The diaphragm is a large, flat muscle between the rib cage and the abdomen. It plays an important role in breathing. Pain around the diaphragm may feel 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 are, 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 downwards. This creates more space in the chest and air flows into the lungs. During exhalation the muscle relaxes and moves back up.

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

What does diaphragm pain feel like?

Symptoms vary from person to person and depend on the cause. Possible symptoms are:

A stabbing or sharp pain under the ribs.
A pressing or constricting sensation around the lower part of the chest.
Pain when breathing in deeply.
Pain when coughing, sneezing or laughing.
Pain during movement or sport.
A burning sensation behind the breastbone.
Shortness of breath or difficulty taking a deep breath.
Pain radiating to the back or shoulder.

Pain while breathing does not always directly point to a problem with 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

Overuse of muscles

Heavy lifting, a lot of coughing or intensive sport strains the muscles around the chest and abdomen. This can cause pain around the lower ribs. The pain increases with deep breathing, twisting, bending, coughing or tensing the abdominal muscles.

Stitch in the side during sport

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

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

Acid reflux and stomach complaints

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

Hiatus hernia

In a hiatus hernia, a part of the stomach slides upwards through the opening for the oesophagus. A hiatus 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 oesophagus passes is simply a little wider than normal.

Problems with the lungs or pleura

Inflammation or irritation of the lungs or pleura can sometimes cause pain in the lower chest. Symptoms worsen during deep breathing or coughing. Fever, coughing and shortness of breath may point to a condition of the airways or lungs.

Problems of the organs in the upper abdomen

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

A blow or a fall

A hard blow to the chest or upper abdomen can irritate or damage the ribs, muscles or other structures around the diaphragm. Severe damage to the diaphragm is rare and usually occurs after a major accident.

Pain when breathing deeply

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 at that time.

Pain during deep breathing can be caused by overworked muscles, a bruised or broken rib or irritation of the pleura. In case of sudden or severe pain, breathlessness or a rapid deterioration, always contact a doctor (GP).

Examination

The GP will ask where the pain is, when symptoms occur and which movements influence the pain. Accompanying symptoms also play a role, such as:

Breathlessness.
Coughing or fever.
Heartburn.
Nausea.
Difficulty swallowing.
Pain during exertion.
A recent accident.

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

Treatment

Treatment depends on the cause. Muscle pain or a stitch in the side usually settle on their own. Temporarily reducing heavy strain and continuing to move gently help recovery.

With acid reflux, changes in diet and lifestyle are sometimes needed to reduce symptoms. A doctor may advise acid-suppressing medicines. A hiatus hernia without severe symptoms usually does not require treatment.

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

When to contact a doctor?

Contact the GP if:

The pain lasts longer or keeps coming back.
Symptoms gradually get worse.
Deep breathing hurts for a prolonged period.
The pain occurs together with coughing or fever.
There are frequent problems with heartburn, swallowing or nausea.
Symptoms started after a hard blow or a fall.

Call the GP or the emergency number immediately in case of sudden severe chest pain, severe breathlessness, fainting or pain radiating to the arm, jaw or back. Sweating and nausea combined with chest pain also require urgent medical assessment.

Diaphragm pain