Pain in the diaphragm

Diaphragm pain can be caused by several factors, including the following:

• Traumas (open or closed);
• Diaphragmatic hernias (traumatic or non-traumatic, which in turn can be congenital or acquired);
• Hernias of the esophageal orifice of the diaphragm (sliding or paraesophageal). In the first case, the part of the stomach adjacent to the cardia shifts and is a segment of the hernial sac.

Such a hernia can be fixed or non-fixed, congenital or acquired. In the second case, the gastric vault or part of the intestine moves into the middle section of the chest cavity, while the cardia remains in the same place. With a paraesophageal hernia, there is a risk of strangulation, while with a sliding hernia, such a possibility is excluded.

• Relaxation of the diaphragm (congenital or acquired, absolute or incomplete) - thinning and displacement of the diaphragm into the chest cavity with adjacent abdominal organs. The area of attachment of the diaphragm remains in the same place.

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Causes of Diaphragm Pain

Causes of diaphragm pain include injuries and hernias of the diaphragm. Closed injuries of the diaphragm can occur in traffic accidents, falls from great heights and with strong pressure on the abdomen. Due to the rapid increase in intra-abdominal pressure, the diaphragm can rupture. As a rule, the area of damage is concentrated in the area of the tendon center or at the point of its connection with the muscular segment of the diaphragm. In almost all cases, its left dome ruptures.

A diaphragmatic hernia may be the cause of pain in the diaphragm. As a result of such a pathology, the organs of the peritoneum are shifted into the chest cavity through the affected areas of the diaphragm. In a true hernia, there is a hernial orifice and a sac. If the hernia is not associated with trauma to the diaphragm, its formation may be caused by the presence of some defects in the diaphragm. A congenital hernia occurs due to the fact that the fetus did not have complete fusion of the connections between the thoracic and abdominal cavities during the intrauterine period. A true hernia of weakened areas of the diaphragm is formed when the pressure inside the peritoneum increases and is characterized by the exit of the peritoneum organs through the sternocostal region or the lumbar-costal region. In a hernia of the esophageal opening, the lower segment of the esophagus, part of the stomach, and sometimes intestinal loops are shifted through it into the chest cavity.

The cause of pain in the diaphragm may be its relaxation. If the muscles of the diaphragm are not sufficiently developed, the relaxation is considered congenital. If there is damage to the nerve of the diaphragm, we are talking about acquired relaxation. When the diaphragm relaxes, it becomes thinner and shifts into the chest cavity along with nearby organs.

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Symptoms of Diaphragm Pain

Symptoms of diaphragm pain in the acute period include problems with the cardiovascular and respiratory systems, bleeding, accumulation of blood and air in the pleural cavity, bone fractures, compression of the lungs, displacement of the organs of the mediastinum. Symptoms of diaphragm injury may include characteristic sounds when tapping the chest, as well as in the intestines when specially listening, problems with emptying, in particular, intestinal obstruction. With a diaphragmatic hernia, there is a feeling of heaviness and pain in the epigastric region, in the chest, under the ribs, breathing becomes difficult, the heartbeat is disturbed, the symptoms may intensify after a heavy meal. Rumbling sounds may occur in the chest, shortness of breath is felt more strongly in the lying position, vomiting may occur after eating. If there is a kink in the esophagus, liquid food is absorbed much worse than solid food.

Symptoms of pain in the diaphragm with a hernia of the esophageal opening of the diaphragm include pain behind the breastbone, which can cause both a burning sensation and a dull pain. With a hernia of the esophageal opening, there are discomfort and pain under the spoon, in the hypochondrium, radiating to the heart area, as well as to the shoulder and scapular area. In a lying position and with physical activity, the pain increases, belching and heartburn may appear, anemia develops.

Pain under the diaphragm

The main causes of pain under the diaphragm, in addition to injuries and damage, include diaphragmatic hernias, hernia of the esophageal opening of the diaphragm or its relaxation. The phenomena that arise in this case are often similar to each other and may include the following factors:

• Feeling of heaviness and pain in the epigastric region;
• Pain in the chest;
• Pain under the ribs;
• Shortness of breath (worsens when lying down);
• Rumbling sounds in the chest on the affected side;
• Heart palpitations;
• Anemia;
• Bleeding (often hidden, sometimes manifested in vomit, tarry stool may appear);
• Vomiting, difficulty in passing liquid food (occurs when the esophagus is bent).

Pain in the diaphragm area

Pain in the diaphragm area requires a thorough examination, as well as differential diagnostics with neoplasms of the lungs, liver, pericardium. Pain in the diaphragm area associated with injuries requires urgent medical care. In the case of the formation and exacerbation of a hernia, the patient is prescribed an X-ray. Depending on the results of the examination and accompanying symptoms, a qualified specialist prescribes surgical or conservative treatment.

Diaphragm pain during pregnancy

Pain in the diaphragm during pregnancy may be associated with the development of a hernia of the esophageal opening of the diaphragm. There are several types of this pathology: sliding, paraesophageal or mixed type, congenital short structure of the esophagus with thoracic placement of the stomach is also possible. Sliding hernias in pregnant women are more common than others, in most cases in women over thirty years old, more often in women who have given birth to many. The development of such a pathology during pregnancy is facilitated by a decrease in the tone of the diaphragm and lower esophageal sphincter, an increase in pressure inside the abdominal cavity, diffuse spasm of the esophagus during toxicosis of pregnancy, accompanied by vomiting. Clinical manifestations during pregnancy, as a rule, do not differ from the general ones. Often this is a burning sensation in the epigastric region, heartburn, belching, a violation of the swallowing process.

A sign of a hiatal hernia may be the release of vomit that occurs in the last month of pregnancy. Anemia that does not go away after the sixteenth week may also indicate the presence of a hernia. The approach to treatment in pregnant women is always individual and requires careful diagnostics based on the full picture of the disease.

Diagnosis of diaphragm pain

Diagnosis of pain in the diaphragm is carried out by tapping the chest area, listening to the intestines, and also by X-raying the organs of the peritoneum, chest cavity, stomach, small and large intestines. The X-ray examination method is the leading one in diagnosing pain in the diaphragm.

When diagnosing a diaphragmatic hernia, the presence of injuries is taken into account, the mobility of the chest, and the state of the intercostal space on the affected side are assessed. In some cases, for diagnostic purposes, the patient's peritoneal cavity is filled with gases, which allows for better visibility of neoplasms in the peritoneum and their connection with nearby organs on an X-ray. Pneumoperitoneography (artificial introduction of gases) is performed on an empty stomach under local anesthesia after emptying the intestines and bladder.

If a hiatal hernia is suspected, in addition to an X-ray examination, an esophagoscopy may be performed – an examination of the inner surface of the esophagus using a special instrument.

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Treatment for Diaphragm Pain

Treatment of pain in the diaphragm due to its rupture or injury involves urgent surgical intervention, which consists of suturing the defects after the downward displacement of the abdominal organs.

In case of a diaphragmatic hernia, if there is a risk of strangulation, surgical intervention is also indicated. If the defects are too large, it is possible to install nylon, lavsan or other prostheses. In case of strangulation of the hernia, the displaced organ is lowered into the abdominal cavity; if this is impossible, it is excised, after which the defect is sutured. In case of a hernia of the esophageal opening, in the absence of complications, conservative treatment methods are used, including preventing an increase in pressure inside the abdominal cavity and reducing inflammatory processes in the esophageal mucosa. It is advisable for the patient to maintain an elevated position of the head during sleep; it is also important to monitor bowel function. The patient should not be in positions that contribute to the occurrence of reflux. Fractional but frequent meals are recommended. Food is not eaten immediately before bedtime. The patient is prescribed a protein-rich diet, as well as local anesthetics, antispasmodics and astringents, sedatives and vitamin preparations. In cases of bleeding, as well as in case of ineffectiveness of conservative treatment methods, surgical intervention is prescribed. Treatment of pain in the diaphragm during its relaxation is also carried out surgically.

Prevention of diaphragm pain

Prevention of pain in the diaphragm, in particular, prevention of exacerbation of hernia includes fractional but frequent meals. After eating, one should avoid being in a horizontal position for several hours. The patient should not overexert himself physically, avoid increasing intra-abdominal pressure, monitor bowel function, maintain normal body weight, avoid falls and injuries.