Diaphragmatic hernia - why me?

Many patients ask themselves: Why did I develop a diaphragmatic hernia? Was it caused by physical strain, sports, or a specific event?

This region of the diaphragm represents a natural weak point in every individual, which is inherently difficult for the body to stabilize. If additional risk factors are present, the system can become unbalanced.

Established risk factors

• pregnancy (especially multiple pregnancy or a large fetus)

• familial predisposition (parents, grandparents)

• scoliosis

• chronic coughing

Common contributing factors

• pectus excavatum

• rapid growth during puberty

• tall and slender body type

• morbid obesity

• improper strength training

In general, risks arise from chronic pressure load, the individual course of muscle fibers, and the anatomical positioning of the organs within the hiatus.

How does a diaphragmatic hernia develop?

A diaphragmatic hernia does not occur suddenly but develops gradually over time.Very slowly — millimeter by millimeter — the tissue begins to give way.

This condition already exists in many people, often without symptoms and without their awareness. The body can compensate for this phase for years.

Only when stability further declines and actual displacement occurs do symptoms arise. From that point on, the process typically progresses slowly but continuously.

Why do symptoms appear suddenly?

Many patients report a specific “triggering moment.”

It is important to distinguish: This usually marks the onset of symptoms — not the origin of the hernia.

The actual diaphragmatic defect has often been present long before. The body is initially able to compensate through stabilizing mechanisms, such as the formation of supportive connective tissue.

When a particular strain or stress occurs, this compensatory system may finally fail — and symptoms appear abruptly.

At that moment, the diaphragm itself does not “rupture.” The defect already existed.

Rather, the compensatory protective system breaks down.

Conclusion

A diaphragmatic hernia rarely results from a single event — it is multifactorial.

What matters is the interaction of multiple risk factors.

And that is precisely why the underlying cause often remains unrecognized for a long time.

Yours

Priv.-Doz. Dr. med. Eckhard Löhde