Diaphragmatic Hernia: Symptoms, Causes & Treatment

Have you ever felt short of breath or tightness in your chest that didn’t seem related to exercise or stress? For some people, these symptoms may be caused by a diaphragmatic hernia, a condition where an opening or weakness in the diaphragm allows abdominal organs to move into the chest cavity. This shift puts pressure on the lungs, making it harder to breathe normally.

Left unchecked, it can lead to complications affecting your breathing and circulation. In this article, we’ll take a closer look at what a diaphragmatic hernia is, the different types and causes, and the treatment options available to help you manage it effectively.

Types and Causes of Diaphragmatic Hernia

There are two main types of diaphragmatic hernias, which differ based on when and how they develop; one occurs before birth, and the other later in life.

Congenital Diaphragmatic Hernia (CDH)

Congenital diaphragmatic hernia develops before a baby is born, when the diaphragm doesn’t close completely during foetal growth. This allows abdominal organs to move into the chest cavity, leaving less room for the lungs to develop properly. CDH is a serious condition that needs immediate medical care after delivery.

Causes include:

• Developmental Defects: The diaphragm may not form fully during early growth, leaving an opening that allows abdominal organs to enter the chest.
• Genetic Factors: Certain genetic mutations or inherited disorders can disrupt diaphragm development, increasing the risk of hernia at birth.
• Environmental Factors: Exposure to harmful substances, infections or nutritional deficiencies during pregnancy can interfere with foetal development and lead to a congenital defect.

Acquired Diaphragmatic Hernia (ADH)

Unlike CDH, an acquired diaphragmatic hernia develops later in life. It may follow an injury, surgery, or repeated strain on the abdominal muscles.

An acquired diaphragmatic hernia may result from:

• Blunt Trauma: Car accidents, falls or sports injuries can tear the diaphragm, allowing organs to shift upward.
• Surgical Complications: Operations near the diaphragm can occasionally weaken or damage it over time.
• Increased Abdominal Pressure: Repeated heavy lifting, chronic coughing, or persistent vomiting can gradually stretch or tear the diaphragm.

What Are the Symptoms of Diaphragmatic Hernia?

A diaphragmatic hernia doesn’t always cause obvious symptoms. It often develops quietly and is sometimes only discovered during a scan for another issue. However, when symptoms do appear, they can make it harder to breathe or cause discomfort, as the shifted organs press against your lungs and reduce their ability to expand fully.

You may notice:

• Difficulty or Rapid Breathing: The hernia limits lung expansion by pushing abdominal organs into the chest, making breathing difficult, especially during physical activity.
• Cyanosis: A bluish tint around the lips or fingertips may appear due to low oxygen levels in the blood.
• Abnormal Chest Development: Pressure from displaced organs can alter chest appearance in children or infants.
• Bowel Sounds in the Chest: When the intestines or stomach move upward, their sounds may be heard in the chest through a stethoscope.
• Concave or “Caved-In” Abdomen: As abdominal organs shift into the chest cavity, the abdomen may look sunken or underdeveloped.

What Are the Risk Factors for Diaphragmatic Hernia?

Some people are more likely to develop a diaphragmatic hernia due to genetic, developmental or physical factors. These include:

• Family History of Congenital Defects: A genetic predisposition may increase the risk of a baby being born with a diaphragmatic hernia.
• Premature Birth: Infants born prematurely may have an underdeveloped diaphragm, making hernia formation more likely.
• Previous Abdominal or Chest Surgery: Surgical procedures in these areas can weaken or damage the diaphragm, raising the chances of an acquired hernia.
• Connective Tissue Disorders: Conditions such as Ehlers-Danlos or Marfan syndrome affect the body’s connective tissues, making the diaphragm more susceptible to tearing or structural weakness.

How Is a Diaphragmatic Hernia Diagnosed?

If your doctor suspects a diaphragmatic hernia, the next step is to confirm the diagnosis and understand how severe it is. Getting an accurate diagnosis early helps guide the right treatment plan and improves recovery outcomes.

• Medical History and Physical Examination

  Your doctor will begin by discussing your symptoms and medical background, including any history of abdominal trauma or congenital conditions. During the physical examination, they may also listen to your chest for unusual bowel sounds or check for reduced breath sounds and uneven chest movement, all of which can signal that abdominal organs have moved into the chest cavity.

• Imaging Tests

  Tests such as a chest X-ray, foetal ultrasound or foetal MRI are used to visualise the diaphragm and confirm whether abdominal organs have moved into the chest cavity. These scans also help determine the size and position of the hernia.

• Other Specialised Tests

  Additional evaluations may sometimes be recommended. A foetal echocardiogram, for instance, helps assess how well a baby’s heart and lungs are developing, while blood gas analysis can check oxygen levels in the blood. Genetic testing may also be suggested if a congenital defect is suspected.

What Are the Treatment Options?

Treatment depends on the type, size and severity of the hernia. In most cases, medical attention and surgical repair will be necessary to prevent complications and restore normal organ function.

• Immediate Stabilisation
  For babies born with a congenital diaphragmatic hernia (CDH), the first step is to stabilise breathing and blood circulation. This may involve oxygen therapy, mechanical ventilation, and intravenous fluids or medications to support the baby’s heart and lungs before surgery is performed.
• Surgical Repair
  Whether congenital or acquired, most diaphragmatic hernias require hernia surgery to close the defect and move displaced organs back into the abdomen. Depending on the case, this can be done through traditional open surgery or minimally invasive techniques such as laparoscopy or thoracoscopy.

If you’re experiencing symptoms like shortness of breath, chest pain or a noticeable bulge in your abdomen, it is important to seek medical evaluation immediately. At our hernia clinic in Singapore, we offer thorough assessment and treatment for both CDH in children and ADH in adults. Book a consultation today to discuss your symptoms and receive care tailored to your needs.