When you swallow food, it passes through the esophagus and into the stomach. The esophagus passes from the chest cavity to the abdominal cavity through the esophageal opening. A hiatal hernia occurs when organs move from the abdominal cavity to the chest cavity through a weakened esophageal opening. In most cases, small hiatus hernias do not cause problems. If the hernia is large, gastric contents are thrown back into the esophagus, resulting in heartburn, belching, and dysphagia and chest pain. If you've been diagnosed with a hiatal hernia, don't worry, there are several ways to treat this condition.
Method 1 of 3: Diagnosing a hiatal hernia
Step 1. Ask your doctor about x-rays of the esophagus and stomach
If you have heartburn, belching, dysphagia, or chest pain that you think is the result of a hiatal hernia, see your doctor who will order the tests you need. Your doctor will most likely order an x-ray of your esophagus and stomach. Your doctor will take an X-ray of your esophagus and stomach to confirm the diagnosis of a hiatal hernia. During the procedure, the patient drinks a liquid containing barium, which coats the inside of the gastrointestinal tract. On the X-ray, the doctor will be able to see a clear image of the outlines of the esophagus and stomach.
If you have a hiatal hernia, x-rays will show a bulge of part of the stomach into the chest cavity through the diaphragm
Step 2. Learn about the endoscopic method
The doctor may prescribe this diagnostic method. During the procedure, the endoscope is inserted into the mouth and further into the esophagus and stomach. An endoscope is a thin, flexible tube with a video camera and a light at the end. This examination allows you to see inflammation or changes in the tissues that may be due to the presence of a hiatal hernia.
Step 3. Take a blood test
Your doctor may recommend that you have a blood test that can show complications resulting from a hiatal hernia. A hiatal hernia, often accompanied by acid reflux, can lead to bleeding if the lining of the esophagus is inflamed, as well as rupture of blood vessels. Bleeding can lead to anemia and low red blood cell counts. Your doctor will ask you for a test to determine the level of red blood cells in your blood.
Method 2 of 3: Changing Your Lifestyle
Step 1. Quit smoking
Since the most common complication of esophageal hernias is the development of reflux, treatment should primarily focus on eliminating reflux, reducing acid production, and improving esophageal clearance. To do this, you need to make lifestyle changes and reduce the risk factors that trigger acid reflux. Smoking worsens hernia symptoms. Studies have shown that smoking relaxes the gastroesophageal sphincter and the muscles around it, which can help move organs from the abdomen to the chest. Normally, the esophageal sphincter prevents acidic stomach contents from entering the esophagus.
Quitting smoking is difficult. Talk to family members, friends, and your doctor if you are determined to quit smoking. They can help you achieve your intended goal through various means, such as nicotine patches, nicotine chewing gum, and medications
Step 2. Eliminate certain foods from your diet
Some foods increase the secretion of gastric juice, which in turn leads to damage to the lining of the esophagus and stomach. Over time, this can lead to disruption of the esophageal sphincter and to the appearance of reflux and hernia. To avoid this, eliminate or limit the use of the following foods:
- Onion and garlic
- Spicy food
- Fatty and fried foods
- Citrus fruits such as oranges
- Tomato-based dishes
- Peppermint or kinky
- Carbonated drinks such as soda
- Dairy products such as milk and ice cream
Step 3. Include healthy foods in your diet
While you may have to cut down on certain foods, include foods in your daily diet that will help prevent hiatal hernia symptoms. Include lean meats, skinless chicken, red meat with a little fat, ground turkey instead of ground beef, and fish in your diet. When choosing beef, go for tenderloin, shoulder or loin. When choosing pork, go for tenderloin or chop. Also, follow the tips below:
- Bake or stew food instead of frying it.
- Remove fat from meat before cooking.
- Don't use a lot of seasonings or spices.
- Include low-fat dairy products in your diet, such as low-fat yogurt instead of ice cream.
- Prefer vegetable stock over meat stock.
- Limit the use of butter, vegetable oils, and creamy sauces. Use cooking spray instead of oil when sautéing.
- Include low-fat or low-fat foods in your diet.
Step 4. Pay attention to other power problems
If you have a hiatal hernia, there are some nuances to consider when choosing your food. When buying this or that product, pay attention to its composition. If you are not sure if you can eat a particular product, you can eat a small amount of it and then evaluate the result. Also, eat small meals often. Limiting yourself to smaller meals will make it easier for your stomach to digest what you eat.
Eat slowly, chewing food thoroughly
Step 5. Reduce the pressure in the stomach
A significant increase in intra-abdominal pressure can negatively affect the esophageal sphincter, which can subsequently lead to acid reflux or hernia. Avoid constipation to relieve pressure. If you're prone to constipation, include fiber-rich foods such as fruits and grains in your diet. Also, try not to lift heavy objects, as this can increase intra-abdominal pressure, which can worsen symptoms and cause a hernia.
Also, don't lie down after eating. The contents of the stomach increase the pressure on the sphincter. Therefore, try not to go to bed after eating
Step 6. Lose weight
If you are overweight or obese, it can aggravate the symptoms associated with a hiatal hernia. Studies have shown that hiatal hernias are more common in overweight people than in people of normal weight. After eating, walk for about 30 minutes so that the food is digested faster and also does not build up in the form of extra centimeters around the waist. Research has shown that walking 30 minutes after a meal can help you shed those extra pounds faster than walking one hour after eating.
- Increase the load gradually. Include cardio activities such as jogging, jogging, jumping in place with changing positions of arms and legs and cycling in your workout schedule to burn more fat and calories.
- If you follow a good exercise schedule and make the necessary lifestyle changes, you can lose weight faster.
Method 3 of 3: Using Medication
Step 1. Take over-the-counter medications
There are a number of medications you can take to help reduce the symptoms of a hiatal hernia. Take antacids like milanta, tams, and maalox. These drugs should be taken before, during, or after meals to neutralize stomach acid. Antacids have a different form of release. They are available in tablet, chewable, and liquid form. You can also take histamine H2 receptor blockers such as ranitidine and pepsid, which block the production of stomach acid. The maximum effect develops within 30 - 90 minutes after taking the drug. Preparations in this group are recommended to be taken before the first meal. Duration of action is 24 hours.
- Proton pump inhibitors such as Nexium and Prilosek are similar in action to H2 blockers. PPIs block the final stage of hydrochloric acid secretion. Take 30 minutes before your first meal.
- All of these drugs can be purchased without a prescription. Be sure to follow the instructions that come with the drug.
- If symptoms persist, consult your doctor. You may need a higher dose of the drug to relieve unpleasant symptoms. In this case, a doctor's prescription may be required.
Step 2. In some cases, surgery may be required
Although most patients with diaphragmatic hernias can improve their well-being with medication and lifestyle changes, some cases may require surgery. If complications from gastroesophageal reflux disease occur, such as bleeding and ulceration, or respiratory manifestations such as asthma, aspiration pneumonia, or chronic cough associated with a hiatal hernia, your doctor may recommend surgery.
A strangulated hernia is a complication of a hiatal hernia, in which the hernial protrusion is infringed. When the hernia of the esophageal opening of the diaphragm is infringed, necrosis of the restrained organ develops. In this condition, the risk of death is very high. In this case, urgent medical attention is required
Step 3. Ask your doctor about the types of surgery for hiatal hernia
There are three types of surgery for the treatment of hiatal hernia. One of them is the Nissen fundoplication, an antireflux operation in which the fundus of the stomach is wrapped 360 degrees around the esophagus. When carrying out fundoplication, the anatomical structure is restored, as well as the functional state of the lower esophageal sphincter. Fundoplication according to the Belsi method consists in the rotation of the fundus of the stomach relative to the esophagus by 270 degrees in order to reduce the following symptoms: dysphagia and abdominal distention.
- A commonly used hiatal hernia surgery is Hill's surgery (gastropexy), in which the upper stomach is sutured to the abdominal wall. This helps to strengthen the antireflux barrier. In some cases, in addition to this, the fundus of the stomach is sutured to the diaphragm with separate sutures.
- The choice of the type of surgical intervention depends on the knowledge and experience of the surgeon, as well as on other indicators.
Step 4. Ask your doctor about modern methods of surgery
The most promising area of minimally invasive surgery is laparoscopic surgery. The main instrument in laparoscopic surgery is the laparoscope, a telescopic tube attached to a video camera. During the operation, the doctor sees the operating field on the monitor screen. This approach, in contrast to the traditional, open version, does not require extensive incisions, so there are no ugly scars left. In addition, this method contributes to the rapid recovery of the patient. During the operation, the doctor will make three to five punctures in the anterior abdominal wall. A laparoscope, a thin light tube with a tiny camera at the end, is inserted into one of the incisions, and the necessary surgical instruments are inserted into the others.
- A laparoscope projects images onto a monitor in the operating room. Thus, the surgeon performs the operation, seeing everything that happens inside in an enlarged view on the monitor.
- The operation is performed under general anesthesia, so the patient does not experience painful sensations. The surgery usually takes two to three hours.