Each cavity in the body (pelvic, abdominal and thoracic) has either negative or positive pressure. These pressure systems work together to ensure proper working order and position of your organs. The negative pressure of the thoracic cavity is essential for breathing but also positioning of the abdominal organs, without which, the occasionally very full stomach and the giant liver would collapse down towards our pelvis.

In most instances, this is very helpful, but in the case of a hiatal hernia, this pressure can suck the stomach up into the thoracic cavity (rib cage) by way of the esophageal hiatus (the hole in the respiratory diaphragm for the esophagus, which is the tube that moves food from your mouth to your stomach.)

Normal diaphragm and stomach relationship

Normal diaphragm and stomach relationship

Hiatal Hernia

Hiatal Hernia

Signs and symptoms of a hiatal hernia include:

  • Heartburn and acid reflux (when stomach acid back-flows into the esophagus)

  • Regurgitation of food or liquids into the mouth

  • Difficulty swallowing

  • Chest or abdominal pain, usually felt around the bra strap line and is worse in the morning (due to a more relaxed diaphragm)

  • Shortness of breath and coughing

Hiatal hernias can be caused by a variety of things:

  • heavy lifting, particularly while breath holding or wearing a weight belt, which increases pressure in the abdomen

  • excessive coughing, vomiting, straining to poop, giving birth, which all increase pressure in the abdomen

  • anatomical anomaly of an enlarged esophageal hiatus (food tube hole)

  • weakening of the myofascia of the respiratory diaphragm due to injury, trauma or pathology - it can alters the fascial pull of the diaphragm, decreases resting tone in the diaphragm or increases intrabdominal pressure

  • excessive abdominal contents - too much food, inflammation and fluid retention, visceral fat, growths (my assumption, not necessarily a documented fact)

What to do:

  • talk to your doctor to confirm diagnosis

  • avoid increasing intrabdominal pressure - heavy lifting, straining to poop, holding your breath, ab crunches (and similar exercises)

  • lose weight, particularly around the abdomen (speak to a professional)

  • wear pants that are loose around the abdomen - bye, bye lulus

  • see a manual therapist trained in visceral manipulation and myofascial release - they can gently pull your stomach back down into your abdomen and decrease the tension on your abdominal wall to decrease the pressure in your abdomen

Eating changes:

  • eat smaller meals and wait three or more hours before reclining

  • eating meals that separate carbohydrates from protein - meals that have both delay the emptying of the stomach

  • decreasing fat intake, as it takes longer to make it’s way out if the stomach

  • decrease highly acidic food to reduce acid reflux symptoms and complications

Occasionally, surgery is the only option. It is worth looking at all other avenues before traveling that route to reduce potential complications. If you suspect you have a hiatal hernia, talk to your doctor.

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