Coping With a Hiatal Hernia

Lifestyle plays just as important a role as medication

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Many people diagnosed with a hiatal hernia will not have any symptoms. For those who do, heartburn and indigestion will be the most common ones experienced. While medications may provide some relief, effective coping strategies are rooted in mitigating discomfort in the first place. If you have a hiatal hernia, some basic approaches—from diet changes to weight loss to hydration—can go a long way in helping you manage your condition and overcome the occasional flare-up.

hiatal hernia symptom relief
Illustration by Brianna Gilmartin, Verywell

Diet

It will come as no surprise to those with chronic heartburn that certain foods can pretty much guarantee a flare-up. 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, obesity 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.

If you are either overweight or obese, you need to include weight loss as an integral part of your treatment plan. The program should ideally be overseen by a doctor or nutritionist experienced in metabolic syndrome.

Among the facets of the plan:

  • Reducing your body mass index (BMI) from above 30 (obese) to below 25 (normal) can half your risk of acid reflux.
  • 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.

Frequently Asked Questions

How do I know if I have a hiatal hernia?

A small hiatal hernia itself may not cause any pain or discomfort—in fact, in 90% of cases, no symptoms occur. However, if the hernia is large, it may start to affect the function of the digestive system. When that occurs, related symptoms include:

  • Heartburn
  • Throat irritation
  • Regurgitation
  • Belching or hiccuping soon after eating
  • Abdominal discomfort
  • Bad breath

Where is a hiatal hernia located?

A hiatal hernia is typically located in the mid- to lower-chest region. Also known as a stomach hernia, it occurs when a portion of the stomach pushes up above the diaphragm, instead of staying beneath the diaphragm.

What can aggravate a hiatal hernia?

Because hernias can affect the position of the lower esophageal sphincter (LES), it may cause food and stomach acid to travel back up into the esophagus, leading to acid reflux. Triggers for hernia symptoms are therefore the same as triggers for acid reflux, and include:

  • Eating too quickly
  • Eating within three hours of bedtime
  • Eating while lying down
  • Lifting heavy objects

What's the best way to reduce hiatal hernia symptoms?

Over-the-counter medications such as antacids and H2 blockers can be used to relieve heartburn and acid reflux attacks. To reduce symptoms and prevent hiatal hernias from getting worse, try the following suggestions:

  • Lose weight
  • Quit smoking
  • Elevate the head of your bed
  • Take a fiber supplement
  • Avoid heavy lifting
  • Try deep-breathing techniques
  • Wear clothing with loose waistbands

If medications and lifestyle changes don't seem to help, surgery may be indicated.

Which foods should I avoid eating with a hiatal hernia?

Common trigger foods that may cause acid reflux symptoms to flare up should also be avoided with a hiatal hernia.

These foods typically include:

  • Fried or greasy foods
  • Foods high in fat
  • Foods high in sugar
  • Spicy foods
  • Fruit juices
  • Citrus fresh fruit (non-citrus fresh fruit is ok)
  • Tomato-based foods
  • Citrus-based foods
  • Peppermint tea
  • Caffeine
  • Alcohol

Does stress affect a hiatal hernia?

Technically, yes. While stress may not directly cause symptoms of a hiatal hernia, studies have shown that stress may impact the way your body responds to symptoms, even increasing the severity of reflux. Deep-breathing techniques, practicing good posture when eating, and eating in a calm environment can help your symptoms pass without progressing.

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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Article Sources
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