How to Relieve Diaphragm Pain During Pregnancy

Breathing is usually effortless. We breathe in, breathe out — sometimes faster, sometimes slower — and it all just seems to happen automatically. But that isn't always the case during pregnancy, when it can feel like your baby is squeezing the air out of your lungs. 

This is because your diaphragm — the main muscle that helps control breathing — is significantly impacted during pregnancy. As your uterus expands in through each trimester, it can put pressure on the muscle, causing pain and discomfort. 

Keep reading to learn about diaphragm pain during pregnancy, its causes, and simple strategies for relief.

What happens to your diaphragm during pregnancy?

Your diaphragm is a large, dome-shaped muscle that sits just below your lungs, attaching to your lower ribs and separating your chest cavity from your abdominal cavity. The diaphragm is the main muscle to help you breath, but it’s essential for so much more including:

• Helping you cough, sneeze, swallow, and talk
• Supporting circulation of lymphatic system, cerebrospinal fluid, and blood
• Contributing to proprioception and pain perception
• Assisting in postural control and lumbar stability

When your diaphragm contracts, it flattens down into your abdominal cavity, giving space for your lungs to fill, and increasing pressure in your abdomen.

Like the rest of your body, your diaphragm undergoes a lot of change in pregnancy:

• Your growing uterus pushes your diaphragm upward by about 5 cm
• Your lower ribs expand outward, increasing the circumference of your rib cage by about 10-15 cm.
• Diaphragm muscle fibers stretch, altering its shape and ability to contract.
• Breathing patterns become more chest-dominant

At the same time that all of these changes are happening, your blood volume and oxygen needs increase, so your body needs your diaphragm to work even harder. And, normally, your diaphragm is totally up for the task (would you expect anything less from a body that’s capable of pregnancy?):

• Your breathing rate increases a bit (this is hormone-driven)
• Diaphragm thickness remains consistent throughout pregnancy, which suggests that despite being stretched by the uterus, it may actually get stronger.
• It works harder to fill your lungs during both normal breathing and heavy breathing (like exercise).

Even though these changes are normal and expected during pregnancy, pain and discomfort can still happen.

Types of diaphragm pain in pregnancy

Your diaphragm muscle is very well protected inside your rib cage, so diaphragm injuries are very uncommon. When injury happens, it’s usually because of things like trauma (like a car accident). 

During pregnancy, it’s more common to develop discomforts in and around your diaphragm because of changes related to pregnancy. Here are some common types of diaphragm pain in pregnancy.

Restricted movement

As your uterus expands, it can feel harder to take deep breaths because of the pressure on your diaphragm. This pressure can disrupt your diaphragm’s normal range of motion. In response, your breathing pattern may adapt, shifting more towards chest breathing rather than abdominal breathing.

Rib sprain or strain

Softening joints and uterine growth can cause your lower ribs to expand (or flare) out. This is also why you may notice the band of your bra is getting tighter. But these pregnancy-related changes can put you at risk for strains or sprains in the muscles and joints of your lower rib cage. These types of injuries can cause a sharp pain in your diaphragm during pregnancy (or what feels like your diaphragm), and even pain during breathing.

Muscle tightness

Another cause of sharp pain in the diaphragm during pregnancy is muscle tightness — sometimes called a “side stitch.” Increased abdominal pressure, changes in your posture, and adjustments in your breathing patterns can cause this feeling in pregnancy. You may feel this tightness more often during physical activities or even when changing positions. 

Hiatal hernia

The diaphragm has a natural opening (hiatus) for your esophagus (the tube that carries food from your to your stomach) to connect to your stomach below. Sometimes, the upper part of your stomach can push through this hole, forming a hiatal hernia. While some people may not have any symptoms, others might develop gastroesophageal reflux (GERD) symptoms, including non-cardiac chest pain or burning pain in your diaphragm because of acid reflux.

Although hiatal hernias can affect anyone and become more common with age, pregnancy is a risk factor. This is because of the shifting of abdominal organs during pregnancy, which can put extra pressure on your stomach and the diaphragm's hiatus.

Heartburn

Another cause of burning pain in your diaphragm during pregnancy is good old fashioned heartburn. Because of changes in things like your hormones, digestion, and pressure on your stomach, all sorts of gastrointestinal symptoms can happen in pregnancy, including nausea, constipation, and heartburn.

Is diaphragm pain normal during pregnancy?

While discomfort around your diaphragm is common during pregnancy, it's important to understand the difference between typical pregnancy symptoms and potentially serious issues. Most diaphragm pain is mild to moderate and shouldn't really interfere much with your daily activities. 

When should I see a doctor for pregnancy diaphragm pain?

Contact your healthcare immediately if you have diaphragm pain and experience any of the following:

• Severe, persistent pain
• Difficulty breathing or shortness of breath at rest
• Dizziness or lightheadedness
• Sudden, severe chest or abdominal pain
• Sudden changes in cough
• Shoulder pain with abdominal pain
• Symptoms of infection (nausea, vomiting, diarrhea, aches, chills)

Can severe diaphragm pain affect the baby?

While diaphragm pain can be uncomfortable for you, most causes of diaphragm pain during pregnancy aren’t harmful to your baby. However, severe, untreated pain isn’t something that you (or your baby) should have to endure during pregnancy. Reach out to a physical therapist who specializes in pregnancy to help to determine the cause of your pain, and develop a path for relief. And if you have diaphragm pain, and any of the symptoms above, contact your healthcare provider right away.

How to relieve diaphragm pain during pregnancy

There are many things that you can try at home to help ease diaphragm pain during pregnancy, including:

Posture Adjustments:

• Practice good posture and body mechanics
• Avoid tight clothing around the chest and abdomen
• Use extra pillows and different positions to support your body during sleep

Breathing Exercises:

• Deep breathing exercises can help encourage your diaphragm’s normal range of motion

Dietary Modifications:

• Eat smaller, more frequent meals
• Avoid trigger foods that may exacerbate GERD symptoms

Ice or Heat Therapy:

• Both heat and ice can alleviate rib joint or muscle pain. Ice soothes nerve and joint pain and inflammation, while heat improves blood flow and relaxes muscles.
• Avoid heating your abdomen or overheating your body — limit heat to 5-7 minutes and ice to 15-20 minutes per session
• Use towel or other protective barrier to avoid hear or old injury to your skin

3 Exercises for diaphragm pain relief

These exercises can be helpful for some types of diaphragm pain during pregnancy. 

1. Thoracic Extension Stretch with Foam Roller

How to do a thoracic extension stretch with foam roller:

• Sit on a chair, feet flat on the floor
• Place a foam roller across your upper back, positioning it near the bottom of shoulder blades
• Interlock fingers behind head and slowly extend your upper back over roller, holding for a few breaths
• Return to start, and move roller up slightly, repeat

2. Open Books

How to do open books:

• Lie on your left side with knees bent, right arm resting on top of your left
• Inhale deeply, then exhale as you rotate your upper body to the right, leading with your right hand
• Open your chest like a book, extending your right arm as far as comfortable
• Hold for 5-10 breaths, focusing on breathing to expand your ribs
• Slowly return to starting position and repeat on the other side

3. Diaphragmatic Breathing

How to do diaphragmatic breathing:

• Sit with your back supported and shoulders relaxed
• Inhale slowly through your nose, allowing your abdomen, pelvic floor, and lower ribs to expand.
• Exhale slowly through pursed lips, gently contracting your abdominal muscles.
• Repeat for several breaths, focusing on deep, slow breaths.

Find lasting relief with expert support

Diaphragm pain during pregnancy can be uncomfortable, but you don’t have to manage it alone. If your symptoms are sticking around or interfering with your daily life, reach out to one of the pregnancy-expert physical therapists at Origin Physical Therapy. They specialize in evaluating and treating diaphragm-related pain, helping you breathe easier and move more comfortably throughout your pregnancy.