A hiatus hernia occurs when the upper part of the stomach protrudes through the opening (or hiatus) of the diaphragm into the esophagus. In most cases there are no symptoms, but the problem can cause partially digested food and stomach acid to back up into the esophagus in a reflux, causing a lot of heartburn and indigestion. Usually the symptoms of hiatal hernia can be controlled with dietary adjustments and lifestyle changes – only a minority of cases require surgery.
Part 1 of 3: Changing Eating Habits
Step 1. Avoid foods that cause heartburn.
Many foods can trigger heartburn (the return of stomach contents into the esophagus) because they are too acidic, sweet, spicy or gassy. Tolerance and sensitivity is different for each person, but you should avoid spicy foods such as tomatoes, onions, citrus fruits and chocolate if you have a hiatus hernia.
- Fried and fatty foods can also trigger heartburn and irritation in the esophagus, weakening the valve (lower esophageal sphincter) between the esophagus and the stomach.
- In addition to heartburn, other common symptoms of hiatus hernia are abdominal pain, bloating, frequent belching, difficulty swallowing, sore throat, bloating, fatigue, and sometimes vomiting.
- Chronic heartburn can also cause bad breath, but avoid sucking on candies or lozenges (especially peppermint) as they can make heartburn worse.
Step 2. Don't eat large portions with meals
In addition to the foods you consume, the size of the dish can also trigger hiatal hernia symptoms. Therefore, eat smaller portions with less time between meals throughout the day (as if they were a larger snack) to avoid overfilling your stomach and putting pressure on the esophageal sphincter. Many people tend to consume a lot more than the necessary amount of nutrients and calories they need, so decreasing servings is unlikely to decrease their intake of needed nutrients.
- Instead of eating three large meals a day, eat five smaller (and lighter) meals approximately 2.5 hours apart.
- Don't let other people put your plate even in your house. Help yourself and don't feel obligated to fill your plate.
- Strive at first to eat a small portion if you are very hungry. Eat slowly and only eat more (another small portion) if you are still hungry.
Step 3. Spend more time chewing
Chewing food correctly is important, as this way you do a "pre-digestion" and absorb some nutrients already in the mouth, also stimulating the production of more saliva. Saliva is alkaline (which neutralizes excess acid from food) and helps to coat and soften the lining of the esophagus, which reduces heartburn and other symptoms related to hiatal hernia.
- Take small portions of food from silverware and chew for at least 20 to 30 seconds before swallowing.
- Cut food into smaller pieces to encourage eating smaller portions. So they also cool faster.
- If your mouth is always very dry before meals, suck on a piece of lemon (Persian lime and orange are also good) to stimulate the production of saliva in the salivary glands.
Step 4. Avoid eating before going to sleep
In addition to choosing the type and quantity of food, mealtime is also very important to control the symptoms of hiatus hernia. More specifically, you should have dinner (or your last meal of the day) at least two to three hours before going to sleep to give your stomach enough time to digest your food and release the contents into your small intestine.
- Going to bed on a full stomach and lying in a horizontal position facilitates the passage of stomach acid reflux through the esophageal sphincter back into the esophagus, causing heartburn.
- A heavier meal takes longer to digest (like red meat) compared to breads, pastas, salads, and cooked vegetables.
- Always eat sitting down and avoid lying down immediately after eating anything. Take a light walk instead of taking a nap if digestion makes you too drowsy.
Part 2 of 3: Stopping drinking
Step 1. Eliminate alcohol
Alcoholic beverages can irritate a hiatus hernia in different ways. Alcoholic beverages, particularly red wine and beer, are very acidic and generally need to be avoided (especially at night) if you have a history of heartburn. Also, alcohol (ethanol) is harmful to the tissues of the esophagus, sphincter, and stomach and can stimulate reflux and other symptoms.
- All alcoholic beverages have the potential to irritate a hiatus hernia, but less acidic ones usually contain less sugar, such as vodka or white wine.
- Excessive alcohol consumption also increases the risk of severe vomiting, which can make the hernia worse.
Step 2. Reduce your consumption of caffeinated beverages
Caffeine is a stimulant that affects the body in a variety of ways, most of them negative. More specifically, caffeine can irritate the stomach and relax the smooth muscle tissue (which lines the esophagus), so people with hiatus hernia must decrease or eliminate the substance from their diet if they are to control their symptoms.
- Caffeine is found in coffee, black and green tea, soft drinks (especially cola), energy drinks and chocolate.
- Many of the caffeine-containing beverages are also very acidic, which is a "double-dose" harm for people with hiatus hernias. At least avoid coffee and soft drinks.
Step 3. Do not drink liquids with meals
While many people believe that drinking fluids (such as water, milk, or soda) helps move food into the stomach, it's actually not a good idea. Too much water or fluid during meals causes saliva and digestive enzymes in the stomach and small intestine to be diluted, making them less effective. In addition, the additional volume of fluid in the stomach can encourage the backflow of the contents into the esophagus, leading to heartburn.
- As mentioned above, chewing food well produces a large amount of saliva, which aids digestion and helps a person swallow more comfortably.
- Do not drink more than a few sips of water (or milk) with meals. Drink water before eating if you are really thirsty.
- Drinking fluids can also lead to aerophagia, which is swallowing air during a meal. Aerophagia can aggravate hiatus hernia and cause belching and indigestion.
Part 3 of 3: Adjusting the Lifestyle
Step 1. Lose weight if you are too fat
One of the most common lifestyle change recommendations for people who have hiatus hernia is to lose weight if the individual is overweight or obese. Overweight people are more likely to have hiatus hernia due to a combination of factors, which include: overeating and overeating, chronic heartburn, excessive consumption of caffeine, alcohol, fatty foods and fried foods, which damages and inflames the esophagus and the esophageal sphincter.
- Less weight means less pressure on the abdominal and chest area, where the stomach and esophagus are located.
- The safest and most effective way to lose weight is to cut back on your daily calorie intake and exercise regularly – at least 30 minutes a day.
- Eliminating as little as 500 days can result in losing nearly 2 kg of fat monthly even if you don't exercise as much.
- Keeping a food diary, both on paper and with a smartphone app, can help you keep track of your diet and maintain your progress.
Step 2. Stop smoking
As with alcohol, several toxic chemicals present in cigarette smoke are harmful to the esophagus and stomach and can damage the sphincter, causing it to not be able to close completely. Therefore, it is recommended that people with hiatus hernia stop smoking as soon as possible. Esophageal cancer is also much more common among smokers and can have symptoms similar to a hiatus hernia (at least initially).
- Smoking also damages the airways and increases the risk of chronic coughs. The exertion of coughing can weaken the diaphragm's muscles and contribute to the formation of a hiatus hernia.
- The vast majority of smokers also drink and tend to eat poorly, which can be a "triple threat" for those who suffer from the problem.
- In addition to using nicotine patches, hypnosis can be very helpful in helping someone to stop smoking.
Step 3. Elevate your head when sleeping
Sleeping or taking a nap after meals is absolutely not recommended for chronic heartburn sufferers, but once you've done all the digestion, raise your head when lying on your back. Raise it approximately 6 inches or a little more when you lie down on the bed or sofa to prevent stomach contents from flowing back into the esophagus.
- Support your head with the help of another pillow when you are in bed or on the sofa, but be careful not to get a stiff neck or a headache.
- Think about the idea of buying a mattress that has position adjustment and raises the head height with an inclination of 15 cm to 20 cm.
- You can also elevate your torso when lying on your side with the help of pillows, but this can also increase the risk of back pain.
Step 4. Find a chiropractor
While these professionals generally focus on treating the spine and peripheral joints, some of them also specialize in treating soft tissue such as hiatal hernia. The idea is to push the stomach back into its normal position under the diaphragm by applying pressure with your hands, as in a kind of deep massage. The procedure can provide great relief, although it is usually only temporary (hours or days).
- Other professionals who perform soft tissue manipulation to control hiatal hernias are massage therapists, physiotherapists, naturopaths and osteopaths.
- According to traditional medicine, there is no evidence that such soft tissue manipulations work as a cure for hiatus hernia, as no research has yet been performed.
- Do not wear tight clothing around your chest or abdomen (belly) if you have a hiatus hernia. The pieces put a lot of pressure on the stomach and can inhibit digestion to some extent.
- Avoid bending over or bending frequently, especially after eating or drinking.
- Hiatal hernias are usually discovered on an examination to identify the cause of chronic heartburn or chest pain, such as an esophaggram (with ingestion of barium contrast), endoscopy, or esophageal manometry.
- The doctor may prescribe medications such as over-the-counter antacids (aluminium hydroxide, magnesium hydroxide, dimethicone, famotidine and calcium carbonate), H2 antihistamines such as cimetidine, famotidine, nizatidine or ranitidine, or proton pump inhibitors, such as lansoprazole and omeprazole.
- Surgery is usually recommended only in cases of "moving" hiatus hernias (up and down, in and out of the chest area) and that do not respond to lifestyle changes or medications.