Coping With a Hiatal Hernia

Many people diagnosed with a hiatal hernia will not have any symptoms. Those who do have symptoms usually experience heartburn and indigestion. While medications may provide some relief, finding effective strategies to cope with pain and discomfort is important.

This article explains how what you eat and how you eat affects symptoms of hiatal hernia. It covers the benefits of losing weight if needed and suggests ways you can manage symptoms when they do occur. 

Diet

As you probably know, certain foods often guarantee a flare-up when you have chronic heartburn. Many of these food triggers are common to all sufferers. Other problems, meanwhile, are related to the amount of food we eat.

What You Eat

This dynamic is, perhaps, best illustrated by a 2014 study from the National Food and Nutrition Institute in Poland which evaluated the association between acid reflux and common food triggers in 513 adults with gastroesophageal reflux disease (GERD).

What they found was that there was as much as a two- to three-fold increase in the risk of symptoms when people ate the following types of foods:

• Fatty foods
• Sugary foods
• Spicy foods
• Fried foods
• Peppermint tea
• Fruit juices
• Sour foods
• Fresh fruit
• Alcohol

While the study didn't take into the account certain common food triggers, like citrus or caffeine, the figures more or less reflect the experience of the typical person with GERD.

To this end, there are certain foods you need to avoid if you have active symptoms or are prone to recurrence. They include red meat, processed foods, mayonnaise, butter, margarine, tomato-based sauces, chocolate, coffee, caffeinated tea, carbonated drinks, citrus and citrus juices, and whole-fat dairy products. In their place, foods like lean chicken, fish, vegetables, grains, and low-fat dairy can provide you the proteins, fats, and carbohydrates you need without triggering the overproduction of stomach acid.

Alcohol should also be avoided and not so much because it triggers acid production. Rather, alcohol has a corrosive effect on the esophagus and greatly amplifies the symptoms of reflux, in some cases tripling the risk of severe heartburn and chest pain. Similar results have been seen in people who overuse salt.

How You Eat 

When it comes to acid reflux and other hiatal hernia symptoms, how you eat plays almost as important a role in the appearance of symptoms as what you eat.

With a hiatal hernia, the protrusion of the stomach into the chest cavity can alter the alignment of the lower esophageal sphincter (LES), the valve that protects your esophagus from the contents of your stomach. As a result, food and acid can leak through this otherwise protective gateway—often profusely.

To remedy this, you need to be mindful of the position of your stomach as you eat. You also need to ensure that you don't overtax the stomach and that food is able to move through the digestive tract without complication.

To achieve this:

• Always sit up straight in a chair while eating. This ensures that your stomach is in the best alignment to receive food. By contrast, slouching (say, on the sofa) not only places your stomach in a more horizontal position, it compresses the junction between the stomach and esophagus, promoting backflow. 
• Eat smaller, more frequent meals. And, more importantly, perhaps, do not skip meals. Doing so will only lead you to overeat.
• Always eat at a table. The thing about nibbling on the run or munching in front of the TV is that you can end up mindlessly putting food into your mouth without even realizing it. Sitting at a table with prepared portions helps avoid this.
• Take smaller bites and chew longer. The rationale is simple: The more your food is pulverized before swallowing, the less the stomach has to do to digest it. This translates to less stomach acid and less acid reflux.
• Sit upright for at least an hour after eating. It is best to do so in a solid but comfortable chair. Also, avoid bending or lying down immediately after eating.
• Avoid eating three hours before bedtime. This includes snacks. Sleeping with an emptied stomach means there will be far less chance of middle-of-the-night reflux.

Weight Loss

As an independent risk factor, being obese increases the risk of heartburn in people who have a hiatal hernia by exerting excessive pressure on the abdominal wall. This compresses the stomach against the diaphragm by altering its position and causing it to bulge even further into the chest cavity.

Including weight loss as an integral part of a treatment plan may be helpful for some people. The program should ideally be overseen by a healthcare provider experienced in metabolic syndrome, such as a doctor or nutritionist.

Among the facets of the plan:

• A low-fat, high-fiber diet is key to both weight loss and the normalization of your digestive function. The low-fat diet should include complex carbohydrates that don't cause a rapid rise in blood sugar. A diet high in soluble fiber can help treat constipation and alleviate the straining that can promote herniation.
• Drinking at least eight glasses of water per day can further relieve constipation while diluting the concentration of acid in your stomach. If you are overweight or obese, your water intake should be even greater. A simple rule of thumb is to drink half your body weight in ounces of water. For example, if you weigh 200 pounds, you should drink no less than 100 ounces of water per day (or roughly three-quarters of a gallon).
• Take a reasoned approach to exercise. An informed fitness program should always start gradually (with maybe 10 to 15 minutes of exercise performed three times per week) and gradually increase in both intensity and duration. The aim of the program is to create a lifetime habit and avoid burnout. To this end, consider working with a trainer to get started and/or to adjust your program as you build endurance and strength.

Everyday Living

When it comes to hiatal hernia symptoms, self-care can go a long way in reducing them and preventing them from returning.

Work to turn these suggestions into habits:

• Relax. While stress doesn't necessarily cause acid reflux, an increasing body of evidence has shown that stress can impact the way in which our body reacts to reflux symptoms. So, rather than tying yourself in a knot, trying sitting calmly and engaging in deep breathing exercises or meditation. Find someplace quiet where you can sit comfortably until the symptoms pass.
• Loosen your belt and remove tight clothing. Ultimately, anything that constricts the abdomen can trigger symptoms as you move about and jostle the contents of your stomach. Give yourself a break and avoid cinched waistlines or anything that places direct stress on the stomach.
• Take a fiber supplement. If you are suffering from chronic constipation, a daily fiber supplement can help improve your regularity. A couple of tablespoons of mineral oil can also help ease hardened stools during acute bouts.
• Elevate the head of your bed 4 to 8 inches. This is especially useful for people who are overweight or have the symptoms of GERD. Aligning the stomach in an ascending (rather than flat) position significantly lowers the risk of gastric backflow related to hiatal hernias.
• Avoid heavy lifting. If you have been diagnosed with a large hernia, lifting heavy objects will only make things worse. If you have to move something heavy, use a cart or trolley, or, better yet, ask someone else to do it. You may also need to alter your workout routine if you use heavy weights or engage in exercises that place excessive stress on the stomach muscles (including weighted squats or crunches).

Finally, stop smoking. While smoking doesn't cause acid reflux, it can affect gastric motility and the way in which food moves through the esophagus. Smoking can also dull the responsiveness of your LES and promote dysphagia (swallowing difficulty). These effects are long-lasting and may become permanent in heavy smokers, turning even a small hernia into a source of ongoing grief.

Hiatal Hernia Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

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