Duration
A diaphragmatic cramp often lasts only a few seconds or minutes. More disturbing and tormenting, however, are the closely following series of cramps, which can last even hours or even days. After each seizure – which can lead to pain – there is a relaxation phase and thus a symptom-free interval, which can be followed by another seizure phase. Complaints that last for hours or days should be urgently presented to a doctor to find out the exact cause.
Diagnosis
The suspected diagnosis is made primarily by interviewing the patient (anamnesis). However, imaging techniques are also used for confirmation. It is extremely difficult to provide definite proof of a diaphragmatic spasm because the spasms are temporary conditions that may not occur during the medical examination.
The diagnosis is usually adapted to the patient’s level of suffering. For example, if hiccups occasionally occur, no further diagnosis will usually be made, but if there is severe pain, prolonged hiccups, or effects on other organs such as the stomach or heart, further examination is recommended. This also includes a CT of the abdomen or an MRT.
An ultrasound or a gastroscopy can be performed if hiatus hernia is suspected. A so-called esophageal pap smear examination can also reveal a diaphragmatic hernia. For this purpose, the patient eats a porridge and at the same time different x-rays are taken during the swallowing phase. This way, bulges, invaginations and hernial orifices can be visualized.
Treatment
The treatment of diaphragmatic spasms depends entirely on the triggering cause. For example, irritation of the nerve that supplies the diaphragm usually does not require treatment. In order to treat this, one can reduce any underlying stress or counteract an over-inflated stomach by eating more slowly.
In extreme cases and when the spasms cannot be controlled in any other way, it may be necessary to ligate one of the two nerves supplying the diaphragm, i.e. to sever it in order to reduce the stimuli that repeatedly hit the diaphragm. Neither of the two diaphragmatic nerves can be ligated, otherwise breathing is no longer possible. If the triggering cause is a diaphragmatic hernia, surgical closure of the hernia should be considered in case of frequent complaints.
Today, the open area of the diaphragm is usually sutured again endoscopically (keyhole surgery technique). Sometimes, however, in the course of time, a new hernial orifice can be formed, which may make further surgery necessary. Furthermore, there are some measures that every patient can take himself to avoid recurrent diaphragmatic spasms.
One should, for example, take small bites while eating and take one’s time. Hectic eating can always lead to excessive irritation of the diaphragm. There are also some exercises that anyone can do at home or at work. These are alternating tension and relaxation exercises that are designed to train the diaphragm and make it less sensitive to cramps.
