How to strengthen lower esophageal sphincter les ?

Take a Deep Breath for GERD Relief

What if relief from reflux was as simple as taking a few deep breaths?

According to recent research, if you have mild gastroesophageal reflux disease (GERD), your breathing could play a role in your overall treatment plan. A small study published in The American Journal of Gastroenterology showed that participants who learned breathing techniques to strengthen the diaphragm had less reflux over time than those who didn’t get the training.

It’s exciting news, and if you stop to think about it, it’s easy to see the connection. Swallowing air is thought to contribute to reflux, and it can happen through a number of everyday habits, such as gulping your food or taking shallow, quick breaths. Training shows you how to breathe correctly so you are not creating pressure, says gastroenterologist Aline Charabaty, MD, director of the Center for Inflammatory Bowel Disease at Georgetown University in Washington, D.C. And, according to researchers, using these techniques will help strengthen the muscles that surround your lower esophageal sphincter, which controls the flow of stomach contents.

More evidence showing that the right breathing can bring GERD relief comes from an Australian study that looked at people with obstructive sleep apnea. The interrupted breathing of sleep apnea can cause nighttime gastroesophageal reflux, and the use of a continuous positive airway pressure, or CPAP, machine to regulate apnea also seems to ease reflux symptoms because of the positive effect it has on the LES.

Learning how to breathe more mindfully and correctly might help reduce stress and anxiety as well as provide relief from GERD. Since stress is a major trigger for bad breathing habits (and a multitude of other health problems), focused breathing can help you break the cycle.

Deep Breathing to Help Heartburn

You don’t need a prescription to try better breathing techniques. Try these ideas to get focused on breathing for heartburn relief:

  • Breathe more slowly and deeply. When you’re stressed, your breathing becomes shallower. Become more aware of your breathing throughout the day so that you can slow it down when you’re feeling more anxious.
  • Try yoga or meditation classes. Both these disciplines emphasize slow and deep breathing by enhancing your awareness of your breath and your body. You might not always be able to use the exact techniques (some yoga breathing exercises may not be appropriate in the workplace, for example), but you’ll learn tools to strengthen your breathing in general.
  • Learn diaphragmatic breathing. Here’s how to do this healthy deep breathing: Start by sitting up comfortably and breathing normally. Place one hand over your chest and the other over your belly. Breathe deep with your diaphragm so that the hand on your belly moves but the hand on your chest does not. Picture air entering low toward your belly rather than high in your chest.
  • Eat and drink more slowly. This will cut down on the air that finds its way into your stomach instead of your lungs.
  • Don’t smoke. Smoking cigarettes is linked with reflux and makes it hard for you to breathe fully and correctly.

Heartburn relief could be as easy as sitting up straight and learning to breathe a bit more deeply and slowly — an approach that has no side effects. And best of all, you can give it a try right now.

GERD: Is the Damage Reversible?

Complications of GERD may include:

  • Barrett’s esophagus
  • erosive esophagitis
  • esophageal stricture, which is a narrowing of the esophagus
  • dental disease
  • asthma flare-ups

Symptoms of GERD can be serious, especially in older people. They may include a severely inflamed esophagus and difficulty swallowing.

Barrett’s esophagus

Barrett’s esophagus tends to occur more commonly in people who have GERD.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, only a small percentage of people with GERD develop Barrett’s esophagus. The average age for diagnosis is 55, and it’s more common in men.

People with Barrett’s esophagus are at higher risk of developing esophageal cancer because of damage to the lining of the esophagus.

Risk factors for Barrett’s esophagus include severe and chronic GERD, obesity, tobacco smoking, and intake of food and drinks that trigger GERD.

Erosive esophagitis

Acid irritation and inflammation can injure the esophagus over time, creating a condition known as erosive esophagitis. People who are obese, especially obese white men, are at the greatest risk of developing erosive esophagitis.

Some people with the condition experience bleeding. This can be seen in dark-colored stools, as well as vomit that looks bloody or like coffee grounds.

Ulcers in the esophagus can cause long-term or severe bleeding, which may result in iron-deficiency anemia. This is a serious condition that requires immediate attention and ongoing care.

Stricture

The esophagus may become severely injured and inflamed over time. This can result in scarring and the development of a narrowed, band-like area known as a stricture. A stricture may result in dysphagia (impaired swallowing). Strictures typically require treatment.

Dental disease

Tooth enamel can become eroded from acid backing up into the mouth. People with significant GERD also have more gum disease, tooth loss, and mouth inflammation, likely due to ineffective saliva.

Asthma flare-ups

GERD and asthma often appear together. The reflux of acid into the esophagus may trigger an immune response, making the airways more irritable. Small amounts of acid may also end up in the mouth and then be inhaled. This also causes airway inflammation and irritation. These processes can trigger asthma flare-ups and make asthma more difficult to control.

Certain asthma medications and asthma flares can also relax the LES, making GERD symptoms worse in some people.

People with GERD are at increased risk for other respiratory and throat conditions, including:

  • chronic laryngitis
  • chronic cough
  • granulomas, consisting of inflamed pink bumps on the vocal cords
  • hoarse voice and difficulty speaking
  • aspiration pneumonia (often recurring and serious)
  • idiopathic pulmonary fibrosis, a restrictive lung disease where lung scarring occurs
  • sleep disorders
  • constant throat clearing

What can I do to strengthen my esophageal sphincter?

What can I do to strengthen my esophageal sphincter?

The issue with lower esophageal function (LES) in gastroesophageal reflux disease (GERD) is not related to the the strength of the muscle in the LES. It relates to how the LES functions, and the root problems can be structural, chemical or mechanical.

Only surgery can deal with a structural issue.

The chemical effects have to do with nervous system control over the LES. When a swallowed bolus of food reaches the LES, the pressure it creates signals the LES to open to allow the food to pass into the stomach. A wave of contraction in the esophagus (peristalsis) occurs with swallowing. When the the wave reaches the LES, the pressure on the esophageal side of the LES is lessened, which signals it to close. The nerve signals that co-ordinate opening and closing are mediated by several chemicals (neurotransmitters) including GABA, nitric oxide and acetylcholine. If there are imbalances in how these neurotransmitters are released, LES closure can be affected.

Medications might be given to compensate for inappropriate nerve signalling associated with an esophageal motility problem, but it’s more common to give drugs that reduce stomach acid so that when it does splash into the esophagus the likelihood of acid-related damage is reduced.

The mechanical issue occurs when too much pressure is put on the contents of the stomach, which then apply pressure to the LES. The pressure can be external (excessive abdominal fat), or internal (overloading the stomach) or a combination of these due to body position or stomach position when there is a hiatal hernia. These effects on pressure account for why the following advice is given to people with GERD:

  • lose excess weight
  • eat smaller amounts at one time and don’t overfill your stomach with fluids when you eat
  • stay in an upright position after eating

Of these various root causes, the mechanical cause is one that is most often present and is most amenable to your efforts to correct it.

When GERD is the result of hiatal hernia, strengthening the diaphragm with deep breathing exercises can improve symptoms. When the diaphragm is strong enough to keep the stomach in its proper position, excessive pressure from stomach contents on the LES is reduced.

Footnotes

Sphincter mechanisms at the lower end of the esophagus

Central control of lower esophageal sphincter relaxation.

Exercises to Prevent a Hiatal Hernia

Published November 14, 2017 by Surgical Consultants of Northern Virginia

A hiatal hernia is when the stomach presses into the chest cavity. Symptoms can vary widely. A hiatal hernia enters the esophagus and passes its way onto the stomach. Larger hernias may require surgery, but typical hiatal hernias can heal with exercises and stretches that can strengthen the diaphragm. These exercises can reduce the risk and may even relieve some symptoms.

Symptoms

  • Some patients may not experience any symptoms
  • Symptoms associated with heartburn and abdominal discomfort
  • Throat irritation
  • Belching
  • Difficulty swallowing

Stretches and Exercises for Prevention & Ease of Symptoms

Yoga

There are several yoga poses that are specifically designed to strengthen your diaphragm.

The Chair Pose: While standing with your arms perpendicular to the ground, move your arms above your head and press your palms together. Exhale and press your knees, making your thighs parallel to the floor as possible. Stay in the position for 30 seconds to one minute. Learn more about this pose here.

Strengthening your Stomach Muscles

Doing exercises to strengthen stomach muscles can help reduce your risk for a hiatal hernia. The exercise is simple and involves lying on flat on the floor on your back and bend your knees, letting your feet touch the floor. Lift your lower back and buttocks off the ground, leaving your shoulds and feet on the floor. You only need to hold this position for up to a couple of seconds, but it is recommended to repeat this several times a day.

Strengthening the Diaphragm

A strong diaphragm can also reduce your risk of a hiatal hernia. A breathing exercise that involves you lying on your back with a pillow under your head and knees can be done to strengthen your diaphragm. Place one of your hands on your upper chest and your other hand below your rib cage and breathe in slowly through your nose. Tighten your stomach muscles while you breathe out of your mouth.

Preventing & Treating Hiatal Hernias in Reston VA

While there may be several exercises and yoga poses that can be done to prevent and reduce the symptoms of a hiatal hernia, it may be recommended to consult an expert to ensure it is a hiatal hernia. If a hiatal hernia is severe enough, your doctor may monitor you for complications and may diagnose medication or recommend surgery.

Contact Surgical Consultants of Northern Virginia today at (571) 512-5300 if you have any additional questions about hiatal hernia prevention, symptoms, and treatment.

Sources:

Tags: deep breathing, hernia, yoga

Categories: Health

Ancient Yoga Breathing Techniques To Treat Hiatal Hernia

A hiatal hernia is a type of hernia in which the upper portion of the stomach moves up through the diaphragm and into the chest region. The diaphragm contracts continually as you breathe in and out. It lies between your abdomen and chest. Today we are going to discuss how yoga breathing techniques or pranayama can help in reducing the severe consequences of hiatal hernia. According to research on yoga, it has been indicated that breathing exercises have therapeutic effectiveness. The ancient yoga philosophy considers breathing a fundamental tool to enhance one’s well-being and treat numerous diseases.

There are certain yoga breathing techniques which we that can be helpful in the aid of hiatal hernia:

Kapalbhati

Kapalbhati is good breathing pranayama for most of the diseases it cures very well but in hiatal hernia, kapalbhati should be done in a different way. Normally, we push and pull our stomach or expand and contract our stomach fast and vigorously which is beneficial for the body but in hiatal hernia it would be risky for you to stain on your stomach or thoracic region, so for the right technique just sit in a comfortable pose adopt sukhasana, padmasana, Ardha padmasana, Vajrayana, or on the chair, just as kapalbhati pranayama take breath in through your nose slowly, do no expand your chest and stomach too much outside and then continuously breath out with a very short and steady breathing exhalation. Remember do not take out your breath vigorously and keep your abdominal muscles relax very short expand and contraction is acceptable you can place your hand on the middle abdominal area or tie a cloth on the stomach to stop movement in the stomach.

READ: 8 Reasons Why You Should do Yoga Every day

Ujjayi Pranayama

In ujjayi pranayama, sit in a comfortable posture and keep inhaling and exhaling slowly through the nose. Usually, in ujjayi pranayama, breathing technique should be fast to raise metabolism and heat in the body and strong and fast movement in chest and abdomen but in hiatal hernia, the slow and steady movement gives you therapeutic results. Within 3 to 6 months you can cure yourself of the hiatal hernia.

Abdominal Deep Breathing

READ: International Yoga Day 2019: Yoga Asanas for Asthma Patients to Lose Weight

This is a foundation of breathing practice for Pranayama. In Abdominal deep breathing, your focus should be on the movement of the stomach in and out. Do this by sitting in any posture like padmasan, Ardha padmasana, Vajrasana or you can also adopt savasana, do not overstretch the stomach out and in. Just observe your breath and movement of the stomach, the right way to breathe is when you breathe in the stomach out and on the breath out stomach in. It is also called Diaphragmatic breathing, is breathing that is done by contracting the diaphragm. Do not hold your breath too much inside your stomach area. Avoid jerks in the whole process. It should be smooth, continuous and relaxing.

Thoracic Breathing

This is just like an abdominal breathing technique, you can also say chest deep breathing. In this practice when you inhale and exhale expanding and contracting the chest only. Air flows through both nostrils, slowly and continuously. Now there is no movement in the stomach to avoid its bulging. To practice this first lie in Shavasana and relax your body. Place your right hand on your stomach and left on your chest. Start inhaling by slowly expanding the ribcage. You can do this practice in any yoga sitting posture.

Apart from this, you can also try some yogasanas like

  • Paschimottanasana
  • Dandasana
  • Bhadrasana
  • Tadasana
  • Utkatasana
  • Vrikshasana
  • Veerasana
  • Padahastasana
  • Naukasana

These are very effective and helpful to aid hiatal hernia. Remember do not perform backward bending postures. Only do forward bending but do not overstretch yourself in forwarding bending postures and always perform asanas under any expert guidance and according to your problem’s stage.

(With inputs from Jasmine Kashyap. She is Fitness Expert & Director at Goodways Fitness)

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Hiatus hernia

What is a hiatus hernia?

A hiatus hernia is a common condition where a part of the stomach slides or protrudes from the abdomen into the chest. Most hiatus hernias don’t cause any problems, but some – especially large hiatus hernias – cause symptoms such as heartburn. There are treatments available, including self-help measures, medicines and surgery.

What are the symptoms of hiatus hernia?

Many people with small hiatus hernias have no symptoms at all and may never know they have the condition unless it is discovered by accident as part of an investigation for another problem. When symptoms do occur, the most common symptoms are those arising from gastro-oesophageal reflux, which can occur as a result of the hernia.

Symptoms include:

  • Heartburn – a painful burning sensation felt in the lower front chest area behind the breastbone and upper abdomen, often after eating or when lying down.
  • Regurgitation of sour or bitter-tasting acid fluid into the mouth, particularly at night, which occurs with more severe reflux.

These symptoms are often worse when you bend over, lie down or strain to lift heavy objects.

Depending on the type of hiatus hernia you have, other symptoms can include:

  • belching or burping;
  • difficulty in swallowing; and
  • pain on swallowing (especially hot drinks).

What causes a hiatus hernia?

The chest and abdomen are normally separated by the diaphragm, a thin sheet of muscle that aids in breathing. The oesophagus (the tube that food passes down from the mouth to the stomach) goes down through the chest, passing through a small opening (called a hiatus) in the diaphragm and entering the abdominal cavity to join the stomach.

Hiatus hernias can occur when there is weakening of the muscle tissue around the gap where the oesophagus passes through the diaphragm or where this gap is otherwise stretched. This allows a portion of the stomach to slide upwards through the opening in the diaphragm, beside the oesophagus, into the chest.

A number of risk factors appear to contribute to hiatus hernias developing including:

  • hereditary factors;
  • age;
  • obesity;
  • pregnancy;
  • sudden, hard physical exertion, such as lifting;
  • a birth defect; and
  • trauma or surgery to the abdominal area.

Types of hiatus hernia

There are 2 main types of hiatus hernia.

Sliding hiatus hernia is the most common type, accounting for about 90 per cent of cases. It occurs when the junction between the oesophagus and the upper part of the stomach protrude up through the oesophageal opening in the diaphragm into the chest cavity. The herniated portion of the stomach can slide back and forth, into and out of the chest.

Rolling hiatus hernia (sometimes called a para-oesophageal hiatus hernia) is the other type. In this case, the junction of the oesophagus and stomach stays down within the abdomen, and the top part of the stomach (the fundus) bulges up into the chest cavity. This type of hernia normally remains in one place, sitting next to the oesophagus, and does not move in or out when you swallow.

Who gets hiatus hernia?

Most hiatus hernias are seen in adults, and about 30 per cent of people over the age of 50 will have a hiatus hernia, although they may not know about it. Women are affected more often than men. Hiatus hernias are often seen in people who are overweight and in pregnant women.

Complications of hiatus hernia

Complications are usually due to severe, ongoing reflux or having a very large hiatus hernia.

Severe reflux

In some people with hiatus hernia, the acidic stomach contents regurgitate (reflux) regularly into the oesophagus. In severe cases, ongoing reflux may cause damage to the oesophagus and even bleeding that may lead to anaemia in some cases. Ongoing reflux may cause injury to the oesophagus and a narrowing of the oesophagus (called a stricture) that can cause swallowing difficulties.

Long-term gastro-oesophageal reflux disease can also cause changes to the cells in the lining of the lower oesophagus — a condition known as Barrett’s oesophagus. Having Barrett’s oesophagus puts you at increased risk of oesophageal cancer.

Strangulated hernia

A rare complication of rolling hiatus hernias is a condition known as strangulation. This is where the protruding part of the stomach becomes twisted or pinched by the diaphragm. This can cause bloating, blockage of the oesophagus or problems swallowing.

Very rarely, the blood supply to the stomach can become blocked, and this can cause severe chest pain and breathing difficulties. This is a medical emergency and surgical treatment is needed immediately.

Breathing problems

Sometimes with large hiatus hernias, there is so much of the stomach protruding into the chest that it presses on your lungs and can make breathing more difficult. See your doctor if you are having difficulty breathing.

How is a hiatus hernia diagnosed?

The most common symptoms caused by hiatus hernia are usually those due to gastro-oesophageal reflux. For this reason, hiatus hernia is often hard to tell apart from reflux just based on symptoms.

It’s important to not assume that you have a hiatus hernia based on symptoms alone. Always see your doctor for a proper diagnosis.

Hiatus hernia is most commonly diagnosed when doctors do an endoscopy to investigate reflux, or when a barium X-ray has been performed. The hiatus hernia can show up as a bulge that is positioned between the oesophagus and your stomach. Large hiatus hernias can be observed on plain chest X-rays.

Barium X-ray

A barium swallow test or barium meal is a test in which you will be asked to drink a chalky liquid containing barium that helps your internal organs show up more clearly on X-ray pictures. The barium will outline your gullet, stomach and upper part of your small intestine. This test may help your doctor see whether you have a hiatus hernia.

Endoscopy or gastroscopy

Another way your doctor may check for a hiatus hernia is by referring you for a gastroscopy, which is an endoscopic examination. This is where you are given a light sedative and a doctor will insert a thin flexible lighted tube (an endoscope) down into your oesophagus (gullet).

The tube allows the doctor to ‘look’ at your oesophagus and check for abnormalities. This common procedure is usually painless and is generally performed in day surgery centres in public or private hospitals.

How is a hiatus hernia treated?

In most cases, symptoms from a hiatus hernia can be kept under control with medicines and lifestyle changes that treat gastro-oesophageal reflux — your doctor can help you with these.

Surgery is normally only required if your symptoms become worse and more constant. Rolling, or para-oesophageal, hernias are more likely to require surgery than sliding hiatus hernias.

Self-care tips

If you have gastro-oesophageal reflux symptoms from a hiatus hernia, there are a number of things you can do to help.

Self-care measures to help ease heartburn include the following.

  • Eat a number of smaller meals rather than 3 larger meals each day. This will help put less pressure on your stomach.
  • Drink most fluids between meals (rather than at meal times). Try avoiding carbonated beverages.
  • Try avoiding foods and beverages that can aggravate symptoms of reflux, such as citrus fruits, spicy foods, chocolate, tomato-based foods, alcohol, and caffeine-containing drinks such as tea, coffee and cola.
  • Avoid fatty foods, as they relax the sphincter muscle in your lower oesophagus and slow down stomach emptying, which allows more time for acid to reflux into your oesophagus.
  • Try to wait a couple of hours after eating before you do any exercise.
  • Do not lie down after eating. Always wait at least 2 to 3 hours before lying down or going to bed. By then, most of your food will have passed into your small intestine and can’t flow back into your oesophagus.
  • Raise the head of your bed by about 10-20 cm if you can. The effects of gravity will help stop stomach acid from moving into your oesophagus when you’re asleep. It’s best to raise the head of the bed by inserting something (such as a piece of wood or a brick) between the floor and the bed at the head end, rather than using pillows to do this, because pillows tend to increase pressure on your abdomen.
  • Avoid bending over or stooping, especially after eating. Do not lift very heavy objects that cause you to strain. Anything that increases pressure in your abdomen can help push your hiatus hernia further through your diaphragm.
  • Try not to wear tight clothing that restricts your chest and stomach.
  • If you are taking non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief and are suffering from heartburn, you may need to change your medication. Certain medicines, including NSAIDs, can affect stomach acid secretion. Talk to your doctor if you are unsure.
  • Give up smoking! Smoking increases stomach acid reflux.
  • If you are overweight, losing weight is one of the most important things you can do to reduce the pressure on your stomach and reduce symptoms. Discuss with your doctor a safe weight loss plan that is suitable for you.

If these self-care measures are not controlling your symptoms, your doctor may recommend further treatments.

Medicines for gastro-oesophageal reflux symptoms

There are several prescription and over-the-counter medicines that can help ease the reflux symptoms associated with hiatus hernia.

Over-the-counter antacids

Antacids are available from pharmacies and include:

Antacids ease pain by working against the excess acid in your oesophagus to neutralise it. They won’t stop the acid from being produced, so be aware that if you stop taking them, it’s very likely your symptoms will return.

Side effects of antacids can include diarrhoea and constipation.

Histamine blocker medications

Histamine blockers, known as H2-blockers or H2-receptor antagonists, reduce the amount of acid your stomach secretes. They include:

Possible side effects of H2-receptor antagonists include diarrhoea, tiredness and headaches.

Small packs of ranitidine (Zantac Relief, Ranoxyl Heartburn Relief) are available from the pharmacist, but if your symptoms are severe, your doctor will probably advise stronger doses of H2 blockers, which are only available on prescription.

Proton pump inhibitors

Proton pump inhibitors block the production of acid and so allow the tissue that has been damaged by the acid to heal. They are usually very effective medicines for reflux.

Proton pump inhibitors include:

Side effects of PPIs can include headaches, diarrhoea and nausea.

Proton pump inhibitors that are available over-the-counter from the pharmacist, usually in a lower strength, include:

  • omeprazole (Maxor Heatburn Relief);
  • rabeprazole (Pariet 10); and
  • pantoprazole (Salpraz Heartburn Relief, Somac Heartburn Relief, Suvacid Heartburn Relief).

Symptoms of gastro-oesophageal reflux should generally be treated with standard-dose proton pump inhibitors. Symptoms not responding to standard doses or recurring soon after stopping treatment should be investigated – see your doctor.

Surgery

Surgery is usually only recommended for people with large hiatus hernias and people with symptoms that are not responding to other treatments. Surgery is also recommended for people who have complications from their hernia, such as obstruction of the oesophagus, severe pain, or bleeding.

Surgery is very rarely required for sliding hiatus hernias. Rolling hiatus hernias are much more likely to cause obstructions and strangulations than sliding hiatus hernias, and so are more likely to need corrective surgery.

Depending on the nature of your hernia, the surgery may involve:

  • pulling the stomach back down into the abdomen under the diaphragm;
  • tightening the opening in the diaphragm where the oesophagus passes through;
  • strengthening the area where the oesophagus joins the stomach; and
  • anchoring the stomach below the diaphragm.

The surgery may be either open or laparoscopic (‘keyhole’) surgery. There are possible side effects associated with both types of surgery – your doctor will be able to discuss the risks and benefits of surgery with you.

Always remember that if there is any change in your symptoms, or symptoms get worse, you should see your doctor.

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Last Reviewed: 06/11/2015

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