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.

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  • The majority of people who have hiatal hernias don't even realize it. Those who do know typically find out when visiting a doctor because of chronic heartburn. Symptoms may include the following:

    • heartburn; regurgitation.
    • difficulty swallowing.
    • chest pain radiating from below the breastbone (the sternum).
    • a bloated feeling after eating.
    • shortness of breath.

    Call Your Doctor If:

  • Under normal circumstances, the hiatus is a small opening in the muscular diaphragm at the juncture where the esophagus meets the stomach. A hiatal hernia develops when the opening widens and allows the upper part of the stomach to protrude upward through the hiatus. Some hiatal hernias are present at birth.

    Most of them, however, develop during life as the opening of the hiatus becomes stretched, often as a result of pregnancy or excessive weight gain, both of which place upward pressure on the stomach.

  • By the term hernia is meant the protrusion beyond its normal position of some part or structure of one of the body cavities. When used without any special qualifications, the term is understood to mean an external abdominal (inguinal) hernia, or rupture. This type accounts for over 90 per cent of all hernias in men and 50 per cent of all hernias in women, in whom femoral hernia is much commoner than in men. Next in frequency come post-operation hernias, or hernias through weak operation scars in the abdominal wall. These account for nearly 10 per cent.

  • An obstruction may occur anywhere along the intestine. The part of the intestine above the obstruction continues to function. As it fills with food, fluid, digestive secretions, and gas, it swells like a soft hose.

    In newborns and infants, intestinal obstruction is commonly caused by a birth defect, a hard mass of intestinal contents (meconium), or a twisting of the intestine on itself (volvulus).

  • Milk is not a remedy for heartburn. The soothing effect felt when drinking milk is deceiving- once in the stomach, milk's fat, calcium, and protein cause increased acid secretion and worsened heartburn. Minis are also often credited with alleviating heartburn, but they don't Mint actually relaxes the LES, making heartburn more likely.

  • Heartburn is the most common symptom of a condition called Gastroesophageal Reflux Disease or acid reflux (GERD). A sphincter (secialized muscle), known as the lower esophageal sphincter (LES), is located at the end of the esophagus and opens during swallowing to allow food to pass into the stomach. The LES muscle then close quickly to prevent the return (reflux) of food and stomach juices back into the esophagus.

  • If you have reflux, you know how it feels when food returns to hauntyou. Dr John Brififa suggests several strategies for taming heartburn at night

    While a good evening meal can send us to bed in a contented state, our last supper may also make its presence felt later in the form of acid indigestion and heartburn.