It is statically suggested that almost 60% of adults will have some degree of a hiatal hernia near the age of 60. Exact prevalence rate of the hiatal hernia is not clear because many times it can be asymptomatic. It is possible that you are walking around with a hiatal hernia and not aware of it.
Some people will never experience any serious discomfort due to this condition, but for others, it might cause severe pain and other symptoms with time and require proper treatment.
If you or someone you care about has been diagnosed with this medical condition, you will surely be searching to learn everything about hiatal hernia and its management. In this article, we will tell you all about hiatal hernia and how you should cope with this problem by making a few adjustments in your lifestyle and diet routine.
So, let’s get on with it.
What is hiatal hernia?
A hiatal hernia is a situation in which the upper part of your stomach protrudes through an opening in the diaphragm. The diaphragm is a thin muscle that works as a separator between your chest and abdomen. Your diaphragm helps keep acid from coming up into your GIT from stomach. If a person suffers from hiatal hernia, the chances for the acid to come up in the esophagus are increased. The return of acid from your stomach into your esophagus is known as GERD (Gastro-esophageal reflux disease). GERD gives rise to symptoms such as:
- Epigastric pain
- Problem to swallow food
- Nausea and vomiting
- Difficulty in breathing
In most cases, the root cause of hiatal hernia is not known. It may have a connection with weak muscles of diaphragm. Sometimes the reason is an injury or a birth deformity. The risk of hiatal hernia increases with your age. You are also at greater risk of this disease if you are overweight or a smoker.
People normally find out that they are suffering from a hiatal hernia when they get tests for GERD, heartburn or abdominal pain. The tests include a chest x-ray, an x-ray with a barium swallow, or an upper endoscopy.
You don't need any treatment for it if you do not experience any symptoms. But if you do have symptoms, a few lifestyle changes are required for hernia management. For example; eat small meals, avoid certain foods, quit smoking or alcohol and reduce weight. Your health care facilitator may recommend antacids or other medications. If these do not work, you may need surgery.
Types of hiatal hernia
There are mainly two types of hiatal hernia.
This is the usual type of hiatal hernia. It happens when your stomach and esophagus slide into and out of the chest through the hiatus line. Sliding hernias are likely to be smaller in size. Therefore, they normally do not show any symptoms.
This is also called a Para esophageal hernia. In this condition a part of your stomach sticks out of the diaphragm and remains there. Most patients do not experience any severe condition. However, there is a danger that blood flow to your stomach could be blocked. If that happens, it could cause serious havoc and is considered a medical emergency.
Testing for and diagnosing hiatal hernias
Several tests are available to diagnose a hiatal hernia.
To perform this test, the doctor will make you drink a liquid with barium in it before taking your X-ray. This sort of X-ray provides a clear outline of your upper digestive tract. This X-ray image helps your doctor to spot the location of your stomach. If it is pushing through your diaphragm then you have a hiatal hernia.
Your doctor may do an endoscopy. To perform this, he will slide a thin tube through your throat and pass it down to your GIT and stomach. Your doctor will then be able to observe if your stomach is protruding through your diaphragm. If there happens to be any strangulation it will be visible.
Management of hernia through healthy diet
What we eat and how we eat are very important questions in this matter. In hiatal hernia, the invasion of the stomach into the chest cavity can alter the position of lower esophageal sphincter (A muscular valve that protects the stomach contents from coming back into the esophagus). If it does not close properly, food and acid leak through this opening and flow back towards gullet.
To avoid this situation, you must watch out your eating schedule.
Foods to eat:
Low acidic foods will minimize the chances and severity of hiatal hernia symptoms. The non-acidic, raw and full of fiber diets are ideal for patients with hiatal hernia.
There are some exceptions for the people who suffer from food intolerance issues.
Safe foods to eat may include:
- Leafy green vegetables
- Fruits (except citrus)
- Beans and legumes
- Whole grains
- Lean protein such as tofu and fish
- Nuts and seeds
- Low fat dairy products
- Apple cider vinegar
- Green teas and all decaf beverages
Fermented foods are a rich source of probiotics (bacteria that neutralize stomach acid). They are also very helpful to reduce hiatal hernia symptoms.
Popular fermented foods are following:
- Greek yogurt
It is important to note that consuming processed sugar along with probiotics may be harmful because sugar boosts up the growth of stomach microbes that destroy probiotics.
It indicates that probiotic juices, sweet yogurts, protein powders, ice creams and chewing gums are not a good source of probiotics.
Foods to avoid:
It is necessary to stay away from certain foods if you experience symptoms of indigestion, heartburn, bloating, gas, and regurgitation.
Patients suffering with hiatal hernia should say no to foods that are acidic in nature, oily or contain preservatives.
These foods include:
- Fried and oily foods
- Red meat
- Citrus fruits
- Carbonated soft drinks
- Peppermint and spearmint
- Sweet candies and juices
- Garlic and onions
- Dairy products with high fat
- Refined or fast food
- Bakery items
- Sit in a chair straight up as you eat to ensure that your stomach is in vertical position to take in food. Do not eat anything while in slouching posture.
- Always eat in smaller portions and do not skip meals. This will only result in overeating.
- Avoid munching in office and in front of the TV because you will end up mindlessly putting food into your stomach without even realizing. Eat on the table with prepared portion of meal.
- Take little bites and chew more. The more your food is pulverized, the less the stomach has to work to digest it. This translates to less stomach acid and less acid reflux.
- Sit up straight for at least an hour after eating or walk for 10 to 15 minutes slowly.
- Avoid eating three hours before going to bed. Sleeping with a relaxed and empty stomach means there will be far less chance of nocturnal acid reflux.
The best way to enjoy the above mentioned foods is to cook them in a healthy manner. The way you cook your meals also makes a difference. Here are some cooking tips to avoid heartburn:
- Pick lean meats such as skinless chicken,lean beef cuts, ground turkey, lean cut pork, low fat meat and fish.
- People who experience heartburn should adopt some healthy cooking routines. For example, all fried foods can trigger the heartburn. Therefore, cook in healthy oils, like coconut, and olive oils.
- Make a habit to eat whole foods more often. The fiber content in these foods helps with your acid reflux.
- Eat smaller portion meals frequently instead of three large meals in a day.
- Add probiotics in your diet routine. Cultured vegetables like pickles and simple yogurt are best natural probiotics. You can also start taking a probiotic supplement.
- Drink simple water. You should aim to drink seven to eight glasses of water every day. Try adding lemon in your water. Lemon is a fruit which is acidic outside the body but is metabolized to have alkaline byproducts inside.
- Choose to bake, grill or broil food instead of frying.
- Remove fat from meat while cooking.
- Go easy on spices. Most of them are not harmful as long as are used in moderation.
- Substitute low-fat dairy foods with high fat containing products.
- Eat steamed vegetables.
- Use a substitute for cooking oil such as cooking spray, also limit the use of vegetable oils, butter and ghee.
- There are all kinds of ways to cook food with alternative recipes. Get creative and do not be afraid to try new ones.
In addition to cooking and eating habits, some other life style changes also help to prevent the symptoms too. Such as:
- Maintain an ideal weight. If you are obese, you need to include weight loss as a fundamental part of your treatment plan. The program should ideally be monitored by your physician or experienced nutritionist. Reduce your body mass index (BMI) from more than 30 (obese) to less than 25 (normal). It will reduce the risk of acid reflux 50 percent.
- Take an easy and reasonable approach to exercise. Start from 10 to 15 minutes of exercise performed thrice in a week and gradually increase the speed and duration. The aim of this activity is to create a lifetime habit.
- Stress does not necessarily a reason of acid reflux but it can impact the way in which our body responds to reflux symptoms. Therefore, rather than tying yourself in a knot, try calming and engaging yourself in deep breathing exercises. Find someplace quiet where you can sit and meditate comfortably until the symptoms go away.
- Loosen your belt and do not wear tight pants. Ultimately, anything that puts pressure on your abdomen and jostle the contents of your stomach will trigger the symptoms of hernia. Give yourself a break and avoid all clothes that place direct stress on the stomach.
- If you are suffering with chronic constipation, a daily fiber supplement can improve your irregular bowel movements. A couple of tablespoons of mineral oil or natural laxatives such as psyllium husk can also help ease hardened stools.
- Raise the head of your bed 6 to 8 inches. This is especially helpful for people who are overweight or have GERD. Aligning the stomach in an ascending position will lower the risk of gastric backflow which is related to hiatal hernia.
- If you have been diagnosed with a hiatal hernia, avoid lifting heavy objects. It will only make the situation worse. If you have to carry something heavy, do it with the help of a trolley, a cart or ask someone else to do it. You may also need to change your workout routine if you are a heavy weight lifter or do exercises that put extra force on the stomach muscles such as squats or crunches.
- Last one is that you have to quit smoking because it affects the gastric motility. The movement of your lower esophageal sphincter muscles slows down due to smoking. It is a long lasting effect and becomes a constant problem in heavy smokers. It also worsens the symptoms of even a small hernia.
If these diet and lifestyle tips provide you no significant relief then over the counter proton pump inhibitors or acid production reducing drugs will help to control your heartburn symptoms. Talk to your physician before taking any medication and learn all about their dose and side effects. Surgery may be required in rare cases.
Treatment of hernia with medicine or surgery
In most cases, there is no treatment required to treat this hernia but if you have severe and chronic symptoms of acid reflux and heartburn, then the only solution is to either take medications or go for a surgery.
Medications that normally doctors prescribe for hernia include:
- Over the counter antacids to neutralize acid in stomach
- H2-receptor blockers to lower acid production (OTC or prescription only)
- Proton pump inhibitors to avert acid production, to give your esophagus time to heal
However, these medications have to be taken daily for years and symptoms can re-start if you discontinue the medication. These medications do not offer a solution but mask the problem. Apart from this, they are known to cause other health problems. The following is a partial list of the most commonly known side effects:
- Severe stomach pain, diarrhea that is watery or bloody
- Seizure (convulsion)
- Kidney problems – urinating more or less than usual, blood in your urine, swelling, rapid weight gain,
- Symptoms of low magnesium – dizziness, confusion; fast or uneven heart rate; tremors (shaking) or jerking muscle movements; feeling jittery; muscle cramps, muscle spasms in hands and feet; cough or choking feeling.
- Stomach pain, gas
- Nausea, vomiting, diarrhea
If medications do not work, you might need surgery to recover from hiatal hernia.
To carry out surgery, doctors make an incision in the chest or abdominal area. Sometimes they may use laparoscopic surgery to shorten recovery time.
There is always probability of recurrence of hernia after surgery.
31% people reported pain and reflux even after a hernia surgery - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1602172/ . In such cases, usually another surgery is done to fix damages or medications are prescribed which aren’t really a solution.
Here's an article on the US FDA site mentioning the following about hernia surgeries: "The most common adverse events following hernia repair with mesh are pain, infection, hernia recurrence, adhesion, and bowel obstruction. Some other potential adverse events that can occur following hernia repair with mesh are mesh migration and mesh shrinkage (contraction)." - https://www.fda.gov/medical-devices/implants-and-prosthetics/hernia-surgical-mesh-implants
Grocare® offers three ayurvedic medicines that address pH balance in the body and begin to decrease inflammation to help hiatal hernias naturally - Xembran®, Hernica®, and Acidim® are very effective in hiatal hernia treatments that do not involve surgery. Hernica® strengthens the intestines and abdominal wall naturally by enhancing digestion & regulating bowel movements. Acidim® maintains optimum pH levels in the body and regulates stomach acid production. Xembran® kills H. pylori and other pathogenic bacteria in the stomach which are known to be a major cause of hiatal hernias.
Ultimately, the inflammation reduces, and it regains its normal shape. It is important to maintain a healthy lifestyle during the treatment. Following a regular diet helps these medicines work internally.
As a result, the inflammation reduces, ultimately healing the hiatal hernia. Chances of recurrence are minimized and even eliminated after the course of treatment because the medicines eliminate the root cause of the problem. This medication is equally effective for post-surgical complications.
About the Author:
Adrian Drew is a writer, managing editor and CEO for personal development publication Mind Cafe, devoted to providing readers with actionable wellness tips and ideas.
Dr. Maithili Rembhotkar -
She is a registered Doctor and have a bachelors degree in Ayurveda (B.A.M.S.) from Bharatiya Vidyapeeth College of Pharmacy. She has been seeing patients since passing out of college and have seen over thousands of patients in just 2 years of practice. She is extremely passionate about Ayurveda and the possibilities it offers. There is very little information on this science on the internet and she hopes her insight will offer a new perspective on this.