- What Is a Hiatal Hernia?
- Treatment for Hiatal Hernias
- Hiatal Hernia vs Ulcer: What You Need to Know
- What is a Hiatal Hernia?
- How Do You Know if You Have a Hiatal Hernia?
- What Hernias and GERD Can Do To Your Esophagus
- Other Important Facts To Keep In Mind
- Why Choose The Surgery Group?
- Hiatal Hernias
- Risk Factors
- Make an Appointment
- General Surgery
- Hiatal Hernia: Hidden Cause of Chronic Illness
What Is a Hiatal Hernia?
Treatment for Hiatal Hernias
Treating a hiatal hernia can involve lifestyle changes, medication, or surgery.
Your doctor will consider a number of factors when deciding on the best course of treatment, including your general health, how large your hernia is, and how severe your symptoms are. (3)
Recommended lifestyle changes are generally aimed at reducing symptoms of GERD and may include:
- Losing weight
- Reducing meal and portion size
- Avoiding acidic foods, like tomatoes and citrus fruit
- Avoiding caffeine and alcohol
- Avoiding peppermint
- Limiting carbonated beverages
- Limiting fried and fatty foods
- Eating at least three to four hours before lying down
- Keeping your head elevated at least 6 inches when you rest or sleep
- Avoiding tight clothing around your abdomen and waist
- Quitting smoking (1)
Your doctor may also recommend the following medication to treat GERD:
Antacids: These drugs neutralize stomach acid and include brands like Mylanta, Rolaids, and Tums.
Proton pump inhibitors: These drugs more strongly block acid production and can help heal your esophagus. They include Prevacid (lansoprazole), Prilosec (omeprazole), and Nexium (esomeprazole). (2)
Emergency surgery is needed for a hiatal hernia if your stomach is being squeezed so tightly that its blood supply is cut off.
Surgery may also be needed if you have severe GERD that isn’t responding well to lifestyle measures and medication.
To surgically repair a hiatal hernia, your doctor will pull the entire stomach back down into your abdomen and make the opening in your diaphragm smaller.
Your surgeon may also repair your esophageal sphincter — the muscle that normally prevents your stomach contents from flowing back into your esophagus — if needed.
This surgery is usually done laparoscopically — involving several small incisions and using a flexible tube containing a light and camera to view the inside of your abdomen and chest.
Less often and usually only when necessary, your doctor may opt for an “open” procedure, which involves longer incisions, a longer recovery period, and a greater risk of infection, pain, and scarring. (1)
By choosing the appropriate test, a doctor can make a precise diagnosis of a structural upper gut disorder, such as esophagitis or peptic ulcer, by recognizing the diseased area. The patient’s history provides the information that permits the doctor to choose the right test.
In the case of the disorders of gastrointestinal function, such as dyspepsia or non-cardiac chest pain, there is no structural abnormality and no diagnostic test. Hence, diagnosis of these disorders depends even more upon how the patient describes his or her symptoms.
Many people use words to describe their gut symptoms that are vague or misleading. Since these terms are unhelpful in identifying the problem they should be avoided or explained carefully. The following are some examples.
A medical dictionary defines indigestion as “incomplete or imperfect digestion, usually accompanied by one or more of the following symptoms: pain, nausea and vomiting, heartburn and acid regurgitation, accumulation of gas and belching.” I have even heard the term used to denote diarrhea and constipation. Apparently indigestion can include almost any gut symptom. Consequently the term is of little use to a doctor trying to analyze a patient’s history in order to make a diagnosis or plan appropriate tests. For this reason the term is best avoided.
Dictionaries state that dyspepsia is a synonym for indigestion, which again is unhelpful. Gastroenterologists have defined dyspepsia more narrowly as a “pain or discomfort centered in the upper abdomen.” Such a pain is found in peptic ulcer disease or nonulcer dyspepsia and must be differentiated from pains of other upper abdominal complaints. Dyspepsia is a symptom complex or diagnosis recognized by doctors, but unhelpful when trying to describe symptoms.
Learn more about functional dyspepsia
Thus neither indigestion nor dyspepsia are of any diagnostic use, and a person should avoid these terms in a medical interview.
It is preferable to describe in a few words the characteristics of the actual pain, discomfort, or gastrointestinal upset in order to help doctors determine what part of the gut is dysfunctioning and what the diagnostic possibilities might be.
Every human gastrointestinal tract contains gas that occasionally escapes through the mouth or anus. However, gas has come to mean different things to different people.
Someone who belches or burps feels “full of gas.”
Another person suffering the release of gas from the other end may use the term gas euphemistically, too embarrassed to describe gas escaping from the anus – and too discreet to use a slang term.
Still another may feel bloated or distended and say they are “full of gas.” Worsening during the day, the connection of this symptom with intestinal gas is poorly understood.
Noises from the stomach, frequently described as growling or grumbling sounds, are known medically as borborigmi. These sounds are the result of air gurgling with liquids as it passes through the ever-moving intestines.
Fortunately these gas scenarios are seldom signs of serious disease. Nevertheless, they can be annoying and worrying, so it is important that the doctor know how the symptoms of gas manifest so he or she can interpret the complaint.
Learn tips about controlling intestinal gas
Nausea is “the unpleasant feeling of sickness that often precedes vomiting.” It’s not that nausea is imprecise – we all know what it feels like.
The problem is that nausea is associated with so many disorders and circumstances that by itself it has no diagnostic significance. Seasickness or the nausea of pregnancy are obvious only if the doctor knows the appropriate history. Nausea very often, but not always, precedes or accompanies vomiting.
The disorders causing nausea are as varied as motion sickness (middle ear), intestinal obstruction, diseases affecting the brain, drug side effects, hormonal changes, and fright or anxiety states. Sometimes the sight of a food can nauseate.
If a person’s main complaint is nausea, only the associated circumstances, symptoms, and medications can help the doctor search for the cause.
Vomiting seems an easy symptom to understand. It is the return of gastric contents including food and gastric acid from the stomach through the mouth.
However, there are some lesser-known symptoms sometimes confused with vomiting. Regurgitation of acid and food into the esophagus may occur due to a weakness in the lower esophageal sphincter. This is called gastroesophageal reflux – the fundamental abnormality underlying GERD. Unlike vomiting, the regurgitated material returns to the stomach without being ejected through the mouth. In both cases the person may experience heartburn as a result of the acid in the esophagus.
Learn more about gastroesophageal reflux disease
A rarer type of regurgitation is known as rumination. Here a person regurgitates the meal from the stomach into the mouth and then swallows it again with neither discomfort nor concern. The meal is returned promptly before it is mixed with acid, so the person suffers no heartburn.
Learn more about rumination syndrome in children and adolescents
Sometimes excess production of saliva by glands in the mouth may accompany upper abdominal symptoms such as nausea or heartburn. Unlike vomiting, the saliva does not burn and is usually swallowed. This is known as waterbrash.
In many people, the junction between the esophagus (food pipe) and stomach “herniates” up through the diaphragm into the chest cavity. This phenomenon may be temporary or permanent, and is often cited as one of the causes of gastroesophageal reflux disease (GERD). However, hiatal hernia is an anatomical abnormality, not a symptom, and its presence or absence does not equate with the symptoms of GERD.
Learn more about symptoms of GERD
Rather than describing “my hiatal hernia,” it is more precise to describe the sensation itself. The most common symptom is heartburn – a burning sensation behind the breastbone. A careful description of heartburn, and noticing what makes it worse (lying down, large meals, effort, etc) is very helpful to a physician who will diagnose it as GERD, not hiatal hernia.
Learn more about GERD, hiatal hernia, and surgery
There are many causes of chest pain, some very serious, and few are connected to the gut.
The primary concern is that chest pain might be due to heart disease. That is why it is very important to be as precise as possible about the nature of the symptom. Is the pain worse after exercise? Does it occur when walking a certain distance, disappear with rest, and then recur when the certain distance is walked again?
Pain resulting from injury to the muscles or bones of the chest wall will worsen with certain movements of the trunk. Pleurisy, an inflammation of the lining of the lung, will be sharply worse with inhaling or exhaling.
If the pain is due to esophageal disease, then a relationship with swallowing, with meals, or an association with acid regurgitation is usually present. Characteristically, acid-related pain is relieved by antacids and most dramatically by the proton pump inhibitors.
The details surrounding upper gut symptoms are often very important in arriving at a correct and timely diagnosis. Therefore describe symptoms such as chest pain with care. None of these are specific, however, and further evaluation is always required – cardiac disease must be ruled out. Your life could depend upon it.
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IFFGD is a nonprofit education and research organization. Our mission is to inform, assist, and support people affected by gastrointestinal disorders.
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Adapted from IFFGD Publication #524 by W. Grant Thompson, MD, Emeritus Professor of Medicine, University of Ottawa, Ontario, Canada
Hiatal Hernia vs Ulcer: What You Need to Know
Hiatal hernias and ulcers both involve the stomach, both involve stomach acid, and cause symptoms that can overlap. They can also occur at the same time. It’s important to get the diagnosis right because each problem is fully treatable with this right combination of medicines and procedures.
What is important to note here is that both hiatal hernias and ulcers are medical problems that need to be dealt with effectively, once they are suspected of being there or diagnosed conclusively.
What is a Hiatal Hernia?
The diaphragm is a comparatively large, wall-to-wall (from one side of the abdominal/thoracic cavities to the other), highly stretchable muscle that separates the upper (the thoracic cavity) part of the human torso from the lower one (the abdominal cavity).
This organ has multiple functions but two of the most important are:
- Its role in separating the crucially important chest organs on top (the heart, lungs, esophagus, etc.) from the abdominal ones (the intestines, kidneys, bladder, pancreas, liver, etc.) on the bottom; and
- Helping the body to breathe by expanding the lungs to fill with air every time it contracts.
This muscle provides a passageway (the hiatus) through which the esophagus can connect to the stomach, allowing food to travel there from the mouth. Should any type of weakening occur to this muscle surrounding the hiatus, part of the stomach can push uncharacteristically through the diaphragm and into the thoracic cavity, what you get is what is called a “hiatal hernia.”
Interestingly, there are actually 2 types of hiatal hernias, a paraesophageal and a “sliding” type. Although the latter is more common than the former, paraesophageal hernias can have more severe symptoms; both, however, may contribute to something called gastroesophageal reflux disease or GERD.
Things like being born with an overly-extended hiatus, excessive pressure being put on the stomach, constipation, coughing, previous surgeries & injuries, concomitant disease, lifting heavy objects and vomiting can contribute to the development of a hiatal hernia. While anyone may suffer from a hiatal hernia, they are more common among the overweight and the elderly.
How Do You Know if You Have a Hiatal Hernia?
Many times, you may not even know that you have a hiatal hernia, there being few or merely mild symptoms. Such a hernia, though, is often discovered while undergoing medical imaging or an examination for unrelated (or possibly related) conditions. They may be spotted with an endoscope, or with the use of medical imaging (e.g., a chest X-ray).
Then again, as the hernias grow in size or severity, the following symptoms may pop up:
- Abdominal discomfort/pain
- Swallowing difficulty
- A “fullness” feeling in the chest
- Breathing difficulties or asthma
- Ulcers in the esophagus (precipitated by the highly caustic acidic juices that are abnormally pushed upwards into the esophagus)
- Bleeding (most probably from the ulcers that may rupture)
- Chest pain that may mimic a heart attack—i.e., as such, it can be intense, persistent & chronic
What Hernias and GERD Can Do To Your Esophagus
As a hiatal hernia gets worse or is not treated (possibly because it hasn’t yet been discovered or diagnosed), one of the possible dangerous developments is that acid from the stomach may impart significant damage to the lining of the esophagus. Slowly and gradually, erosive esophagitis (serious irritation of the esophagus) may set in which, at first, may only cause slight symptoms and, possibly, some difficulty swallowing, or swallowing accompanied by some discomfort.
As time goes by, and the situation worsens, a patient with a hiatal hernia (and the other contributing factors, like maybe too much acid being produced by the stomach, and a bacterium called H. pylori that is often found in these situations) can inflict dangerous problems like Barrett’s Esophagus, heartburn, burping/gas, scarring and ulcers.
As for these “ulcers,” they should first of all be distinguished from peptic ulcers, which generally occur along the lining of the stomach or initial part of the intestine (duodenum). The types of ulcers being discussed here, though, are found further up the digestive system—i.e., the esophagus; it should also be noted that the ulcers in question may be referred to under different terminologies or categories. Three such distinctive terms are hiatal hernia ulcers, erosions or Cameron ulcers, and discreet esophageal ulcers.
What must be remembered about these ulcers is that they are the direct result of ongoing damage to the esophagus from acid and, if the conditions that lead to them aren’t treated, serious long-term consequences may be the result, not the least of which are bleeding that can lead to iron-deficiency anemia, breathing difficulties, and violent coughing, sleep apnea and cancer.
The bottom line is that ulcers can be the result of hiatal hernias. In most cases, however, medicine and surgery can restore normal conditions, including reducing, and possibly eliminating, the problem of stomach acid coming back into the esophagus. Once this is accomplished, then it’s just a matter of giving treatments that will help the esophagus heal effectively.
Unfortunately, the damage already done may also require surgical intervention; otherwise, medications may be given, as well as lifestyle and dietary changes, that with time can help the esophagus heal. The esophagus in question, especially if exposed to stomach acid conditions for a long time (before being diagnosed), may not completely heal and may even deteriorate into permanent or difficult to treat conditions like Barrett’s Esophagus and, worse yet, malignant neoplasms (cancer).
Because the ulcers that hiatal hernias can contribute to or help make possible can be so dangerous and so permanently far-reaching, they need to be taken seriously and aggressively looked for, if a hiatal hernia is ever diagnosed.
Other Important Facts To Keep In Mind
–If a patient is ever diagnosed with chronic upper GI bleeding and/or iron-deficiency anemia, then Cameron lesions may be present if a hiatal hernia or GERD are also involved.
–People with esophageal ulcers may also be suffering from often related conditions, including acid-peptic ailments, reflux esophagitis, ischemia, mechanical trauma, breathing disorders (i.e., sleep apnea, chronic coughing, etc.), iron-deficient anemia, as well as acid mucosal injury.
–Hiatal hernias and the many complications and concomitant ailments that may come with them can be life-threatening, if their symptoms and ramifications aren’t treated adequately, preferably with the use of surgery.
— But the same can be said, unfortunately, for such serious diseases as obesity, high blood pressure, cancer, cardiovascular disease, etc. For the record, both hiatal hernias and esophageal ulcers shouldn’t be taken lightly and, if long-term good health is your goal, then both should be dealt with proactively and, once diagnosed, aggressively.
Why Choose The Surgery Group?
We remain committed to providing our patients with innovative, safe alternatives to open surgery. However, there are times when open surgery is warranted, and minimally invasive surgery is not an option. In cases such as these, our board-certified surgeons are prepared to perform conventional surgery and provide each patient with the compassionate, high-quality, personalized care they deserve.
OUR SURGEONS ARE NOT DIRECTLY OR INDIRECTLY ASSOCIATED WITH ANY HOSPITAL. As such, we can recommend the best place for your Surgery to be done. Our only interest is resolution of your health problem in the safest and easiest way. Any surgeon who works for a hospital is bound by the administrative policies dictated by that hospital which can affect your care. These surgeons may be encouraged to use techniques or consultants or diagnostic tests which benefit the hospital system and are not in the best interests of the patient.
Our surgeons are continually maintaining their skills and expertise. This is accomplished by keeping up with the latest surgical techniques and technological advancements in our field. Whether we are performing an open surgery, a minimally invasive procedure or a robot-assisted surgery, our expert surgeons can perform complex and delicate procedures with unmatched precision.
If you need surgical intervention for any of the conditions or diseases listed above, contact our office today, at 850-444-4777, to schedule an initial consultation with one of our Board-Certified Surgeons. We proudly serve Southwest Alabama (the Gulf Coast), Northwest Florida, Fort Walton Beach, Destin, Florida Panhandle, Milton, Foley, Atmore, Brewton and Santa Rosa County.
A hernia occurs when an organ protrudes through the wall of muscle that encircles it. A hiatal hernia means that the upper part of your stomach has protruded up into your chest, pushing through the little opening (or hiatus) in your diaphragm (which separates your abdomen from your chest).
Most of the time, hiatal hernias are so small they might not be felt at all. But if the hernia is a bit larger, it could force the opening in your diaphragm to become larger, too. At that point, the entire stomach and other organs are in danger of sliding up into your chest.
A hiatal hernia can also put undue pressure on your stomach, by squeezing or twisting it. This pressure can make your stomach retain acid, which can then flow up into your esophagus. You could develop chest pain, gastroesophageal reflux disease, and/or heartburn, and have trouble swallowing or even breathing. The acid may also cause ulcers within the stomach that can bleed and lead to acute or chronic anemia (low blood counts).
There are a few different kinds of hiatal hernias. Type I hernias, or sliding hiatal hernias, are the smallest and most common variety. These hernias cause your stomach to slide through a small opening in the diaphragm, and up into your chest. These often do not require an operation or treatment.
Much less common than these are Types II, III, and IV hernias, or paraesophageal hernias. These occur when a part of the stomach protrude into the chest adjacent to the esophagus. That part of the stomach is “trapped” above the diaphragm and can’t slide back down again. While these hernias are far less common, they can be more dangerous, since they cause more serious symptoms, and because the blood flow to your stomach can be compromised.
Those over the age of 50, pregnant women, and the obese are at higher risk. A hiatal hernia can also be triggered by insistent pressure on the hiatus muscles. That pressure can be caused by coughing, vomiting, immoderate straining during bowel movements, lifting heavy objects, and/or excessive physical exertion.
Hiatal hernias, especially Type I hernias, do not usually cause symptoms. They may, however, be associated with the following: burping, heartburn, nausea, vomiting, and/or regurgitation into the esophagus.
A paraesophageal hernia, or Type II, III, or IV hernia, may cause more severe symptoms. These can include:
- Abdominal/chest pain
- Abdominal bleeding (which can be indicated by blood in vomit, red or black stool, anemia, blood test indicating loss of blood)
- Change in voice
- Early satiety (or becoming full after only eating a small amount of food)
- Occasional trouble swallowing (especially solid food)
- Shortness of breath or trouble breathing after eating
- Acid reflux
- Regurgitation or a sensation of food “sticking”
Along with a complete exam and detailed medical history, your surgeon may use one or more diagnostic tests to determine the best course of treatment.
Barium Swallow / Upper GI study requires that you swallow a small amount of contrast material, or liquid barium, which coats the lining of your esophagus so that X-ray images may be obtained. If you have experienced trouble swallowing, this procedure can help to locate any areas in your esophagus that may have narrowed. These areas are called strictures.
Chest X-rays: Electromagnetic energy produces images of internal tissues, bones and organs.
CT-Scans: These scans make up a series of images of the inside of your body, all taken from different angles, to reveal a high level of detail. To ensure that your veins and organs show up clearly in these scans, you may need to swallow a dye used for that purpose, or have it injected into your vein.
Upper Endoscopy (EGD): A procedure in which an endoscope is threaded through your mouth and then into your esophagus. This procedure allows your surgeon to actually see your upper digestive tract, which includes your esophagus, stomach, and duodenum, or the first part of your small intestine. Your surgeon can then remove a tissue sample as well.
Hiatal hernias don’t always require treatment beyond regular monitoring and medications. Under certain conditions, however, treatment will be necessary. Those conditions include: chronic anemia; chronic pain; complications by gastroesophageal reflux disease; complications by esophagitis; danger of strangulation; inability to vomit; recurrent pneumonia or other infections. The following treatments are available for those with hiatal hernias.
Minimally Invasive Hernia Repair
Minimally invasive surgery can effectively diminish the size of a hernia, as well as reduce the opening in the diaphragm, thereby preventing strangulation. During this procedure, surgeons will insert a tiny video camera into your abdomen. They’ll be able to view images projected onto a monitor, which will allow them to complete the procedure with greater control and finesse. The purpose of this surgery is to restore the stomach into your abdomen and close down the hole in the diaphragm. Minimally invasive surgery is associated with a quicker recovery and faster return to function than traditional open repair. Your doctor will determine if you are a candidate for this approach. (Video)
Your surgeons may also perform a fundoplication, which will help to prevent acid from rising through the stomach.
Make an Appointment
To discuss a potential hernia treatment or surgery, contact the Surgery Call Center at (734) 936-5738.
What is a paraesophageal hernia?
Any time an internal body part pushes into an area where it doesn’t belong, it’s called a hernia. The hiatus is an opening in the diaphragm – the muscular wall separating the chest cavity from the abdomen. Normally, the esophagus goes through the hiatus and attaches to the stomach. In a hiatal hernia, the stomach bulges up into the chest through that opening. There are two main types of hiatal hernias: sliding and paraesophageal (next to the esophagus). There are two main types of hiatal hernias: sliding and paraesophageal (next to the esophagus).
In a sliding hiatal hernia, the stomach and the section of the esophagus that joins the stomach slide up into the chest through the hiatus. This is the more common type of hernia. These sliding hiatal hernias are a risk factor for gastroesophageal reflux disease (GERD), and many patients with hiatal hernias suffer from GERD symptoms such as heartburn.
The paraesophageal hernia is less common, but is more cause for concern. In many patients, paraesophageal hernias may not cause any symptoms for the patient. These asymptomatic hernias can be safely observed and do not require surgery. When a paraesophageal hernia begins to cause symptoms (chest pain, upper abdominal pain, difficulty swallowing), these are usually repaired. Symptomatic paraesophageal hernias are at higher risk for progressing to incarceration (stomach gets stuck resulting in obstruction) or ischemia (blood supply to the stomach is cut off) resulting in the need for emergency surgery.
When should a paraesophageal hernia be repaired?
In general, all paraesophageal hernias causing symptoms should be repaired. Common symptoms from a paraesophageal hernia include:
- Chest pain—there are many causes for chest pain. It is important that patients who have a large paraesophageal hernia with chest pain undergo some kind of a cardiac evaluation to make sure that the chest pain is not from their heart. Typically, eating brings on chest pain from a paraesophageal hernia. Some patients have pain every time they eat, and others only experience discomfort every once in a while.
- Epigastric pain—this is pain in the middle, upper abdomen.
- Dysphagia—difficulty swallowing.
- Shortness of breath—in some very large paraesophageal hernias, the stomach may push on the diaphragm or compress the lungs contributing to a sensation of shortness of breath. There are many other reasons for shortness of breath in addition to a paraesophageal hernia.
- Stomach ulcer—in some patients with paraesophageal hernias, the stomach may twist upon itself resulting in a specific kind of stomach ulcer known as a Cameron’s erosion. These ulcers can occasionally contribute to chronic slow blood loss and anemia.
Many patients (but not all) with paraesophageal hernias may also suffer from gastroesophageal reflux disease symptoms. GERD by itself is not a reason to repair a paraesophageal hernia. GERD is first treated with medications, and surgery is reserved for those who fail medical management.
For an in-depth discussion on whether a paraesophageal hernia should be repaired, please make an appointment with one of our surgeons.
How are paraesophageal hernias repaired?
Currently, most paraesophageal hernias can successfully and safely be repaired laparoscopically (with about 5 very small incisions) and through the abdomen (rather than the chest cavity). The laparoscopic repair of large paraesophageal hernias (most of the stomach resides above the diaphragm in the chest cavity) is a complex procedure and should only be attempted by expert laparoscopic surgeons with extensive experience in laparoscopic foregut surgery.
During surgery, the stomach is gradually moved back into the abdominal cavity. The diaphragm at the esophageal hiatus is closed to prevent the stomach from re-herniating. In some cases, a special kind of mesh is needed to close the diaphragm appropriately. Once the diaphragm has been closed, most patients undergo a fundoplication or a ‘wrap’ similar to what is done for a patient with GERD. The fundoplication is performed to help keep the stomach from herniating back into the chest cavity.
What are the results of paraesophageal hernia repair?
In the hands of experienced surgeons, the results of laparoscopic paraesophageal hernia repair are excellent. A minimally invasive laparoscopic approach results in significantly fewer complications than an open abdominal approach (many small incisions instead of one large incision in an open approach). Most patients are in the hospital for only 1-2 days, and are back to their usual activities within 4 weeks.
Side effects can occur, and are similar to those observed after laparoscopic Nissen fundoplication. Abdominal bloating can occur, but is rarely severe. Difficulty swallowing (dysphagia) is another side effect that tends to improve in most patients with time – provided food is chewed thoroughly. The majority of patients are able to belch easily when necessary; especially once some time has passed following surgery.
For a more detailed discussion about the options, risks, and outcomes of paraesophageal hernia repair, and to determine if a patient is a candidate for a laparoscopic repair, please make an appointment with a minimally invasive gastrointestinal surgeon in the Division of General Surgery at the Medical College of Wisconsin.
“Elective Repair of Paraesophageal Hernia is Safe”
Hiatal Hernia: Hidden Cause of Chronic Illness
When people are new to natural healing, they can often feel overwhelmed by the various supplements and modalities that are available. Often, they just don’t know where to begin—especially when there are so many different companies and healers telling you to “buy our products!”
Although I do sell herbs and nutritional supplements, there are many things that are important to improving health that don’t involve swallowing something. In fact, there is one key to helping people improve their health that has solved more health problems than anything else I’ve ever learned. It has helped me resolve cases where people had been to numerous doctors and healers but had made no progress. It is an underlying problem in all chronic illness. This problem is tension in the solar plexus and/or a hiatal hernia.
My own health improved dramatically when Jack Ritchason taught me about the hiatal hernia (also called a hiatus hernia), and pulled mine down. At the same time, I learned about the ileocecal valve and how to fix that, too. Learning to fix these problems was the single biggest key to improving my health and has been a big key in improving the health of others, too.
Before I learned how to fix this problem, I had to be extremely careful about what I ate and I had to take a lot of herbs and supplements to stay healthy. I also had to do a lot of cleansing. Even then, my health was not as good as I would have liked it to be.
Once my hiatal hernia was fixed and my ileocecal valve was closed, I found that I could eat a wider variety of foods without suffering a negative impact to my health. I also had to take less than half as many herbs and supplements to get the same results. When this was corrected, I had more energy, gained muscle mass and felt better overall.
Jack taught me that all chronically ill people have a hiatal hernia. I’m not sure that this is the case, but I do know that nearly all chronically ill people have tension at the solar plexus that is interfering with digestion and breathing. Whether this condition would be considered a full-blown hiatal hernia by the medical profession or not, I don’t know.
The esophagus passes through an opening in the diaphragm muscle called the hiatus. The esophagus ends where it connects to the stomach. The stomach lies in the abdominal cavity below the diaphragm. What a person has a hiatal hernia, a portion of the stomach protrudes up into the chest cavity through the opening for the esophagus (as pictured below).
The diaphragm muscle is supposed to contract downward into the abdominal cavity to expand the chest area when we inhale. As the diaphragm relaxes upward, we exhale. This is why a baby’s tummy rises and falls when they are breathing. The movement of the diaphragm causes the abdomen to expand outward when we inhale and relax inward as we exhale.
When the stomach is in the way of the diaphragm, it can’t move like it is supposed to, so the person can’t take a deep abdominal breath. In order for the person with a hiatal hernia to take a deep breath, they must lift their chest and shoulders.
This is what I do to determine if a person has a hiatal hernia. First, I ask them to take a deep breath. If they breathe upwards into their chest, I show them how to breathe abdominally and ask them to try it. A person who has a hiatal hernia cannot take an abdominal breath—even when I try to coach them how to do it.
Chronically ill people are almost universally chest breathers. Occasionally, with a little coaching they can take a little bit of an abdominal breath, but even then it is strained, suggesting that they may have a partial hiatal hernia. Some chest breathers seem able to be taught how to breathe abdominally and can do it with coaching. This suggests they don’t have a hiatal hernia, but they still have tension in the solar plexus, which is inhibiting breathing. I believe this tension is adversely affecting digestion, too, even though the problem is not actually a hiatal hernia.
Check yourself, right now. Place one hand on your abdomen and one hand on your chest. Take a deep breath. Your chest should move only slightly, but your abdomen should expand outward noticeably when you inhale. If your chest expands outward and your stomach pulls inward when you take a deep breath, you probably have a hiatal hernia or at least tension in the solar plexus.
Medical literature suggests that 1-20% of the population have a hiatal hernia, but about 95% of the people I see have problems breathing deeply from their diaphragm. While this doesn’t mean they have a medically-diagnosable hiatal hernia, it does suggest they have problems with both breathing and digestion that are contributing to their health problems.
Problems Caused by a Hiatal Hernia
The first problem a hiatal hernia creates is shallow breathing. Shallow breathing increases acidity in the body because breathing is the first line of pH buffering. Shallow breathing also increases pain, since pain is usually a sign of lack of oxygen to the tissues. Shallow breathing reduces energy levels, because the cells need oxygen to create energy. A low oxygen environment is ideal for the growth of bacteria, parasites and cancer cells. In short, lack of oxygen is one of the primary causes of chronic illness—a cause that is overlooked by most people who are selling nutritional supplements or teaching people about nutrition or health.
That’s bad enough, but the problem doesn’t stop there. Besides causing shallow breathing, the hiatal hernia also inhibits digestion. It causes stress on the nerves to the stomach, which reduces secretion of acid and enzymes. As a result, proteins are not properly digested and minerals are not properly absorbed. This is why people with severe hiatal hernias lack muscle tone and are often very sickly. Many young people with this problem are excessively thin, while older people tend to be overweight with poor muscle tone.
Depending on how far up into the diaphragm a person’s stomach protrudes, a hiatal hernia may or may not cause problems with acid reflux. If the stomach is in certain positions, the sphincter at the top of the stomach will not close properly to hold acid in the stomach. In my experience, people with chronic acid reflux always have a hiatal hernia. However, the reverse is not true—not everyone with a hiatal hernia experiences acid reflux.
The ironic thing is that people with hiatal hernias don’t produce enough hydrochloric acid to properly digest food, but because they are prone to acid indigestion, heartburn and acid reflux, they are frequently neutralizing what little acid they do produce with antacids and acid blockers. The result is a vicious downward spiral of declining digestive function and general health.
The Ileocecal Valve
The problems we’ve discussed so far are directly caused by the hiatal hernia, but there are also numerous secondary problems caused by this condition. For instance, a hiatal hernia will often cause frequent gas and bloating. This is because improperly digested protein will accumulate in the intestinal tract and contribute to intestinal irritation and inflammation. Poorly digested food irritates the ileocecal valve (which separates the small intestine from the colon) causing it to become inflamed. When the ileocecal value is inflamed, it swells and the swelling prevents it from shutting properly. This allows bacteria from the colon migrate into the small intestines and feast on the sugars in the small intestine. This will cause severe gas and bloating. I’ve relieved many severe cases of bloating just by closing the ileocecal valve.
An open ileocecal valve is like having your septic tank or the sewer back up into your kitchen. Not a very pleasant thought is it? About 95% of all people with a hiatal hernia also have an open ileocecal valve, although occasionally you’ll find one without the other. An open ileocecal valve weakens the entire body.
You can locate the ileocecal valve by drawing an imaginary line from your belly button to the protrusion of bone on the front of your right hip. The ileocecal valve is located just under the halfway point along this line. Find this point right now and press inward. If you feel pain when you press on this spot, you probably have an open ileocecal valve. You can close it by massaging this area using small circular movements while breathing deeply. When the pain goes away, the valve is closed. You’ll probably need to do this at least once a day for a few weeks to keep it closed.
Other Problems Related to a Hiatal Hernia
If the hiatal hernia protrudes upward far enough, it puts pressure on the bottom of the heart. Occasionally, I have seen people with a rapid or irregular heartbeat which cleared up when their hiatal hernia was fixed. Also, Jack Ritchason taught me that a large percentage of heart attacks (about 50%) are triggered by intestinal gas and bloating putting pressure on the heart via a hiatal hernia. So, add cardiac problems to the list of potential problems from a hiatal hernia.
Since the esophagus has to be shortened because the stomach is protruding upward, this can cause a slight “kink” in the esophagus. This often happens in the throat area, which can cause the sensation of a “lump” in the throat. It can also cause difficulty in swallowing food or capsules. If this “kink” in the esophagus occurs near the thyroid, it can irritate the thyroid. In younger people, this can cause the rapid metabolism that makes them very thin. In older people, it can cause low thyroid and excess weight.
The shallow breathing and lack of hydrochloric acid (HCl) production can cause an over acid pH in the body, which makes a person more susceptible to infection. Lack of HCl also makes one more prone to infection because HCl kills infectious organisms in the stomach so they can’t reach the small intestines. Lack of HCl also makes one more prone to fungal infections.
Improper digestion of proteins and lack of proper mineral absorption have more subtle and far-reaching effects. For starters, a hiatal hernia weakens the immune system and makes one more prone to infectious diseases, autoimmune conditions and cancer. It also weakens the structural system, causing more problems with arthritis, back pain, osteoporosis and other structural problems. Improperly digested proteins also contribute to chronic respiratory problems such as chronic sinus congestion, allergies and asthma. The glandular system is also weakened.
In muscle testing some clients, I’ve found that nearly every system of the body tested weak. Just by working on the hiatal hernia, I’ve had most of these systems test strong again. Clearly, the hiatal hernia weakens the whole body, so I think instead of saying, “death begins in the colon,” we should say, “death begins in the stomach.”
This article has three pages. Continue reading with “Correcting a Hiatal Hernia”