Table of ContentsView AllTable of ContentsAnatomyFunctionConditionsEvaluationFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Anatomy
Function
Conditions
Evaluation
Frequently Asked Questions
The diaphragm is a large muscle that separates the chest, and the organs in it, from the abdomen and the body organs located there. This muscle, also called thethoracic diaphragm, plays an important role in breathing as its alternating movement helps you to inhale and exhale.
This article explains the diaphragm and its function, as well as related health conditions. It adds some information about how conditions affecting the diaphragm are diagnosed and treated, too.
ZEPHYR / SCIENCE PHOTO LIBRARY / Getty Images
The diaphragm is a parachute-shaped fibrous muscle that runs between the chest and abdomen, separating these two large cavities. It is asymmetric, as its right dome is larger than the left dome. The diaphragm has openings that allow certain structures to span the chest and abdominal cavities.
As it moves rhythmically, the diaphragm remains anchored to the ribs,sternum(breastbone), and the spine.
Structure
The diaphragm is primarily composed of muscle and fibrous tissue. The central tendon is a large part of the diaphragm that anchors the diaphragm to the ribs.
There are three large openings (holes) through the diaphragm. They are:
In addition to these openings, several smaller openings also allow smaller nerves and blood vessels to run through.
Location
Your diaphragm body part spans from the front to the back. It is the floor of the thoracic cavity and the ceiling of the abdominal cavity.
Many body organs are near the diaphragm. Your heart, lungs, and the upper part of your esophagus (food pipe) are in the thoracic cavity above the diaphragm. Your lower esophagus, stomach, intestines, liver, andkidneysare below the diaphragm, in your abdominal cavity.
The left and right phrenic nerves send signals to control the diaphragm, which receives its blood supply primarily from the inferior phrenic arteries.
Anatomical Variations
A healthy person can have some minor variations in the diaphragm’s anatomy. For example, the left or right side may be slightly higher or lower without affecting physical functions.
During pregnancy, a woman’s enlarged uterus can shift the abdominal space a bit, raising the diaphragm and causingshortness of breath.
Diaphragm Function
The diaphragm plays an integral role in respiration (breathing). Most of the time, the diaphragm moves involuntarily.
Your thoracic diaphragm also plays a role in helping the movement of muscles during childbirth, having a bowel movement, urinating, and lifting heavy objects. This muscle also helps maintain the flow of lymphatic fluid throughout the body.
The Anatomy of the Lymphatic Vessels
Your diaphragm contracts rhythmically and involuntarily (such as during sleep) due to signals from your brain. You can also voluntarily contract your diaphragm to hold your breath, to breathe more deeply or faster, or to exert your muscles.
Conditions Affecting the Diaphragm
Hiccups
When the diaphragm is irritated, such as when eating or drinking quickly, it can repeatedly contract involuntarily, resulting inhiccups. The sound of hiccups is produced when air is exhaled at the same time that the diaphragm contracts.
Generally, hiccups tend to resolve on their own, but there aretreatmentsfor persistent cases.
Hiatal Hernia
Ahiatal herniais a protrusion of the lower esophagus (and sometimes the stomach, too) into the chest cavity through an opening in the diaphragm. This defect can cause heartburn, indigestion, and nausea.
A number of conditions cancause a hiatal hernia, including:
Hiatal hernias can betreatedwith lifestyle measures and medications alone. In some cases, surgery is recommended to reduce the risk of complications, such asvolvulus(twisting) and strangulation (cutting off the blood supply) of tissues.
Surgery may be performed either through an open orlaparoscopic procedure. With the latter technique, several small incisions are made in the abdomen and the repair is done through special camera-equipped instruments.
An Overview of Hiatal Hernias
Diaphragmatic Hernias
Diaphragmatic herniasare structural defects that allow abdominal organs to enter the chest cavity. They may be present from birth, or, less commonly, can result from trauma.
What Happens if the Diaphragm Is Damaged?Traumatic injury to the diaphragm is rare.It can occur, however, with penetrating trauma (stab wounds) or blunt force trauma (vehicle accidents or falls). Injuries can be life-threatening, and typically involve more than one organ. There is some evidence from animal studies that the diaphragm can heal naturally,but it needs to be surgically repaired (and quickly) in most cases.
What Happens if the Diaphragm Is Damaged?
Traumatic injury to the diaphragm is rare.It can occur, however, with penetrating trauma (stab wounds) or blunt force trauma (vehicle accidents or falls). Injuries can be life-threatening, and typically involve more than one organ. There is some evidence from animal studies that the diaphragm can heal naturally,but it needs to be surgically repaired (and quickly) in most cases.
Paralysis
Conditions that affect the nerves that control the diaphragm can result in weakness or complete paralysis of the muscle.
These nerves can be damaged due to several mechanisms:
Nerve injury-induced diaphragmatic weakness can result in shortness of breath, especially when lying down.Management may require medication, surgery, rehabilitation, or support with mechanically assisted breathing.
The Use of Noninvasive Positive Pressure Ventilation (NPPV)
Chronic Obstructive Pulmonary Disease (COPD)
Lung disease, especiallyCOPD, can cause weakness of the diaphragm. This happens through a progressive process that involves a number of contributing factors.
COPD results inhyperinflated lungsthat physically push on the diaphragm. The whole muscle becomes flattened and its mobility declines. Over time, the cells of the diaphragm are altered due to excessive strain, causing them to lose the ability to function with maximal strength. Chronic oxygen deprivation due to COPD also damages these cells.
The result of COPD-induced diaphragmatic weakness is worseningshortness of breath.
Treatment of COPDcan help slow down the damage to the diaphragm. If oxygen levels are affected, treatment withsupplemental oxygenmay be necessary.
Cancer
Tumors can spread to the diaphragm or may take up space in the chest or abdominal cavity, placing physical pressure on the diaphragm and interfering with its ability to function.
Types of cancer that may affect the diaphragm include:
The symptoms can be gradual or abrupt, and may include shortness of breath, pain with breathing, or loss of consciousness. Treatment generally involves surgical removal of the tumor, radiation treatment and/orchemotherapy, and in some cases,immunotherapy drugsandtargeted therapies.
How Cancer Is Treated
Evaluating the Diaphragm
Evaluation of the diaphragm can include a variety of tests tailored to the suspected medical problem. Imaging tests such as chest or abdominalcomputerized tomography (CT),magnetic resonance imaging (MRI), or ultrasound may identify anatomical variations or tumors.
A hiatal hernia diagnosis may include tests like anupper endoscopyor abarium swallow, which evaluate the structure of the gastrointestinal system. And COPD-associated diaphragmatic problems may be assessed with breathing tests likespirometryorpulmonary function tests.
A Word From Verywell
Your diaphragm plays a critical role in your ability to breathe, as well as other body functions. Contact your healthcare provider if you have diaphragm pain or other symptoms, such as those associated with hiatal hernia or COPD. Early diagnosis and treatment may improve the outlook.
Frequently Asked QuestionsNot exactly. It’s unclear what causes the sharp abdominal pain that sometimes occurs during exercise, but one theory is that a so-called side stitch may occur when the diaphragm tightens up. This doesn’t mean there’s anything wrong with the muscle, though. Side stitches usually go away fairly quickly after you stop exercising.Learn MoreCauses of Rib Cage PainAlthough it’s typically viewed as one muscle, it actually is two distinct muscles: the crural diaphragm and the costal diaphragm. Both play a role in how the lower rib cage expands during breathing.Learn MoreAnatomy of the RibsNo. Without it, your lungs would not be able to function. In fact, the diaphragm is the only organ all mammals have and no mammals, including humans, can survive without.Learn MoreWhen a Ventilator Is Necessary
Not exactly. It’s unclear what causes the sharp abdominal pain that sometimes occurs during exercise, but one theory is that a so-called side stitch may occur when the diaphragm tightens up. This doesn’t mean there’s anything wrong with the muscle, though. Side stitches usually go away fairly quickly after you stop exercising.Learn MoreCauses of Rib Cage Pain
Not exactly. It’s unclear what causes the sharp abdominal pain that sometimes occurs during exercise, but one theory is that a so-called side stitch may occur when the diaphragm tightens up. This doesn’t mean there’s anything wrong with the muscle, though. Side stitches usually go away fairly quickly after you stop exercising.
Learn MoreCauses of Rib Cage Pain
Although it’s typically viewed as one muscle, it actually is two distinct muscles: the crural diaphragm and the costal diaphragm. Both play a role in how the lower rib cage expands during breathing.Learn MoreAnatomy of the Ribs
Although it’s typically viewed as one muscle, it actually is two distinct muscles: the crural diaphragm and the costal diaphragm. Both play a role in how the lower rib cage expands during breathing.
Learn MoreAnatomy of the Ribs
No. Without it, your lungs would not be able to function. In fact, the diaphragm is the only organ all mammals have and no mammals, including humans, can survive without.Learn MoreWhen a Ventilator Is Necessary
No. Without it, your lungs would not be able to function. In fact, the diaphragm is the only organ all mammals have and no mammals, including humans, can survive without.
Learn MoreWhen a Ventilator Is Necessary
15 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kanwal Naveen S. Bains; Sarah L. Lappin. Anatomy, Thorax, Diaphragm.StatPearls.Bordoni B, Zanier E.Anatomic connections of the diaphragm: influence of respiration on the body system.J Multidiscip Healthc. 2013;6:281-91. doi:10.2147/JMDH.S45443Chen Y, Li P, Wang J, Wu W, Liu X.Assessments and Targeted Rehabilitation Therapies for Diaphragmatic Dysfunction in Patients with Chronic Obstructive Pulmonary Disease: A Narrative Review.Int J Chron Obstruct Pulmon Dis. 2022 Mar 3;17:457-473. doi:10.2147/COPD.S338583.Cole JA, Plewa MC.Singultus (Hiccups). In:StatPearls[Internet].Straatman J, Groen LCB, Van der wielen N, et al.Treatment of paraesophageal hiatal hernia in octogenarians: a systematic review and retrospective cohort study.Dis Esophagus. 2018;31(7). doi:10.1093/dote/doy010Puligandla PS, Skarsgard ED, Offringa M, et al.Diagnosis and management of congenital diaphragmatic hernia: a clinical practice guideline.CMAJ. 2018;190(4):E103-E112. doi:10.1503/cmaj.170206Spellar K, Gupta N.Diaphragmatic Hernia. In:StatPearls[Internet].Koenig ZA, Schick S, Quigley R, Turner J.Penetrating Thoracoabdominal Trauma With a Cryptic Diaphragmatic Injury in a 23-Year-Old Male.Cureus. 2021 Feb 3;13(2):e13102. doi:10.7759/cureus.13102.LA-Falce TS, Martini Filho D, Botter M, Saad Junior R.Natural evolution of perforating wounds of 30% extension of the left diaphragm and the anatomopathological characteristics of its healing. Experimental Study.Rev Col Bras Cir. 2022 Jul 1;49:e20223162.Dubé BP, Dres M.Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies.J Clin Med. 2016;5(12). doi:10.3390/jcm5120113Mccool FD, Manzoor K, Minami T.Disorders of the Diaphragm.Clin Chest Med. 2018;39(2):345-360. doi:10.1016/j.ccm.2018.01.012Kaufman MR, Bauer T, Onders RP, Brown DP, Chang EI, Rossi K,et al.Treatment for bilateral diaphragmatic dysfunction using phrenic nerve reconstruction and diaphragm pacemakers.Interact Cardiovasc Thorac Surg. 2021 May 10;32(5):753-760. doi:10.1093/icvts/ivaa324.Santana PV, Albuquerque ALP.Respiratory muscles in COPD: be aware of the diaphragm. JBras Pneumol.2018;44(1):1-2.doi:10.1590/S1806-37562018000010001Pickering M, Jones JF.The diaphragm: two physiological muscles in one.J Anat. 2002;201(4):305-312. doi:10.1046/j.14697580.2002.00095.xKitaoka H, Chihara K.The diaphragm: a hidden but essential organ for the mammal and the human.Adv Exp Med Biol. 2010;669:167-171. doi:10.1007/978-1-4419-5692-7_33Additional ReadingDube, B., and M. Dres.Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies.Journal of Clinical Medicine.5(12):113. doi:10.3390/jcm5120113U.S. National Library of Medicine. Medline Plus.Diaphragm and Lungs.
15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kanwal Naveen S. Bains; Sarah L. Lappin. Anatomy, Thorax, Diaphragm.StatPearls.Bordoni B, Zanier E.Anatomic connections of the diaphragm: influence of respiration on the body system.J Multidiscip Healthc. 2013;6:281-91. doi:10.2147/JMDH.S45443Chen Y, Li P, Wang J, Wu W, Liu X.Assessments and Targeted Rehabilitation Therapies for Diaphragmatic Dysfunction in Patients with Chronic Obstructive Pulmonary Disease: A Narrative Review.Int J Chron Obstruct Pulmon Dis. 2022 Mar 3;17:457-473. doi:10.2147/COPD.S338583.Cole JA, Plewa MC.Singultus (Hiccups). In:StatPearls[Internet].Straatman J, Groen LCB, Van der wielen N, et al.Treatment of paraesophageal hiatal hernia in octogenarians: a systematic review and retrospective cohort study.Dis Esophagus. 2018;31(7). doi:10.1093/dote/doy010Puligandla PS, Skarsgard ED, Offringa M, et al.Diagnosis and management of congenital diaphragmatic hernia: a clinical practice guideline.CMAJ. 2018;190(4):E103-E112. doi:10.1503/cmaj.170206Spellar K, Gupta N.Diaphragmatic Hernia. In:StatPearls[Internet].Koenig ZA, Schick S, Quigley R, Turner J.Penetrating Thoracoabdominal Trauma With a Cryptic Diaphragmatic Injury in a 23-Year-Old Male.Cureus. 2021 Feb 3;13(2):e13102. doi:10.7759/cureus.13102.LA-Falce TS, Martini Filho D, Botter M, Saad Junior R.Natural evolution of perforating wounds of 30% extension of the left diaphragm and the anatomopathological characteristics of its healing. Experimental Study.Rev Col Bras Cir. 2022 Jul 1;49:e20223162.Dubé BP, Dres M.Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies.J Clin Med. 2016;5(12). doi:10.3390/jcm5120113Mccool FD, Manzoor K, Minami T.Disorders of the Diaphragm.Clin Chest Med. 2018;39(2):345-360. doi:10.1016/j.ccm.2018.01.012Kaufman MR, Bauer T, Onders RP, Brown DP, Chang EI, Rossi K,et al.Treatment for bilateral diaphragmatic dysfunction using phrenic nerve reconstruction and diaphragm pacemakers.Interact Cardiovasc Thorac Surg. 2021 May 10;32(5):753-760. doi:10.1093/icvts/ivaa324.Santana PV, Albuquerque ALP.Respiratory muscles in COPD: be aware of the diaphragm. JBras Pneumol.2018;44(1):1-2.doi:10.1590/S1806-37562018000010001Pickering M, Jones JF.The diaphragm: two physiological muscles in one.J Anat. 2002;201(4):305-312. doi:10.1046/j.14697580.2002.00095.xKitaoka H, Chihara K.The diaphragm: a hidden but essential organ for the mammal and the human.Adv Exp Med Biol. 2010;669:167-171. doi:10.1007/978-1-4419-5692-7_33Additional ReadingDube, B., and M. Dres.Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies.Journal of Clinical Medicine.5(12):113. doi:10.3390/jcm5120113U.S. National Library of Medicine. Medline Plus.Diaphragm and Lungs.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Kanwal Naveen S. Bains; Sarah L. Lappin. Anatomy, Thorax, Diaphragm.StatPearls.Bordoni B, Zanier E.Anatomic connections of the diaphragm: influence of respiration on the body system.J Multidiscip Healthc. 2013;6:281-91. doi:10.2147/JMDH.S45443Chen Y, Li P, Wang J, Wu W, Liu X.Assessments and Targeted Rehabilitation Therapies for Diaphragmatic Dysfunction in Patients with Chronic Obstructive Pulmonary Disease: A Narrative Review.Int J Chron Obstruct Pulmon Dis. 2022 Mar 3;17:457-473. doi:10.2147/COPD.S338583.Cole JA, Plewa MC.Singultus (Hiccups). In:StatPearls[Internet].Straatman J, Groen LCB, Van der wielen N, et al.Treatment of paraesophageal hiatal hernia in octogenarians: a systematic review and retrospective cohort study.Dis Esophagus. 2018;31(7). doi:10.1093/dote/doy010Puligandla PS, Skarsgard ED, Offringa M, et al.Diagnosis and management of congenital diaphragmatic hernia: a clinical practice guideline.CMAJ. 2018;190(4):E103-E112. doi:10.1503/cmaj.170206Spellar K, Gupta N.Diaphragmatic Hernia. In:StatPearls[Internet].Koenig ZA, Schick S, Quigley R, Turner J.Penetrating Thoracoabdominal Trauma With a Cryptic Diaphragmatic Injury in a 23-Year-Old Male.Cureus. 2021 Feb 3;13(2):e13102. doi:10.7759/cureus.13102.LA-Falce TS, Martini Filho D, Botter M, Saad Junior R.Natural evolution of perforating wounds of 30% extension of the left diaphragm and the anatomopathological characteristics of its healing. Experimental Study.Rev Col Bras Cir. 2022 Jul 1;49:e20223162.Dubé BP, Dres M.Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies.J Clin Med. 2016;5(12). doi:10.3390/jcm5120113Mccool FD, Manzoor K, Minami T.Disorders of the Diaphragm.Clin Chest Med. 2018;39(2):345-360. doi:10.1016/j.ccm.2018.01.012Kaufman MR, Bauer T, Onders RP, Brown DP, Chang EI, Rossi K,et al.Treatment for bilateral diaphragmatic dysfunction using phrenic nerve reconstruction and diaphragm pacemakers.Interact Cardiovasc Thorac Surg. 2021 May 10;32(5):753-760. doi:10.1093/icvts/ivaa324.Santana PV, Albuquerque ALP.Respiratory muscles in COPD: be aware of the diaphragm. JBras Pneumol.2018;44(1):1-2.doi:10.1590/S1806-37562018000010001Pickering M, Jones JF.The diaphragm: two physiological muscles in one.J Anat. 2002;201(4):305-312. doi:10.1046/j.14697580.2002.00095.xKitaoka H, Chihara K.The diaphragm: a hidden but essential organ for the mammal and the human.Adv Exp Med Biol. 2010;669:167-171. doi:10.1007/978-1-4419-5692-7_33
Kanwal Naveen S. Bains; Sarah L. Lappin. Anatomy, Thorax, Diaphragm.StatPearls.
Bordoni B, Zanier E.Anatomic connections of the diaphragm: influence of respiration on the body system.J Multidiscip Healthc. 2013;6:281-91. doi:10.2147/JMDH.S45443
Chen Y, Li P, Wang J, Wu W, Liu X.Assessments and Targeted Rehabilitation Therapies for Diaphragmatic Dysfunction in Patients with Chronic Obstructive Pulmonary Disease: A Narrative Review.Int J Chron Obstruct Pulmon Dis. 2022 Mar 3;17:457-473. doi:10.2147/COPD.S338583.
Cole JA, Plewa MC.Singultus (Hiccups). In:StatPearls[Internet].
Straatman J, Groen LCB, Van der wielen N, et al.Treatment of paraesophageal hiatal hernia in octogenarians: a systematic review and retrospective cohort study.Dis Esophagus. 2018;31(7). doi:10.1093/dote/doy010
Puligandla PS, Skarsgard ED, Offringa M, et al.Diagnosis and management of congenital diaphragmatic hernia: a clinical practice guideline.CMAJ. 2018;190(4):E103-E112. doi:10.1503/cmaj.170206
Spellar K, Gupta N.Diaphragmatic Hernia. In:StatPearls[Internet].
Koenig ZA, Schick S, Quigley R, Turner J.Penetrating Thoracoabdominal Trauma With a Cryptic Diaphragmatic Injury in a 23-Year-Old Male.Cureus. 2021 Feb 3;13(2):e13102. doi:10.7759/cureus.13102.
LA-Falce TS, Martini Filho D, Botter M, Saad Junior R.Natural evolution of perforating wounds of 30% extension of the left diaphragm and the anatomopathological characteristics of its healing. Experimental Study.Rev Col Bras Cir. 2022 Jul 1;49:e20223162.
Dubé BP, Dres M.Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies.J Clin Med. 2016;5(12). doi:10.3390/jcm5120113
Mccool FD, Manzoor K, Minami T.Disorders of the Diaphragm.Clin Chest Med. 2018;39(2):345-360. doi:10.1016/j.ccm.2018.01.012
Kaufman MR, Bauer T, Onders RP, Brown DP, Chang EI, Rossi K,et al.Treatment for bilateral diaphragmatic dysfunction using phrenic nerve reconstruction and diaphragm pacemakers.Interact Cardiovasc Thorac Surg. 2021 May 10;32(5):753-760. doi:10.1093/icvts/ivaa324.
Santana PV, Albuquerque ALP.Respiratory muscles in COPD: be aware of the diaphragm. JBras Pneumol.2018;44(1):1-2.doi:10.1590/S1806-37562018000010001
Pickering M, Jones JF.The diaphragm: two physiological muscles in one.J Anat. 2002;201(4):305-312. doi:10.1046/j.14697580.2002.00095.x
Kitaoka H, Chihara K.The diaphragm: a hidden but essential organ for the mammal and the human.Adv Exp Med Biol. 2010;669:167-171. doi:10.1007/978-1-4419-5692-7_33
Dube, B., and M. Dres.Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies.Journal of Clinical Medicine.5(12):113. doi:10.3390/jcm5120113U.S. National Library of Medicine. Medline Plus.Diaphragm and Lungs.
Dube, B., and M. Dres.Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies.Journal of Clinical Medicine.5(12):113. doi:10.3390/jcm5120113
U.S. National Library of Medicine. Medline Plus.Diaphragm and Lungs.
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