When a person breathes, the diaphragm tightens and relaxes as air moves in and out of the lungs. The diaphragm is a large, thin muscle at the bottom of the chest.
Due to the position of the stomach just below the diaphragm, pain when breathing can feel as though it is in the stomach when it is actually coming from the diaphragm or other nearby chest muscles and tissues.
In this article, we describe some of the possible causes of stomach pain when breathing. We also explain when to see a doctor.
A diaphragm injury can cause stomach pain when breathing.
As with any muscle, it is possible for a person to injure their diaphragm. Causes of diaphragm injuries can include:
- heavy blows to the chest
- injuries that penetrate the chest
- severe coughing
It can be difficult for doctors to diagnose diaphragm injuries because they often occur alongside other significant injuries to the abdomen and chest area. It is also possible that a person may not experience symptoms until weeks or even months after the injury occurred.
The symptoms of a diaphragm injury can include:
- pain in the abdomen or chest
- difficulty breathing
- a cough
The diaphragm needs to move continuously to support breathing, so it is not possible for an injury to recover through rest alone. People with diaphragm injuries usually require surgery to repair the damage.
Gastroesophageal reflux disease
Gastroesophageal reflux disease (GERD) is a condition in which acid leaks out of the stomach and flows back up into the esophagus, or food pipe.
The most common symptom of GERD is heartburn, which is a painful, burning sensation that occurs in the middle of the chest or abdomen. However, not everyone with GERD experiences heartburn.
Other symptoms of GERD may include:
- pain in the chest or upper abdomen
- breathing difficulties
- nausea or vomiting
- bad breath
- painful swallowing or difficulty swallowing
- tooth decay
GERD can occur when the valve at the bottom of the esophagus becomes weak or impaired. Causes of GERD and potential risk factors include:
- being overweight
- being pregnant
- certain medications, such as calcium channel blockers and nonsteroidal anti-inflammatory drugs
- hiatal hernia
Some people can control the symptoms of GERD by making dietary and lifestyle changes. These can include:
- maintaining a healthful weight or losing weight if necessary
- avoiding wearing tight clothing
- stopping eating at least 2 hours before bedtime
- having several small meals a day rather than three large meals
- keeping the body upright after eating
- quitting smoking if necessary
- raising the head of the bed by 6 to 8 inches
Certain foods can also trigger or worsen symptoms in some people. Avoiding these foods may help reduce or prevent symptoms.
Examples of common trigger foods include:
- greasy, fatty, or spicy foods
Doctors can also prescribe medications that help reduce stomach acid and control symptoms. For people with difficult-to-treat GERD, a doctor may recommend surgery.
Smoking may increase a person’s risk of hiatal hernia.
A hiatal hernia, or hiatus hernia, occurs when the top of the stomach pushes through a weakened section of the diaphragm.
Doctors do not fully understand what causes a hiatal hernia, but risk factors include:
- being over the age of 50 years
- being overweight or having obesity
A hiatal hernia does not usually cause symptoms itself, but it can make it easier for stomach acid to flow up into the food pipe, which can lead to GERD.
The most common symptoms of GERD are heartburn and acid reflux, but it can also cause breathing difficulties and pain in the chest or abdomen.
People with a hiatal hernia who experience few or no symptoms may not require treatment.
For people with symptoms, treatment is generally similar to that for GERD and includes lifestyle modifications and medications that reduce stomach acid. If these treatments are not effective, a doctor may recommend surgery.
During pregnancy, a woman’s uterus expands, which can place pressure on the diaphragm. Hormonal changes, such as increased progesterone levels, might also lead to deeper breathing.
These two changes may cause shortness of breath and pain or discomfort in the chest or abdomen in some women, particularly in the third trimester.
A pregnant woman may be able to reduce pain and breathing difficulties by:
- maintaining good posture
- using pillows to prop up the upper body while sleeping
- taking it easy and avoiding activities that trigger or worsen symptoms, such as strenuous exercise
Pleurisy is an inflammation of the pleura, which is a thin membrane that folds back on itself to cover the lungs and line the inside of the chest cavity. This inflammation creates friction between the two layers of the membrane, which can cause sharp, stabbing chest pain when a person breathes deeply or coughs.
Other symptoms of pleurisy can include:
- shortness of breath
- unintentional weight loss
- fever and chills
Other pleural disorders involve the buildup of gas, fluid, or blood within the pleural space, which is the area between the two layers of the membrane.
These disorders can cause symptoms that are similar to those of pleurisy, together with:
People with symptoms of a pleural disorder should see a doctor as soon as possible. The treatment options will depend on the type of disorder, the underlying causes, and the severity of any symptoms.
Doctors may prescribe anti-inflammatory medications to help relieve symptoms. They may also recommend a procedure to remove fluids, gas, or blood from the pleural space.
When to see a doctor
A person who is experiencing severe or ongoing abdominal pain or breathing issues should see a doctor.
Pain in the stomach area or abdomen that occurs while breathing may resolve without treatment. However, people with severe, recurring, or ongoing abdominal pain or breathing difficulties should see a doctor.
Anyone who experiences the following symptoms should seek immediate medical attention:
- severe breathing difficulties
- sharp, severe chest pain
- frequent vomiting
Stomach pain when breathing is often due to a problem with the diaphragm or other muscles or tissues in the chest cavity rather than the stomach itself. Causes can include diaphragm injuries, hiatal hernia, pregnancy, GERD, and pleurisy.
It is important to see a doctor for recurring, ongoing, or worsening pain when breathing. Seek immediate medical attention for severe chest pain or breathing difficulties.