By a diaphragmatic protrusion, physicians understand a change in position of the diaphragm. This causes it to bulge upward toward the thorax. The causes of a raised diaphragm can vary and do not always require medical treatment.
What is an elevated diaphragm?
When experts refer to a diaphragmatic herniation, they mean a cranial, upward protrusion of the diaphragm. The muscle-tendon plate that separates the abdominal cavity from the chest cavity shifts upward toward the rib cage. This shift can occur either to the left or to the right. The diaphragmatic high forms the contrast to the diaphragmatic low, in which the bulge occurs downward toward the abdominal cavity. The diaphragmatic protrusion is not an independent disease, but usually an accompanying symptom of a pre-existing disease. It is not uncommon for the affected person to visit the doctor because of symptoms caused by the diaphragmatic bulge, such as shortness of breath or flatulence. Most often, however, the diagnosis of the same is an incidental finding. The type of treatment depends largely on the underlying condition responsible for the change in position of the diaphragm.
Causes
Often, diaphragmatic elevation occurs when there is a change in the thoracic-abdominal cavity as a result of which the muscle-tendon plate cannot maintain its original position. This can be, among other things, a malformation of the lung or even pneumonia. An existing scoliosis is also considered a possible cause of diaphragmatic hypertension, as is a heart attack. A disease of the liver, for example a fatty or congested liver or even a cyst or tumor in this region can cause the diaphragm to bulge upward. A significantly enlarged spleen is also a potential trigger of the symptoms. During pregnancy, it is not uncommon for the diaphragm to bulge accordingly as a result of fetal growth. In this case, it is not a disease, but a natural condition that occurs as a consequence of the expanding uterus.
Symptoms, complaints and signs
The main symptoms associated with a diaphragmatic hernia are respiratory symptoms. In mild cases, only the ability to breathe is somewhat limited. However, severe respiratory distress may also occur. Furthermore, the patient suffers from a feeling of pressure on the costal arch. Breathing is further strained during physical exertion or when eating. The same applies to flatulence. However, flatulence is often also the result of a diaphragmatic elevation. Pain occurs only in connection with breathing or when pressure is exerted. Considered in isolation, a diaphragmatic hernia is easily treatable. However, it is caused by displacement processes that are often triggered by enlargement of internal organs. Therefore, the respective cause must be treated. The accompanying symptoms depend on the underlying disease. Thus, there is left-sided, right-sided and bilateral diaphragmatic hypertension. Since the symptoms are similar in all three forms, only a detailed examination can provide information about the nature of the disease. The right diaphragmatic dome may be elevated in liver enlargement and the left in spleen enlargement or gastrointestinal tract changes. Bilateral diaphragmatic elevation may indicate diaphragmatitis, diaphragmatic paralysis, tumor, or abdominal changes. However, diaphragmatitis sometimes develops as a result of a diaphragmatic hernia. It is characterized by painful and severe restriction of respiratory function and can have a life-threatening course.
Diagnosis and course
If there is a suspicion of diaphragmatic hypertension, the first step is an extensive discussion with the patient. In this way, the exact complaints are determined, and not infrequently, a possible cause already arises that comes into question in the specific case. In most cases, the physician obtains certainty through an appropriate X-ray image, which makes the change in position of the diaphragm visible. CT and MRI scans are also conceivable to support the diagnosis. The course of a diaphragmatic herniation is largely determined by the underlying disease.If the bulge occurs due to pregnancy, there is no cause for concern, as it will regress on its own after birth. Untreated fatty liver can lead to further liver diseases and, in the worst case, can also result in the formation of a tumor. This can become life-threatening for the patient if left untreated.
Complications
Diaphragmatic herniation does not always have to lead to complications or to severe symptoms. For this reason, medical treatment is not always necessary. However, those affected by the diaphragmatic herniation may suffer from very severe shortness of breath and likewise difficulty breathing. In this case, the shortness of breath can cause the skin to turn blue. In this case, the organs and the brain are no longer supplied with sufficient oxygen. If the disease is not treated, the internal organs can also be irreversibly damaged. Shortness of breath may also occur. Due to the breathing difficulties, many affected persons can no longer actively participate in everyday life, nor can they engage in sports or strenuous activities. The patient’s everyday life is severely restricted by the disease and the quality of life is reduced as a result. Fatty liver and other liver diseases can also occur as a result of the diaphragmatic hypertension and may have a negative impact on the life expectancy of the affected person. Treatment of the disease is usually without complications and always depends on the underlying disease. In most cases, however, the symptoms can be well limited and alleviated reactively.
When should one go to the doctor?
If breathing is disturbed or impaired, a physician should be consulted. There is cause for concern if the irregularities persist over a long period of time or increase. If states of anxiety, sleep disturbances, or panic reactions occur due to the respiratory impairments, a physician should be consulted immediately. If left untreated, respiratory distress can become life-threatening. Therefore, an investigation should be initiated as soon as there are problems performing physical activities or sports exercises. If the usual tasks and obligations can no longer be performed without discomfort, clarification of the cause is advisable. In case of flatulence, digestive problems, irregularities of the gastrointestinal tract, a general feeling of indisposition, as well as a decrease in physical performance, consultation with a physician should be sought. These are symptoms that are indicative of an existing disease and should therefore be followed up. If there is a pressure pain, a feeling of tightness or irregularities in the intake of food, the affected person needs medical help. If inconsistencies occur in everyday activities such as laughing, coughing as well as speaking, it is advisable to have these checked by a doctor. Abnormal behavior, apathy or withdrawal also indicate the existence of a health disorder. The irregularities should be discussed with a physician.
Treatment and therapy
If a diaphragmatic hump has been clearly identified, the appropriate method of treatment depends primarily on the underlying condition that exists. As mentioned earlier, diaphragmatic bulging during pregnancy does not require treatment because it resolves on its own when the uterus reaches its normal size. However, it may be possible to treat the accompanying symptoms, such as bloating and breathing problems, if they are frequent and/or severe. Pneumonia is treated with medication. Since the causative agents are usually bacteria, antibiotics are administered here to fight the infection. If diaphragmatic hypertension occurs due to severe obesity, weight reduction is advised. Eating smaller portions can also relieve the pressure on the diaphragm. In the case of a fatty liver, the patient’s weight may also need to be reduced. A change in diet may also alleviate discomfort in this case. A cyst or tumor often needs to be surgically removed to restore normal conditions. If the disease is cancerous, chemotherapy is also advisable. In this, the cancer cells are prevented from growing and destroyed.
Prevention
Diaphragmatic herniation can be effectively prevented in some cases.Since it is a symptom and not a disease in its own right, preventive measures apply to the diseases responsible for the change in position. A healthy lifestyle with a balanced diet and sufficient exercise prevents obesity and fatty liver disease. Some cancers are also promoted by an unhealthy lifestyle and can be prevented by changing habits. Excess weight should always be reduced to avoid possible secondary diseases. If frequent and severe flatulence and breathing problems occur, a doctor should be consulted as a precaution. This person can determine whether it is a case of diaphragmatic hypertension and, if necessary, diagnose the underlying disease and initiate appropriate therapy.
Follow-up care
In follow-up care, it is important to assume that the underlying conditions for the diaphragmatic herniation have been found and treated so that the diaphragm could reposition itself properly. However, depending on how long the affected patient has suffered from diaphragmatic herniation, their breathing may still be restricted. Cigarettes are taboo in this case. Regular breathing exercises make people aware of how much lung capacity there is in the first place, how deeply they can breathe in and how long they can breathe out. There are special meditation courses that also offer breathing exercises, but breathing is also trained again and again in yoga. Breathing also stabilizes the body’s oxygen supply. Now the patient can start doing sports again. In any case, running or cycling in the fresh air is recommended because it stabilizes the heart and circulation. In addition, sport ensures better body awareness. This is especially important if the diaphragmatic herniation has occurred due to obesity. Then a main focus should be to lose weight and then keep one’s body weight in the normal range. Various diets can be considered for this purpose, all of which, according to studies, are similarly successful, provided they are carried out consistently. In any case, the patient should make sure to eat a healthy diet, using fresh foods, preferably organic. Alcohol and sweet drinks should be avoided and plenty of clear water should be drunk instead.
What you can do yourself
In the case of a diaphragmatic hernia, medical clarification is necessary. Depending on the cause, various measures can be taken to support medical treatment. If the diaphragmatic herniation is due to an organic condition such as fatty liver or a liver tumor, rest and sparing as well as dietary adjustments apply. The patient is usually referred to a specialist who can provide further advice. If a diaphragmatic herniation occurs in the course of pregnancy, the bulge must be observed in the first instance. The most important self-help measure is to watch for unusual symptoms and complaints and report them to the doctor. If the diaphragmatic protrusion is due to scoliosis, further measures such as taking alternative remedies are advisable. A malformation of the lung can only be treated surgically. However, there are special lung gymnastics, which can bring relief. In the case of diaphragmatic paralysis, self-help measures are also limited to compliance with the doctor’s instructions. If splenomegaly or its cause is responsible for the diaphragmatic herniation, the diet must be changed (in the case of iron deficiency anemia) or the condition must be cured by rest (in the case of infectious causes such as viral hepatitis or mononucleosis), depending on the trigger. Because of the many possible causes of diaphragmatic hypertension, self-help measures should be discussed in detail with a specialist.
