Hernias are usually associated with overstraining. However, a hiatus cannot really be said to be caused by anything that you might have done, except perhaps overeating to the point of obesity. Nonetheless, its symptoms are all too real to those affected and can be painful in the extreme.
It is important to understand the anatomy of the chest area before grasping how a hiatus hernia comes about. The stomach lies immediately under the diaphragm, a muscular sheet which separates the chest from the abdomen. The gullet (oesophagus) passes through a small opening in the diaphragm in order to reach the stomach. Normally, the stomach end of the oesophagus and its muscular control ring (sphincter) lie just beneath the diaphragm. When the stomach is distended, pressure pushes upwards against the diaphragm and this closes the sphincter, preventing the stomach contents from passing back up into the gullet.
Sometimes, however, the junction of the gullet and the stomach slips up through the oesophageal opening in the diaphragm and into the chest. This is called a hiatus hernia and the main effect is that the mechanism which prevents regurgitation into the gullet cannot operate properly and so the acidified and highly irritating stomach contents are able to move up into the gullet, damaging the lining and causing a condition called esophagitis.
Hiatus hernias are most common in middle-aged and elderly women, especially in the obese. They cause severe heartburn (a deep burning pain behind the breast bone) made worse by bending forward, by straining and by lying down. The pain is so intense that it often disturbs sleep and can be mistaken for a heart attack. Other symptoms of hiatus hernia and the associated esophagitis include acid in the mouth (water brash) and difficulty in swallowing. Sometimes, the condition is complicated by ulceration, bleeding, scarring, and narrowing of the gullet. In such cases, anaemia can result from blood loss. Long-term hiatus hernia can cause dangerous changes in the cells lining the oesophagus and some authorities believe this may progress to cancer.
In the first instance, a patient will be advised to lose weight if obesity is part of the problem. More generally, you will be recommended to eat small meals; avoid fatty foods, aspirin and other non-steroidal anti-flammatory drugs; avoid too much bending from the waster; and sleep with the head of the bed raised. In some cases, H-2 receptor antagonists such as Zantac (cimetidine) or rantidine are prescribed. If all else falls, surgery may be a last resort.
Any persisting or severe discomfort in the throat, chest or upper abdomen – all of which can be caused by a hiatus hernia – should be reviewed by a physician. Complementary treatment is generally effective and can safely be used, but occasional review by your physician is recommended if symptoms persist.
With hiatus hernia an immediate adjustment to the patient’s dietary habits is essential. We would advise consultation with a naturopath or an Ayurvedic practitioner. Once an improvement is noticeable some of the dietary modifications can be relaxed. However, given that there is a weakness in this area of the body, following a simple diet in the years ahead may be important.
Marma massage (part of the Ayurvedic system) can help a great deal by releasing the pressure on the hiatus hernia. Ayurveda may also use some exercises and medicines. Acupuncture and Shiatsu are very effective, especially when combined with dietary modifications. Homeopathy can help relieve the symptoms.
According to traditional Indian medicine, the digestive function is controlled by the lower part of the brain which is located at the back of the neck. If the muscles in the neck become weak, it produces pressure in the stomach area and this can result in a hiatus hernia. A Marma therapist would use the traditional Indian deep-massage techniques on Marma points on the neck to tone up the muscles and relieve the pressure on the hiatus hernia area. Depending on the symptoms – for example, if the patient was producing a lot of gas or acidity – Ayurvedic medicines would be prescribed to complement the massage.
Since a hiatus hernia is a mechanical condition, the following Ayurvedic advice should be followed:
These principles apply to all hiatus hernia sufferers, but after a consultation Ayurvedic medicines or exercises may also be prescribed to suit the individual case.
This ancient Japanese pressure-point massage technique has been known to be effective in the treatment of hiatus hernia. Firstly, a consultant would ascertain what was needed from a diagnosis of the meridians and a consideration of all the functional, structural, and emotional levels of the body. They would also look at the quality of muscle tone and the meridians that govern the muscles, stomach, and digestive system in general. Diet and exercise are obviously important and these areas would also be investigated. Shiatsu can help a hiatus hernia not only by relaxing the muscles, but also by strengthening and contracting them so that they start to pull themselves back together. At least four treatments would be required to produce good results.
The philosophy of homeopathy is to treat the whole person by boosting the body’s own healing powers. It cannot “cure” a hiatus hernia, but three or four consultations with a homeopath should result in a marked improvement in symptoms in most cases. Arsencium or Nux may be used to relieve the discomfort of heartburn, and Bryonia to counteract the acid taste in the mouth. Dietary changes may also be recommended.
According to Chinese medicine, a hiatus hernia is caused by energy blockages. These are cleared by inserting needles at points along the liver and stomach meridians. The liver is seen as a yin organ (the passive, gentle aspect) and the stomach as a yang (positive, aggressive) – the aim, is always with Chinese medicine, is to achieve a balance between the two.