From the Desk of Carolyn Dean MD ND

A hernia occurs when an organ pushes through a weak spot in the surrounding area. The major symptom is the bulging of the affected area. Hernias usually occur in the abdomen where there are the most options for bulges. A hiatus hernia occurs when a small portion of the stomach pushes through the esophageal sphincter and the diaphragm and peeks up into the chest area, getting trapped there. This implies the muscular sphincter is weak. It is likely weak due to magnesium deficiency.

The symptoms of hiatus hernia are similar to heartburn and GERD with burping and bad breath but with more pain. You might have nausea or find the food you eat regurgitates back into your mouth. Hiatal hernia pain in your upper abdomen can radiate into your chest. A pain like that can be confused with angina or a heart attack, so it’s important to know as much as possible about this condition.

Carolyn Dean MD ND

What Dr. Google might say about hiatus hernia:

Pregnancy and obesity are “risk factors” for hiatus hernia because an enlarged abdomen pressing up against the stomach can push a portion of it up through the esophageal sphincter of the diaphragm.

You may never have a hiatus hernia diagnosed unless you seek medical advice for heartburn or acid reflux (GERD) or chest or abdominal pain because you attribute all your symptoms to plain old burping and belching.

https://medlineplus.gov/hiatalhernia.html

If Dr. Google sends you to a doctor:

  • If you have upper abdominal or chest pain, your doctor may send you for x-rays to determine a possible cause. This would include drinking a barium solution to coat the esophagus and stomach to highlight any abnormalities.
  • You may be put on a tilt table to see if the barium refluxes back up your esophagus.
  • Your doctor may want to take a look at the area using an endoscope, which is a tube with a camera that is inserted down your throat to get images of the esophagus, stomach and diaphragm. Fortunately, you will be well sedated before anyone attempts to make you swallow a camera.

Dr. Google suggests these drugs:

Because having a hiatus hernia can result in having symptoms of heartburn and GERD, often antacids and other acid-blocking drugs are suggested, or prescribed by doctors to address those symptoms.

If your doctor suggests surgical intervention

Doctors have come up with three ways to fix what they think is an anatomical abnormality that causes hiatus hernia. Surgery can be performed where instruments are inserted through small incisions in the abdominal wall to manipulate the stomach and diaphragm.

  1. Your stomach can be pulled back into the abdomen.
  2. Stitches put in the diaphragm opening to make it smaller.
  3. The esophageal sphincter can be surgically reconstructed to make it tighter.
  4. Hernial sacs can be surgically removed.

Hiatal hernia symptoms that might make surgery necessary include:

  • bleeding
  • scarring
  • ulcers
  • narrowing of the esophagus

Contradictory statistics note that hiatus hernia surgery has an estimated 90% success rate even though about 30% of patients have a return of reflux symptoms. Also, I would note that the symptoms that make more surgery necessary can also be the side effects of surgery.

More invasive surgery can wrap the stomach around the lower part of the esophagus. Or less invasive surgery can insert an endoscope through the mouth to place small clips at the end of the esophagus to prevent reflux.

What I say about Hiatus Hernia

The stomach is like an upside-down triangular pouch with the larger end lying to the left side of the upper abdomen and the narrow end going to the right and attaching to the small intestine. If that area feels hard and painful, the stomach may be in spasm. A small area at the top of the stomach can occasionally become intermittently trapped between the esophageal sphincter and the two sides of the diaphragm. This extra tissue in the wrong place can interfere with the movement of the diaphragm, leading to shortness of breath or inability to take a deep breath. If severe, there can be pain that travels around to the back and up the front of the chest.

Often, but not always, there is a reflux of acid up the esophagus because the normal sphincter between the esophagus and the stomach becomes stretched and weakened. When there is chest pain and no acid reflux to identify it as a GI problem, many people, including doctors, mistake these symptoms for heart pain.

When I was in family practice in Toronto, I realized that children can have stomach spasm or mild hiatus hernia after vomiting. Adults who do too many sit-ups can suffer mild hiatal hernia symptoms and women during pregnancy are susceptible, as are people with constipation, all of which puts more pressure on the stomach. Generalized tension, where you breathe high in the lungs and can’t take a deep breath because you are in a constant state of “fight or flight”, can cause the stomach to be “elevated.”

I personally suffered from hiatus hernia after I spent months doing the Pilates “100” exercise, which is equivalent to 100 sit-ups.

There is no medical treatment for hiatus hernia and when it is very severe, surgery is offered. This operation is a last resort because of the many possible side effects including limited stomach capacity, severe discomfort when eating and inability to vomit or belch normally.

However, there are natural treatments for this condition consisting of magnesium along with traction massage on the abdomen to relax the stomach and ease it into its proper position. See below for instructions on Hiatus Hernia Massage.

Healthy options for hiatus hernia

  • Avoid coffee, tea, and alcohol, which weaken the sphincter between the stomach and esophagus making it susceptible to bulging hernias.
  • Avoid sit-ups or do modified sit-ups. To do a modified sit-up, sit on a mat with your knees bent and back straight. Fold your arms over your chest, lean back a few inches and sit up. Choose the number of repetitions that is best for you.
  • Do not lie down after a meal.
  • Do not eat a large meal at night.
  • Do not drink liquids with meals.
  • In the morning, to settle the stomach in its proper position, drink a glass of room temperature water, rise up on your toes and then thump down on your heels about ten times.
  • Learn yogic breathing; when you inhale, let your abdomen rise so that your diaphragm falls. This opens up the lungs to full capacity and massages the stomach in place.
  • Have a professional massage your stomach firmly down and to the right to release the spasm; often you will hear a gurgle as stomach contents that have been trapped are released.

Self Massage

When I had my hiatus hernia episodes after Pilates, I was treated by a chiropractor who showed me how to do my own massage.

  • Stand with your back to a wall.
  • Put your fingers below your breastbone (sternum), find your rib cage and exert some pressure downward on the abdominal tissue.
  • Keep massaging the area pressing and pushing towards your belly button.
  • Imagine that you are pushing out the contents of your stomach and pulling it back into place.
  • Do the same for 5 minutes.
  • Massage the area at least twice a day, preferably in the morning and evening.

Diet:

As mentioned above:

  • Avoid coffee, tea, and alcohol, which relax the sphincter between the stomach and esophagus.
  • Do not eat a large meal at night.
  • Do not drink liquids with meals.

Supplements:

Magnesium: This versatile mineral helps stabilize the muscular function of the esophageal sphincter. The best form to take is a liquid picometer-sized ion of magnesium.

Carolyn Dean MD ND
The Doctor of the Future