Diaphragm Problems: Causes and Treatment

The diaphragm is a muscle that sits beneath the lungs and separates the chest cavity from the abdominal cavity. Any issue with the diaphragm can significantly impact your ability to breathe.

Mr Kelvin Lau, leading consultant thoracic and cardiothoracic surgeon, explores common diaphragm problems, their causes, treatment options, and when surgery might be necessary.

What are common diaphragm problems?

Several conditions can affect the diaphragm, including:

Diaphragmatic paralysis

Diaphragmatic paralysis happens when the diaphragm muscle loses its ability to contract or move properly, often due to damage to the phrenic nerve which controls diaphragm movement. This can lead to difficulty breathing, especially during exertion, and shortness of breath when lying down.

Diaphragmatic hernia

A diaphragmatic hernia is a condition that happens when an organ from the abdomen, such as the stomach or intestines, pushes through an abnormal opening or weakness in the diaphragm into the chest cavity. This can occur at birth (congenital) or later in life as a result of trauma or age-related weakening of the diaphragm.

Diaphragmatic spasms (hiccups)

A diaphragmatic spasm is a brief, involuntary contraction or twitching of the diaphragm that can be triggered by various factors, such as overeating, stress or an upset stomach. Severe and prolonged spasms can cause discomfort, pain and difficulty breathing, often indicating an underlying problem that affects the diaphragm or the nerves controlling it.

How are diaphragm problems assessed?

Diagnosing diaphragm problems typically involves a combination of:

Physical examination

Your doctor will begin by conducting a physical examination, including assessing your breathing patterns and checking for signs of weakness in the diaphragm, such as a reduction in chest movements during breathing. They may also listen to your chest to detect abnormal lung sounds or signs of respiratory issues.

Imaging tests

Images like X-rays, CT scans, MRI scans or ultrasound will be used to visualise the diaphragm and identify issues such as a diaphragmatic hernia, tumours or other structural abnormalities. Additionally, pulmonary function tests will be performed to measure lung function and assess how well the diaphragm is assisting in breathing.

Electromyography (EMG)

An EMG measures the electrical activity of the diaphragm, which can help determine whether the muscle is responding properly to nerve signals. This test is particularly useful for diagnosing issues like diaphragmatic paralysis.

Endoscopy

In some cases, your doctor will perform endoscopic procedures to view the diaphragm directly, especially if a hernia or another abdominal issue is suspected. These minimally invasive procedures allow for detailed examination and can help guide treatment options.

What treatment options are there for diaphragm problems?

The treatment for diaphragm problems depends on the specific condition, its severity and the underlying cause. Common approaches include:

Conservative treatments

Physiotherapy: Diaphragmatic breathing exercises and respiratory therapy can strengthen the diaphragm, improving its lung capacity and breathing function. These treatments are often recommended for conditions like diaphragmatic paralysis.
Ventilatory support: For patients with significant breathing difficulties, ventilators or non-invasive breathing aids (such as CPAP machines) may be required to support respiratory function.
Medications: In cases where diaphragm problems are due to inflammation or infection, medications such as anti-inflammatory drugs or antibiotics may be prescribed. For diaphragmatic spasms, muscle relaxants can help ease the discomfort.

Surgery

In more severe cases, surgery may be necessary. This includes:

Diaphragmatic plication: In cases of diaphragmatic paralysis, diaphragmatic plication may be required. This is a procedure where the diaphragm is surgically tightened to improve its function and reduce breathing difficulties.
Hernia repair: In cases of diaphragmatic hernias, surgery may be required to repair the hole in the diaphragm and reposition the organs that have moved back into the abdomen.

If you suspect a diaphragm-related problem, it’s important to seek medical advice to receive a proper diagnosis and explore your treatment options.

To book an appointment with Mr Lau, head on over to his Top Doctors profile today.