There is no doubt in my mind that good digestion is the key to good health. Without the digestive system in good functioning order, all other systems in the body are doomed to break down eventually. I see this time and time again in my clinic. 

This is why any issues involving digestion can lead to a wide array of symptoms! 

There are many things that can go wrong in the digestive system, from low stomach acid (find out more here) to gut infections (such as SIBO or parasites), to structural issues.

Today, I want to focus on a condition called hiatal hernia syndrome. You might have heard of a hiatal hernia… this is its cousin… more on that in a minute! 

I first heard of hiatal hernia syndrome when doing a workshop with Dr Steven Sandberg-Lewis. He described it as one of the most common functional GI disorder, which when treated successfully, can lead to a dramatic turnaround in health.

Indeed, if corrected successfully, the results can be quite amazing:

  • Better digestion (less reflux, burping, bloating, etc)
  • Less abdominal discomfort
  • Better, deeper breathing
  • More energy!

I have since then treated many clients with great success, although sometimes a bit of persistence and patience is needed! 

WHAT IS A HIATAL HERNIA

The hiatus is the special hole in the diaphragm, the breathing muscle through which the esophagus normally passes to become the stomach. Hernia is the term for a weakened, stretched or torn muscle. If for any reason, the diaphragmatic muscle is weakened or torn, the stomach will be forced upward through the diaphragm, creating a hiatal hernia.

THE DIAGNOSIS IS OFTEN MISSED, HERE’S WHY: 

  1. Too small! The stomach does not have to protrude far into the diaphragm to cause all sorts of unpleasant symptoms. If it’s small, it will either be missed on tests, or you might be told it’s too small to cause any issues. This is simply not true. 
  2. Not a ‘true’ hernia. The stomach can in fact simply be ‘stuck’ or ‘shoved up’ against the diaphragm without penetrating it.  This means that you won’t technically be diagnosed with a hiatal hernia as it will not show on the typical tests. However, it can cause just as much pain and gastrointestinal distress as a true hernia. This is especially common if you are a shallow breather or spend too much time sitting —in fact, as I am writing this article… I am doing just that!! 
  3. Sliding hernia. The stomach can also move up and down (usually called a sliding hiatal hernia), causing symptoms that come and go…. which can be really confusing, let alone be hard to see on lab tests. 

This means that many people might be suffering from many distressing symptoms caused by a hiatal hernia, but have no idea what is causing those symptoms. 

One thing I have learned from my years working with hundreds of people with digestive issues is that a lot can be learned from symptoms, history, and conducting a thorough examination. 

 So if you have all the symptoms of a hiatal hernia (see more on that below), but you are not officially diagnosed with it, then you might have hiatal hernia syndrome — a syndrome being a condition characterized by a set of associated symptoms. 

SIGNS & SYMPTOMS OF A HIATAL HERNIA SYNDROME

  • Belching
  • Reflux
  • Regurgitation
  • Nausea
  • Bloating
  • Pain or burning in upper chest
  • Globus sensation ( sensation of a lump or foreign body in the throat)
  • Difficulty swallowing
  • Easy satiety (feeling full easily after eating a small amount of food)
  • Chest oppression and/or stitching chest pain
  • Pressure below breastbone
  • Aversion to abdominal constriction
  • ‘Spare tire’ bulge just below the inferior margin of the ribs
  • A tickling non-productive cough
  • Shallow breathing/ difficulty to take a deep breath
  • Rapid heartbeat
  • Fatigue (mostly due to reduced breathing, hence reduced oxygen flow)
  • Left shoulder or neck pain (referred pain)
  • Pain between the shoulder blades

WHAT CAUSES THOSE SYMPTOMS

The stomach is crowding and pressing up against the esophagus, the diaphragm and the lungs. 

In this position, the stomach pinches and disrupts the function of the vagus nerve as it enters into that area. The vagus nerve is needed for most digestive function in the body… so if it’s not functioning optimally, everything can go wrong in your digestive system. 

Learn more about the vagus nerve

The hiatal hernia also interferes with the movement of the diaphragm muscle by not letting it move up and down during the breathing cycle, making it difficult to take a deep breath, which creates a vicious cycle and lower the flow of oxygen in the body. 

WHAT CAN LEAD TO HIATAL HERNIA SYNDROME

Some people genetically have a wide diaphragmatic hiatus, which make it more likely to develop this syndrome. 

Trauma, such as: abdominal surgery, the impact of jumping, horseback riding, abdominal exercise, vomiting, a blow to the abdomen or a ‘belly flop dive, falling from a height. 

Increased abdominal pressure caused by pregnancy or obesity can also lead to this. Constipation with straining can also cause increased abdominal pressure and could lead to hiatal hernia syndrome.  

HOW DO YOU KNOW IF YOU HAVE HIATAL HERNIA SYNDROME

First, do you have a lot of the symptoms above? If yes, then it is safe to assume you might have it, as the treatment is harmless, and in fact can potentially help everybody.

However, there are a few tests you can try that, if positive, will increase your suspicion that you might have this syndrome.

 

1- Hiatal Hernia Reflex Point:

This point is located directly to the left of your xyphoid process (breastbone). Press directly down towards the back, applying a fair amount of pressure. If tender, it’s a sign that you might have hiatal hernia syndrome. 

*You can use this point to retest after doing the recommendations below. If the tenderness disappears, you have treated successfully. 

2- Pain in specific areas along the spine (you might need help to check those out): T4, T10 , paravertebral.

3- Tenderness/feeling of tightness around the diaphragm. Most commonly on the left side, but I have seen this on the right side as well, or toward the centre, just under the breastbone.  

4- Inability to take a full breath down to the pubic bone.

5- There are a few other kinesiology tests that I use in my clinic, but you do need someone who can perform those on you.  

TREATMENT

The treatment involves the following:

Visceral manipulation: This is best performed by a trained practitioner. Many chiropractors can perform this technique, so have a look in your local area. You might also find a few videos if you search ‘hiatal hernia’ on YouTube. The technique is actually pretty straight forward.

I have learned this technique during my training with Dr Sandberg-Lewis and have since used it effectively with many clients.  I do find that, although effective on its own, it’s a lot more powerful when combined with my other suggestions below. 

Myofascial release to free the diaphragm: This is really important. In fact, I often find that this is what leads to correction of the hiatal hernia syndrome. So many people are tight around the diaphragm, mainly from sitting all day and stress (which leads to shallow breathing). 

You can try that yourself, although it is more effective when done by a practitioner, as it allows you to relax more easily. The technique involves placing the hands just around the ribs and gently drawing the hands down towards the belly-button. Applying pressure down towards the back all around the ribs and holding for a few minutes on any ‘pressure points’ is also very effective. 

Breathing exercises: Techniques to restore normal breathing patterns are really important, especially after the hiatal hernia syndrome has been corrected, to prevent reoccurrence. 

You can learn some useful breathing techniques as well as a unique yoga pose to release the diaphragm in my free Exclusive Digestion Series. 

Diet: It is beyond the scope of this article to discuss diet, but I did want to mention that it will play a role in the overall success of the treatment.

Heel drops: This exercise might seem a bit weird at first, but it does have some merits. The idea is that the water acts as a weight on the stomach, pulling it back into place. It’s great to perform this about the visceral manipulation technique, to ensure the stomach stays into the correct position. Here is how you do it: 

  • Drink 250- 500ml of water quickly on an empty stomach (upon waking works well).
  • Stand and rise on your toes, then drop onto the heels as hard as you can, putting your full weight on your heels as you drop. 
  • Repeat 10 times. 

 

A FEW NOTES ON WHAT YOU MAY EXPERIENCE

  • Don’t be surprised if you burp after the stomach is down. Sometimes this will go on for a while! Don’t worry, it’s normal. Excessive air can accumulate in the trapped upper stomach area, this needs to come out once the stomach is down. 
  • Many people experience an ability to breathe deeply after the stomach is back into its natural position. This can feel pretty amazing! 

 

It is useful to know that the hiatal hernia syndrome may recur, and hence you might need to perform the above techniques for several weeks to get improvements. This has been my personal experience. Don’t give up!

However, I have had clients who have experienced very quick results… it depends! 

Do you have a personal experience with hiatal hernia syndrome? Let us know!

 

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