The diaphragm is a large, thin, dome-shaped muscle located at the base of the chest cavity, separating the chest from the abdomen. This muscle contracts and flattens when you inhale, pulling air into the lungs, and relaxes when you exhale. Because of its central location, pain felt in the diaphragm area can originate from various bodily systems, including the musculoskeletal structure, the digestive organs below, or the lungs above.
Strain and Physical Causes
Pain in the diaphragm area often relates to mechanical stress or muscle function. Like any muscle, the diaphragm can become strained or fatigued from overuse, leading to temporary discomfort. This physical strain frequently occurs after intense coughing or sneezing, which puts forceful pressure on the muscle fibers.
A common experience is the “side stitch,” or diaphragmatic spasm, often felt during strenuous exercise like running. This sharp pain is a muscle cramp, typically caused by the rapid, shallow breathing patterns associated with intense activity. Spasms can also manifest as persistent hiccups, which are sudden, involuntary contractions followed by the quick closing of the vocal cords. These physical causes are generally benign and resolve quickly with rest and controlled breathing.
Digestive System Contributors
Discomfort in the diaphragm region can often be referred pain originating from organs in the abdominal cavity directly beneath it. The diaphragm has an opening, called the hiatus, through which the esophagus connects to the stomach. This close anatomical relationship means digestive issues can easily irritate the muscle from below.
Gastroesophageal Reflux Disease (GERD), or acid reflux, is a frequent culprit. When stomach acid flows back up into the esophagus, it irritates the lining, causing pain or burning near the diaphragm. A more specific structural problem is a hiatal hernia, where a portion of the stomach bulges upward through the hiatus into the chest cavity. This protrusion puts direct pressure on the diaphragm muscle, causing pain, shortness of breath, and often worsening acid reflux symptoms.
Trapped gas within the digestive tract is another source of referred pain that can mimic diaphragm discomfort. Gas buildup, particularly in the upper colon, causes distention and pressure that irritates the underside of the diaphragm. This feeling is often described as a dull ache or pressure that may radiate to the back or shoulder, sometimes intensifying after eating.
Lung and Chest Conditions
Conditions affecting the respiratory system or the membranes surrounding the lungs can cause pain in the diaphragm area. Pleurisy is the inflammation of the pleura, the thin layers of tissue lining the lungs and inner chest wall. Normally, these layers glide smoothly, but inflammation causes them to rub, resulting in a sharp, stabbing pain that worsens with deep breathing, coughing, or sneezing.
Infections like pneumonia can lead to pleurisy, as the infection spreads and irritates the diaphragm’s surface. Pneumonia is a serious lung infection that causes the air sacs to fill with fluid, often leading to a persistent cough, fever, and chest pain felt near the diaphragm. The underlying inflammation and the body’s response to the infection are the primary source of discomfort.
More severe conditions, such as a pulmonary embolism—a blockage in a pulmonary artery—can also present with sudden, sharp, pleuritic pain. Any process causing significant, rapid inflammation or pressure in the chest cavity will affect the diaphragm. The pain from these conditions is often compounded by shortness of breath and a rapid heart rate.
Warning Signs and When to Call a Doctor
While many causes of diaphragm pain are minor and temporary, certain symptoms warrant immediate medical evaluation. Pain in the chest that is sudden, severe, and persistent requires serious attention, especially if accompanied by other signs of a medical emergency.
It is important to seek immediate help if the pain radiates to your arm, jaw, neck, or back, or if it feels like crushing or squeezing pressure, as these can be signs of a cardiac event. Persistent shortness of breath, particularly if it occurs at rest or worsens when lying down, requires urgent attention. Other alarming symptoms include high fever, coughing up blood, dizziness, lightheadedness, or profuse sweating alongside the pain. If diaphragm pain is persistent or rapidly worsening, or if it has not resolved within 24 to 48 hours, consult a healthcare provider to rule out a more severe underlying condition.