Hiatal Hernia

The hiatus is an opening in the diaphragm (a muscle separating the abdomen and chest) that the esophagus passes through to reach the stomach. If the hiatus weakens and stretches, part of the stomach and/or the oesophagus can squeeze into the chest cavity, producing a hiatal hernia.

Essentially, there are three types of hiatal her-nias. In a sliding hernia, the lower oesophagus and stomach move upward, bringing the top part of the stomach into the chest cavity.

In a para-oesophageal hernia, the stomach moves through the hiatus and rests beside the oesophagus. Mixed hernias have features of both sliding and para-oesophageal hernias.

Although typically small, some hiatal hernias expand until a large portion of the stomach is squeezed through the hiatus. Slow bleeding, from the compressed stomach or from oesophagitis, can eventually cause anaemia. Sometimes a hernia will become strangulated, or so tightly constricted that blood flow is cut off to the squeezed part of the stomach and the nearby oesophagus. This is unlikely in mixed and sliding hernias but common in para-oesophageal hernias. Generally, sliding and mixed hiatal hernias show no symptoms and pose no threat to good health.

Causes

All ages are susceptible, but frequency increases with age: More than half of those over age 50 have a hiatal hernia. Sliding hernia is by far the most common type. Like other hernias, hiatal hernias are probably caused by excessive pressure in the abdomen related to pregnancy, obesity, injury, or straining to have a bowel movement. Risk factors include constipation, heavy lifting, and persistent coughing or vomiting.

Usually, hiatal hernias cause no symptoms, but when they do, symptoms are worsened by wearing tight clothing, eating foods that cause heartburn, and bending over or lying down after eating.

Diagnostic And Test Procedures

A physical examination for hiatal hernia is similar to that for heartburn, with two additions:

X-rays may be ordered to show the hernia, and if anemia is a concern, a blood sample may be taken to check your red blood cell count.

Treatment

Heartburn or other symptoms that occur with sliding or mixed hernias may be treated by both conventional and alternative therapies.

Para-oesophageal hernias, however, should be repaired by conventional surgery because the danger of strangulation is high.

Conventional Medicine

Often, alleviating heartburn is all that is required. Surgery is indicated, however, if a para-oesophageal hernia exists, or when sliding or mixed hernias bleed or become large, strangulated, or inflamed. In surgery, the hiatus is reinforced and the stomach is repositioned.

This surgery is now commonly done using a laparoscope, a thin telescope-like instrument for viewing inside the abdomen. Typically, a two-night hospital stay is required and regular activity may be resumed in two weeks.

Alternative Choices

The therapies for hiatal hernia symptoms are similar to those for heartburn.

Herbal Therapy

Slippery elm (Ulmus fulva) tea is soothing and is reputed to have strong anti-inflammatory qualities. Mix 1 part powdered bark in 8 parts water, simmer for 10 minutes, and drink ½ cup, three times daily.

Lifestyle

Refrain from eating large meals; instead, eat four or five small meals each day, and eat slowly. This, along with maintaining a weight in proportion to your l will minimize abdominal pressure - and heartburn. Reducing fat in your diet may also substantially reduce symptoms. Smoking is an intense heartburn generator; if you smoke, stop.

Prevention

To prevent symptoms:

• Wear loose clothing. Anything that presses on the stomach can aggravate hiatal hernia symptoms.
• When your stomach is full, avoid bending over or lying down.

This increases abdominal pressure and makes gravity work against you, so heartburn is more likely.

To prevent hiatal hernia:

• Maintain a reasonable weight.
• Don't smoke.

Source: Alternative Medicine.