Hiatal Hernia

Jill Blakeway, M.S. L. Ac.
Kathy was a patient I hadn’t seen for many years. She’d originally come to me to manage her back pain and once she was better we had lost touch. However a new set of symptoms had brought her back to the YinOva Center in the hope that Chinese medicine could help.

A month prior she’d had a worrying episode. Out of the blue she suddenly felt a pain in her chest. This was accompanied by a sour stomach and pain down her left arm. Naturally Kathy feared she was having a heart attack and, quite sensibly, had gone to the ER in the middle of the night. There she was tested and pronounced fine. The ER doctor prescribed some antacids and suggested she see a GI specialist. Since then Kathy had been taking antacids regularly but found they didn’t help much. The GI doctor suggested an endoscopy and had found that Kathy had a hiatal hernia. He too prescribed antacids and a special diet but Kathy was finding her symptoms to be increasingly unpleasant. “Is there anything else I can do apart from taking the antacids”, Kathy asked me. Actually there was much Kathy could do to help herself and we set about coming up with a treatment plan.

What is a hiatal hernia?

Your esophagus passes through a small hole (a hiatus) in the diaphragm to connect with your stomach. Sometimes the stomach can push up through this hole and that is what’s known as a hiatal hernia. It’s a very common condition and many people who have a hiatal hernia have no idea it’s there because they have few symptoms. Other people, like Kathy, do have symptoms including acid reflux, nausea, belching and chest pain. Some of my patients also feel that their hiatal hernia’s give them more systemic symptoms such as fatigue and body aches. I’ve even seen some patients who’s hiatal hernia was irritating their vagus nerve and causing an irregular heart beat. Many doctors dismiss these broader symptoms but to me, as a practitioner of Chinese medicine, a hiatal hernia is not just a local phenomenon but a symptom of a weak digestive system or weak earth element as it is know in Chinese medicine. Weak earth can lead to fatigue and muscle aches. Kathy’s full diagnosis was Wood overacting on Earth which is a way of expressing how stress affects the liver and weakens digestion. A sludgy, stagnant liver can cause gastric inflammation and is often overlooked in many conventional treatments for this condition. So Kathy and I set about treating her whole body and her digestive system in particular.

Why does it happen?

First we looked at what had caused Kathy’s hernia. The causes of hiatal hernia can vary but these are the main ones.
  • Mechanical causes – Anything from improper lifting, bouts of coughing, repeated vomiting, a sharp blow to the abdomen, to tight clothing and poor posture can cause a hernia
  • Dietary causes – Overeating, eating a large meal and then lying down, eating rich fatty foods and excessive alcohol consumption can all cause a hernia.
  • A backed up GI system – Many people who have a hiatal hernia also have an inflamed ileocecal valve lower down in their digestive tract causing gas to build up and creating pressure higher up in the digestive system. I’ve noticed that many of my hiatal hernia patient have a long history of constipation causing their GI tract to flow poorly.
  • Emotional causes – In Chinese medicine the wood element can become excessive when the patient represses anger. It’s almost as if they “can’t stomach” a situation and anger causes them to tighten up and suck their breath upwards. If this anger doesn’t get released it can lead to pressure in the stomach and a hernia.
As Kathy and I talked she realized that she had put her body through a few of these challenges. She had recently been through a difficult divorce where she had been very angry but had tried not to show resentment in front of her children. She’d also started dating again and, worried about an extra few pounds on her tummy, had taken to wearing high waisted control underwear which gave her a nice figure but pushed her stomach upwards. She also confided that she had been bulimic in the past although not recently and that when she was going through her divorce she had got into the habit of having a couple of large glasses of wine after the kids had gone to bed.

Solutions

After Kathy and I had worked all of this out we set about making a plan. She agreed to stop wearing the control underwear and to follow a diet aimed at calming her acidic stomach. We talked about various ways of releasing anger and Kathy told me she had tried talk therapy in the past and found it wasn’t for her, so I suggested several sessions with our YinOva Massage therapist who has training in therapeutic abdominal massage. Next we used acupuncture to treat both the root and the the symptoms of the hiatal hernia and I prescribed a Chinese formula that supported her liver, cleared heat and inflammation from the GI tract, promoted healthy digestive function and relieved emotional anxiety.

I also taught Kathy the following maneuver which I’m happy to pass on to you. This exercise helps get the stomach back down through the hole in the diaphragm. Many of my patients with hiatal hernias have found it really helpful.

Exercise to reverse a hiatal hernia

First thing in the morning drink a cup of warm water (not tea or juice – just warm water!) Then, while standing, bring your arms straight out to your sides and then bend your elbows so that your hands are touching your chest. Stand up on your toes as high as possible and then drop, you should feel a jolt. Drop down about 10 times in a row. Then, while standing with the arms up, pant short quick breathes for about 10-15 seconds. That’s it! How does it work? The water acts as a weight and the fact that it’s warm relaxes the stomach. Raising your arms and bending your elbows stretches the diaphragm and opens up the hiatus. The jolt as you drop down pulls the stomach out of the hiatus and the panting tightens up the diaphragm and helps the hiatus to close up.

Other advice we give YinOva patients with a hiatal hernia

  • Do the maneuver above every morning. After you feel better keep going for a further three weeks every day to strengthen the area and stop a recurrence.
  • A massage therapist skilled in abdominal massage will know massage techniques that can help bring the stomach back through the hiatus. Our own Nicole Kruck is especially skilled at this.
  • Eat regular small meals – “little and often” should be your mantra
  • Don’t eat right before you go to bed. Sit up and allow your digestive system to do it’s job.
  • Acupuncture can be used to treat both the symptoms and the cause of a hiatal hernia
  • A specially tailored Chinese herbal formula can be very helpful and can be designed to fit your particular pattern
  • Avoid alcohol
  • Limit fatty foods
  • Lose weight if you need to
  • Find a way to relieve stress (acupuncture and massage may be helpful here too)
Kathy followed the plan we’d created together and was particularly diligent about doing the special exercise every day. Within two weeks she was feeling much better. After 4 weeks we stopped the herbal formula and after 6 weeks she didn’t need the acupuncture anymore either. We decided she’d carry on doing the massage once a month to relax the area and follow the guidelines above. Before I wrote this article I rang Kathy to check in on her and ask her permission to write about her case (with names changed). She told me she’s been symptom-free for 8 months and hadn’t needed an antacid in all that time. She’s even been able to have the occasional rich meal and some wine here and there without a problem.
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