach slides upward through the opening for the esophagus. A hiatal hernia does not always cause symptoms. Some people experience heartburn, regurgitation, pain behind the breastbone, or a feeling of fullness after eating.

Despite the name, there is usually no tear in the diaphragm. The opening through which the esophagus passes is simply a bit wider than normal.

Problems with the lungs or pleura

An inflammation or irritation of the lungs or pleura sometimes causes pain in the lower chest. Symptoms worsen during deep inhalation or coughing. Fever, coughing, and shortness of breath may fit with a disorder of the airways or lungs.

Problems of organs in the upper abdomen

The stomach, liver, and gallbladder lie close to the diaphragm. Problems with these organs can therefore cause symptoms that feel like diaphragm pain. The pain is often high in the abdomen or under the ribs.

A blow or fall

A hard blow to the chest or upper abdomen sometimes irritates or injures the ribs, muscles, or other structures around the diaphragm. A severe injury to the diaphragm is uncommon and usually occurs after a serious accident.

Pain with deep breathing

Pain around the diaphragm often stands out more during deep inhalation. The diaphragm moves with every breath. The ribs, intercostal muscles, and pleura also move then.

Pain with deep breathing can be caused, among other things, by overused muscles, a bruised or broken rib, or irritation of the pleura. With sudden or severe pain, shortness of breath, or rapid deterioration, always contact the (family) doctor.

Examination

The family doctor asks where the pain is located, when the symptoms occur, and which movements influence the pain. Accompanying symptoms also play a role, such as:

Shortness of breath.
Coughing or fever.
Heartburn.
Nausea.
Difficulty swallowing.
Pain during exertion.
A recent accident.

The family doctor may then examine the chest and abdomen and listen to the lungs. If a disorder of the lungs, heart, or abdominal organs is suspected, blood tests, an X-ray, ultrasound, or other additional tests may follow.

Treatment

Treatment depends on the cause. Muscle soreness or a side stitch usually improves on its own. Temporarily reducing heavy loads and continuing to move gently helps recovery.

With acid reflux, adjustments in diet and lifestyle are sometimes needed to reduce symptoms. A doctor may recommend acid-reducing medication. A hiatal hernia without severe symptoms usually does not need treatment.

If symptoms come from the lungs, heart, or abdominal organs, treatment focuses on the underlying condition.

When to contact a doctor?

Contact your family doctor if:

The pain lasts longer or keeps coming back.
Symptoms gradually get worse.
Deep breathing is painful for a prolonged period.
The pain is accompanied by coughing or fever.
There is frequent heartburn, swallowing problems, or nausea.
Symptoms started after a hard blow or fall.

Call your family doctor or the emergency number immediately with sudden severe chest pain, severe shortness of breath, fainting, or pain that radiates to the arm, jaw, or back. Sweating and nausea combined with chest pain also require prompt medical assessment.

Diaphragm pain