10 Tips for Living With a Hiatal Hernia

Coping Tips and Lifestyle Changes for People with Hiatal Hernias

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Have you or a loved one been diagnosed with a hiatal hernia? While hiatal hernias do not generally cause symptoms, for some people they can cause symptoms of gastroesophageal reflux disease, or GERD, like burning in the chest or throat.

The good news is that surgery is usually not needed to treat hiatal hernias, as most can be managed with a combination of lifestyle and diet changes and medication.

Definition of Hiatal Hernia

To understand what a hiatal hernia is, it's best to explain a couple of terms first.

Diaphragm

The diaphragm is a thin sheet of muscle that separates the organs within the chest from the organs within the abdomen.

Esophagus

The esophagus, which is the tube that carries food to your stomach, normally passes through an opening in the diaphragm, called the esophageal hiatus or diaphragmatic hiatus.

Hiatal Hernia

A hiatal hernia occurs when the upper part of the stomach pushes through an opening in the diaphragm, and up into the chest. 

There are two types of hiatal hernias:

  • A sliding hiatal hernia (called type I)
  • A para-esophageal hiatal hernia (called type II)

Sliding Hiatal Hernia

Approximately 90 percent of hiatal hernias are sliding, which occurs when both the gastroesophageal junction (where the esophagus meets up with the stomach) and the upper part of the stomach slide into the chest.

This means that as a person swallows, the esophagus contracts and shortens, and pulls on the stomach. After the swallow, the junction falls back into the abdomen.

Sliding hiatal hernias may occur from a weakening of the anchors of the esophagus to the diaphragm, or from increased pressure in the abdomen.

Para-esophageal Hiatal Hernia

A para-esophageal hiatal hernia is much less common and occurs when the gastroesophageal junction remains where it belongs, but the upper part of the stomach is squeezed up into the chest beside the esophagus. These hernias remain in the chest at all times.

With this type of a hernia, serious complications can occur, which is why surgery is needed to treat it if a person is having symptoms.

These serious complications include incarceration and strangulation. Incarceration means a hernia is stuck and being squeezed. Strangulation results from the lack of blood supply, leading to the death of the tissues involved when incarceration persists too long.

Tips for Dealing With a Hiatal Hernia

No matter what type of a hernia you have, the following ten tips can help limit the amount of discomfort you feel.

Eat Six Small Meals Instead of Three Big Meals

This keeps your stomach from getting too full. This will also reduce gastric pressure. Another tip is to eat slowly.

Don't Eat or Drink Anything Two to Three Hours Before Going to Bed

If you take naps, try sleeping in a chair. Lying down with a full stomach can cause stomach contents to press harder against a hernia, increasing the chances of refluxed food.

Avoid Foods That Are Known to Increase Heartburn

Avoid the foods that can trigger your heartburn, either by increasing acid production and gastric pressure or by loosening the lower sphincter muscle. Foods and drinks that classically worsen symptoms of GERD include spicy foods, coffee, chocolate, citrus fruit, high-fat foods, carbonated beverages, and beverages.

If you aren't sure what foods trigger your heartburn symptoms, try keeping a heartburn record for a week. You can also check out a chart of foods with little risk of causing heartburn.

Interestingly, too, research suggests that adopting a high fiber diet may actually reduce your GERD symptoms, although experts are still teasing this link out.

Lose Weight

If you are overweight, obese, and/or recently gained weight, losing weight is very important for easing your GERD symptoms. 

Avoid Alcohol

Alcohol increases the production of stomach acid. Alcohol also relaxes the lower esophageal sphincter (LES), allowing stomach contents to reflux back up into the esophagus. This is compounded if you have a hiatal hernia.

If you still want to consume alcohol, find out how and when to consume alcohol when you suffer from heartburn.

Consider Medication Under Your Doctor's Guidance

There are different types of acid-relieving medications your doctor may recommend:

  • Antacids will work very quickly on heartburn you may be experiencing because of a hiatal hernia.
  • H2 blockers will work for a longer period of time, usually up to 12 hours, but can take an hour or so to begin working.
  • Proton-pump inhibitors work up to 24 hours but have a delayed onset of action.

Sleep with Your Head and Shoulders on an Incline

With the head higher than the stomach, gravity helps reduce this pressure` and keeps stomach contents where they belong (in the stomach).

You can elevate your head in a couple of ways like placing bricks, blocks or anything that's sturdy securely under the legs at the head of your bed. You can also use a wedge-shaped pillow to elevate your head

Don't Wear Clothing that Constricts the Stomach

Clothing that fits tightly around the abdomen will squeeze the stomach, forcing food up against a hiatal hernia, and causing food to reflux into the esophagus. Clothing that can cause problems includes tight-fitting belts and slenderizing undergarments.

Don't Smoke

Smoking stimulates the production of stomach acid and also decreases saliva production, which can worsen GERD as saliva helps to neutralize acid.

Avoid Activities that Cause Abdominal Strain

This includes heavy lifting and straining during bowel movements. If you must lift something that is heavy, bend your knees and lift with your legs and don't bend at the waist to lift a heavy object. If straining during your bowel movements, consider taking a stool softener.

A Word From Verywell

While a combination of medication and the above-mentioned lifestyle and dietary habits can help ease your GERD, it's important to remember that a hiatal hernia is simply one cause of GERD.

In other words, just because you have a hiatal hernia, does not mean you have GERD symptoms. Likewise, having GERD symptoms does not mean you have a hiatal hernia. This is why it's important to see your doctor for a proper diagnosis and treatment plan.

Sources:

Kahrilas PJ. (2016). Hiatus hernia. Talley NJ, ed. UpToDate. Waltham, MA: UpToDate Inc.

Khan A, Kim A, Sanossian C, Francois F. Impact of obesity treatment on gastroesophageal reflux disease. World J Gastroenterol. 2016 Jan 28;22(4):1627-38.

Ness-Jensen E, Hveem K, El-Serag H, Lagergren J. Lifestyle intervention in gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2016 Feb;14(2):175-82.e3.

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