Hiatal Hernia

By Dr. Loretta Lanphier, ND, CN, HHP, CH

Heartburn and acid reflux are not the worst things that can happen to a person. They are annoying and can be very inconvenient at times, and are a sure way to ruin some of the finer things in life, like a leisurely dinner with old friends. However, perhaps the worst thing about these unpleasant manifestations is that, like many conditions, they often could have been completely avoided through wise lifestyle choices and a moderate, disciplined approach to life that we seem to have lost in this day and age, for the most part. Hiatal hernias are sometimes the source of such symptoms, so let’s see if I can get off my soapbox long enough to learn a bit about how to avoid and deal with them.

What is a Hiatal Hernia?

A hiatal hernia is a protrusion of the upper portion of the stomach into the chest cavity through the “esophageal hiatus,” an opening of the diaphragm, when it is abnormally enlarged. Technically a hernia (an unnatural intrusion of one body part into another part of the body where it does not belong) can occur almost anywhere in the body, but they are most often found in the abdominal area, and hiatal hernias are no exception. The esophageal hiatus is the place where the esophagus (or “food pipe”) enters the diaphragm (the upper stomach). Hiatal hernias are also known as “diaphragmatic hernias” because of their location. Normally, the esophageal hiatus is only big enough to fit the esophagus, but when it is in a weakened or enlarged state, herniation can occur.

Hiatal hernias, to one degree or another, are very common in the United States, mostly due to our poor diets and sedentary lifestyles. By the age of 60, it is estimated that hiatal hernias afflict about 60% of the population. There are basically two types of hiatal hernias:

  • The sliding type of hiatal hernia is characterized by movement of the stomach up into the esophagus during times of pressure in the abdomen, and then its retreat back to the normal position after the pressure subsides, presumably due to the force of gravity.
  • The fixed type (paraesophageal) is a permanent hernia, whereby a portion of the stomach always remains as an intruder in the chest cavity.

Most smaller hiatal hernias may not cause the patient any problems. In fact, many people have a hiatal hernia and never even know it. It is the larger ones that cause most of symptoms typically associated with hiatal hernias, such as acid indigestion, heartburn, acid reflux, and chest pain.

What Causes Hiatal Hernias?

The diaphragm is a large dome-shaped muscle that sits between your chest cavity and abdomen. One of its primary functions is to aid in proper breathing. You may also have heard that voice teachers tell their students to sing “from the diaphragm.” The esophagus, which transports food and drink from the mouth to the stomach, passes through the diaphragm via a hole called the esophageal hiatus, as we spoke of earlier. The bottom line is that anything that strains the esophageal hiatus and causes it to stretch out of shape, enables the formation of a hiatal hernia. This strain often is the result of intense pressure in the abdominal area. There are certain factors that can increase the likelihood of this happening. These risk factors include:

  • Obesity: Any time the body carries excessive amounts of extra weight, it is a strain on all of its systems, but can be especially troublesome in the abdominal area. This extra fat tissue can be a factor in causing a hiatal hernia, or worsening an existing one.
  • Slouching: Poor posture while seated crimps the muscles of the abdomen and also increases pressure that can contribute to hiatal hernias. This is an especially bad habit while eating.
  • Forcing bowel movements: This puts obvious strain on the abdomen, and will contribute to increasing the risk for hiatal hernias. By the way, it’s a great way to get hemorrhoids too, if one had a mind to do so!
  • Improper bending/lifting: This is the classic action that most of us associate with all kinds of hernias. Using your leg muscles, and not your stomach and back muscles, will spare your body a multitude of problems, including hiatal hernias.
  • Pregnancy: As most or you ladies already know, it is a lot easier to strain your muscles, especially the abdominal ones, when carrying a baby. Be careful that you don’t get careless and inadvertently complicate your pregnancy with an unnecessary hiatal hernia.
  • Coughing or persistent vomiting: Ever hear of the “dry heaves?” Well, if you’ve had them, you’ll never forget how uncomfortable they can be. Certain conditions can cause you to have the vomit reflex repeatedly, even when there is nothing to spit up. This is very similar to extended coughing spells, in that both of these conditions can put extraordinary strain on your abdominal muscles. This can also lead to increased problems with hiatal hernias.
  • Smoking: Tobacco smoke is a noxious poison that does all kinds of awful things to your innards, but one of its negative affects is that it stimulates acid reflux, which can be a real problem already for folks with a hiatal hernia. Smoking also dries up your saliva, and one of saliva’s functions is to help protect the esophagus from the damaging effects of stomach acid.

What Are the Symptoms of Hiatal Hernias?

The typical symptoms of hiatal hernia are as follows:

  • Heartburn
  • Indigestion
  • Belching and burping
  • Coughing
  • Hiccups
  • Difficulty swallowing
  • Chest pain or pressure

The above signs are rather ambiguous at times because they can be associated with many other conditions. Hiatal hernias can range in seriousness from an uncomfortable nuisance to complications that could lead to life threatening illnesses such as cancer.  One of the most dangerous results of a hiatal hernia can be a condition called “gastroesophageal reflux disease”, or GERD as it is commonly known. GERD is a condition that is due to a faulty valve between the esophagus and the stomach that malfunctions and allows stomach acid to back up into the esophagus causing irritation.  Hiatal hernias, especially larger ones, can contribute to increasing the risk for GERD. GERD is no mere inconvenience. It causes serious and sometimes dangerous damage to occur in the esophagal area from long-term exposure to stomach acids. Some common complications from GERD are:

  • Difficulty swallowing: Continual exposure to the destructive effects of stomach acid can cause the esophagus to become swollen and constricted due to inflammation and scarring. If this condition continues to worsen, it can become serious and you may have little choice but to undergo surgery to remedy it.
  • Barrett’s esophagus: Repeated exposure to stomach acid in GERD patients sometimes leads to this condition. It is associated with abnormal growth in the esophagus of cells that are very similar to those that compose the stomach lining. Barrett’s esophagus greatly increases your risk of developing esophageal cancer.
  • Esophageal cancer: Esophageal tumors are usually extremely serious, and the prognosis for recovery is oftentimes very poor. Complications such as these are the reason that hiatal hernias and digestive tract problems that often accompany them are a very serious matter that should never be accepted as something you just “have to live with.”  Listen to your body when it cries out to you, before it’s too late to avoid possibly deadly results.

One more critical complication that can occur from hiatal hernias is deserving of special mention due to its life threatening possibilities. Although it is rare, occasionally a fixed hiatal hernia can cause a part of the stomach to be cut off from the blood supply and become very painful and potentially deadly. This condition is called a “strangulated hiatal hernia.” Symptoms that may tip you off to this complication include severe chest pain, difficulty swallowing and breathing, and obstruction of the esophagus. If you have a strangulated hiatal hernia, it is a true medical emergency and you should seek immediate care. Symptoms are often mistaken for those of a heart attack.

What Treatments Are Available for Hiatal Hernias?

First a word about the drugs that are usually passed out to help with the symptoms of hiatal hernia or GERD. While they may provide temporary relief to some degree, they have some serious side effects including making the acid reflux WORSE in the long run by stimulating the production of more stomach acid. So, the more you use them, the more you need them. Hmmmm… I wonder if the drug companies are aware of this little fly in the ointment?  Many antacids are also high in aluminum, which has been linked to Alzheimer’s disease.

So, what can I do to help treat or prevent hiatal hernia if I don’t want to take drugs that make my condition worse or submit to invasive treatments like surgery?

Well, I hate sound like a broken record, but we are what we eat, and the vast majority of cases of hiatal hernia and GERD would not be an issue if we took better care of our bodies through life giving habits like eating smaller amounts of whole foods and getting the physical exercise that we so desperately need for vibrant health. Besides these critical steps, there are a few more tips I’d like to pass along that will specifically help you to conquer the effects of hiatal hernia:

  • Stop smoking if you haven’t already. The cancer sticks have got to go for a thousand different reasons, one of them being that they aggravate hiatal hernias and associated symptoms.
  • Learn to eat slowly in a relaxed and easygoing manner. Take time to enjoy your food instead of looking at it as something to get out of the way.
  • Lose the extra weight. Again, obesity rears its ugly head and wreaks havoc with digestive problems such as hiatal hernias and GERD. You will feel better in so many ways, both physically and emotionally, if you bite the bullet and do whatever it takes to slim down. As the saying goes, “ The joy is in the journey.” Normalizing your weight will give you so many rewards that you will kick yourself for not doing it earlier. One of them will be less heartburn and acid reflux.

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