Anatomy Organs The Anatomy of the Diaphragm This muscle's function is critical to breathing By Lynne Eldridge, MD Lynne Eldridge, MD Facebook Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time." Learn about our editorial process Updated on November 14, 2021 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Rochelle Collins, DO Medically reviewed by Rochelle Collins, DO LinkedIn Rochelle Collins, DO, is board-certified in family medicine. She is an assistant clinical professor of family medicine at Quinnipiac University and works in private practice in Hartford, Connecticut. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Anatomy Function Associated Conditions Evaluation Frequently Asked Questions The diaphragm, often called the thoracic diaphragm, is a large muscle that separates the chest from the abdomen. This muscle plays an important role in breathing as its alternating movement helps you inhale and exhale. ZEPHYR / SCIENCE PHOTO LIBRARY / Getty Images It isn't easy to recognize that you have a medical issue affecting your diaphragm. Symptoms, if present, can include issues like heartburn, nausea, and shortness of breath. Medical conditions involving the diaphragm can range from minor issues—such as hiccups—to more serious problems like hiatal hernias or paralysis. Typically, problems with the diaphragm can be managed medically or treated with surgical intervention. Anatomy The diaphragm is a parachute-shaped fibrous muscle that runs between the chest and abdomen, separating these two large cavities. It is asymmetric, as the 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: The esophageal opening (esophageal hiatus), through which the esophagus, right and left vagus nerves, and left gastric artery and vein pass The aortic opening (aortic hiatus), through which the aorta, thoracic duct, and azygous vein pass The caval opening (cavus hiatus), through which the inferior vena cava and parts of the phrenic nerve travel In addition to these openings, several smaller openings also allow smaller nerves and blood vessels to run through. Location The diaphragm spans across the body from the front to the back. It is the floor of the thoracic cavity and the ceiling of the abdominal cavity. 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, and kidneys are 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 causing shortness of breath. 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. Diaphragmatic Movement When the diaphragm is activated by a nerve, it contracts and flattens. This action decreases pressure and increases the space in the thoracic cavity, allowing your lungs to expand as you inhale. When the diaphragm relaxes, your chest cavity becomes smaller and your lungs release air. 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. Diaphragmatic breathing is a technique that is used to strengthen the diaphragm, allowing more air to enter and exit the lungs without tiring the chest muscles. This is also referred to as "belly breathing" and is often used by singers. Associated Conditions There are several medical conditions that involve the thoracic diaphragm. Traumatic injuries or anatomical defects can interfere with the muscle's function, and the movement of the diaphragm can also be impaired by issues like nerve disease or cancer. Hiccups When the diaphragm is irritated, such as when eating or drinking quickly, it can repeatedly contract involuntarily, resulting in hiccups. 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 are treatments for persistent cases. Hiatal Hernia A hiatal hernia is a protrusion of the lower esophagus (and sometimes the stomach, too) into the chest cavity. This defect can cause heartburn, indigestion, and nausea. A number of conditions can cause a hiatal hernia, including increased pressure in the abdomen (from obesity or pregnancy) or straining (such as with heavy lifting, coughing, or having a bowel movement). Smoking increases the risk, as do some genetic conditions such as Ehlers-Danlos syndrome. Sometimes hiatal hernias can be treated with lifestyle measures and medications alone. In some cases, surgery is recommended to reduce the risk of complications, such as volvulus (twisting) and strangulation (cutting off the blood supply) of tissues. Surgery may be performed either through an open procedure or laparoscopically. 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 hernias are structural defects that allow abdominal organs to enter the chest cavity. They may be present from birth, or, less commonly, can result from trauma. Congenital: The diaphragm doesn't develop as it should in roughly 1 in 2,000 births. As a result, some of the contents of the abdominal cavity can enter the chest cavity. This can result in incomplete development of the lungs (pulmonary hypoplasia). Major strides have been made in supporting babies with a congenital diaphragmatic hernia. For example, with surgery, an artificial diaphragm may be constructed. Acquired: Diaphragmatic hernias may also affect adults as a result of injuries, such as trauma due to motor vehicle accidents, gunshots, or stab wounds. These hernias can cause life-threatening issues, such as lung compression, and they generally need to be repaired surgically. 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: Tumor compression Damage during surgery Traumatic injury Neurological conditions, such as diabetic neuropathy, Guillain-Barré syndrome, and muscular dystrophy. Viral infections, such as polio Bacterial infections, such as Lyme disease 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, especially COPD, can cause weakness of the diaphragm. This happens through a progressive process that involves a number of contributing factors. COPD results in hyperinflated lungs that 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 worsening shortness of breath. Treatment of COPD can help slow down the damage to the diaphragm. If oxygen levels are affected, treatment with supplemental oxygen may 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. For example, mesothelioma—a cancer of the pleura (lining of the lungs)—can spread to the diaphragm. Lung cancer, lymphoma, and stomach cancer are other types of cancer that may affect the diaphragm. 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/or chemotherapy. Evaluation Evaluation of the diaphragm can include a variety of tests tailored to the suspected medical problem. Imaging tests such as chest or abdominal computerized tomography (CT), magnetic resonance imaging (MRI), or ultrasound may identify anatomical variations or tumors. A hiatal hernia diagnosis may include tests like an upper endoscopy or a barium swallow, which evaluate the structure of the gastrointestinal system. And COPD-associated diaphragmatic problems may be assessed with breathing tests like spirometry or pulmonary function tests. Frequently Asked Questions Does a stitch in your side mean something is wrong with your diaphragm? 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 More: Causes of Rib Cage Pain How many muscles make up the diaphragm? 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 More: Anatomy of the Ribs Can you live without a diaphragm? 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. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 14 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. 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 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 Kanwal Naveen S. Bains; Sarah L. Lappin. Anatomy, Thorax, Diaphragm. StatPearls. Martarelli D, Cocchioni M, Scuri S, Pompei P. Diaphragmatic breathing reduces exercise-induced oxidative stress. Evid Based Complement Alternat Med. 2011;2011:932430. doi:10.1093/ecam/nep169 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]. Dubé BP, Dres M. Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies. J Clin Med. 2016;5(12). doi:10.3390/jcm5120113 Qureshi A. Diaphragm paralysis. Semin Respir Crit Care Med. 2009;30(3):315-20. doi:10.1055/s-0029-1222445 Santana PV, Albuquerque ALP. Respiratory muscles in COPD: be aware of the diaphragm. J Bras Pneumol. 2018;44(1):1-2.doi:10.1590/S1806-37562018000010001 Cleveland Clinic. Diaphragm. Pickering M, Jones JF. The diaphragm: two physiological muscles in one. 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