If you or a loved one are having shortness of breath or fatigue, your first suspicion might be a heart or lung problem. But these symptoms could also signal a problem with the diaphragm, a muscle that facilitates breathing.
Most people don’t know much about the diaphragm. It typically goes unnoticed when it’s working like it’s supposed to. But as a thoracic surgeon, I always keep conditions related to this vital muscle on my radar. Many diaphragm conditions are treatable — with the right diagnosis. So, I want my patients to be aware of possible symptoms and know when to seek help.
What is the diaphragm?
The diaphragm is a thin, dome-shaped muscle that separates your chest from your abdominal cavity. It sits below your lungs and your heart and helps your body:
- Inhale and exhale
- Prevent acid reflux by putting pressure on the esophagus
- Move urine and feces out of the body by putting pressure on the abdomen
Why diaphragm disorders happen
The diaphragm normally contracts when you inhale and relaxes when you exhale. That helps you take full, deep breaths. But certain conditions can cause the diaphragm to weaken or even become paralyzed. Often, that happens when there’s too much pressure on the phrenic nerve, which controls the diaphragm, or when the nerve becomes damaged.
Phrenic nerve issues can stem from a variety of causes, including:
- Complications from neck or chest surgeries or trauma
- Spinal cord injuries
- Birth defects or trauma during labor and delivery
- Cervical spine arthritis
- Certain autoimmune or inflammatory conditions, such as Guillain-Barre syndrome, lupus, or Parsonage-Turner syndrome
- Lyme disease
- Lung conditions such as chronic obstructive pulmonary disease (COPD)
- Neurological disorders such as multiple sclerosis (MS) or amyotrophic lateral sclerosis (ALS)
- Spine tumors, lung cancer, and certain metastatic cancers
Symptoms to know about
Diaphragm disorders usually lead to respiratory symptoms. But the issues each person may experience can vary. Often, it depends on the underlying issue that’s causing their phrenic nerve and diaphragm to malfunction.
When I see patients, there are a few symptoms that put me on alert for a possible diaphragm issue. These include:
- Shortness of breath that’s worse when lying down
- Shortness of breath when standing in water (up to the lower chest or deeper)
- Persistent hiccups
- Significant difficulty bending over (i.e., to tie shoes)
Other symptoms are less specific. They can overlap with other respiratory issues, such as:
- Shortness of breath during activity
- Acid reflux or heartburn
- Bluish skin color
- Chest pain, pressure, or tightness that might be worse after eating
- Coughing
- Fatigue
- Pain or pressure in the back, side, shoulder, or abdomen (usually under the rib cage)
- Pulsing or fluttering in the belly under the ribs
- Racing heart
- Recurrent pneumonia
- Trouble sleeping
These symptoms don’t always mean that a person has a diaphragm disorder. Still, they are signs that something may be amiss. It’s important to have them checked out by a doctor as soon as possible.
Treating diaphragm disorders
Diaphragm problems can be treated and managed to make it easier to breathe. The right therapy will depend on what’s causing the disorder.
Some patients may benefit from conservative options. One such option is physical therapy to train the diaphragm muscle or other surrounding muscles. Another is using continuous positive airway pressure (CPAP) to help with breathing during sleep. If a person is carrying excess weight, losing weight can also help.
In other cases, medication or surgery may be needed. Your respiratory team can help you decide on the best treatment for you.
Getting help
Some diaphragm disorders can be hard to diagnose. It’s important to seek medical attention from a specialist who is familiar with diaphragm weakness or paralysis.
If you or a loved one are having possible diaphragm issues, reach out to Temple’s Diaphragm and Respiratory Muscle Disorders program. Temple has the only program in the Philadelphia region with the tools and expertise to do specialized testing to diagnose and treat diaphragm disorders (including diaphragmatic pacing and diaphragm plication). Request an appointment online or call 800-TEMPLE-MED (800-836-7536) today.