I was diagnosed with a hiatal hernia! What can be done to reduce acid reflux and my hiatal hernia pain? I do take a prescribed drug to control the reflux and all the other suggested lifestyle adjustments, but it still does not always control the reflux while sleeping.
Thank you for your question and please know that you are not alone; many members and visitors to RefluxMD struggle this condition and hiatal hernia pain. In fact, according to Harrison’s Principal of Internal Medicine, 60% of all adults over the age of 50 have this condition. There are several risk factors that can cause the development of a hiatal hernia, and all involve activities creating pressure in the abdomen. This includes heavy lifting, violent vomiting, straining, pregnancy, and delivery, or stress. Many people with a hiatal hernia never experience discomfort or symptoms; however, for others, it can be very a painful.
Hiatal Hernia and GERD
Hiatal hernia and GERD can be connected, but it is possible to have either one of those conditions and not the other. Doctor Dengler wrote an article about the relationship between hiatal hernias and GERD where he noted that a sliding hiatal hernia is most commonly associated with GERD. According to Dr. Dengler, GERD can also be the cause of a hiatal hernia, “GERD is a disease that progresses through various stages over periods of years, and a hiatal hernia can be a consequence of longstanding GERD. As the disease progresses, the lower esophageal sphincter (LES) loses its function. It cannot “squeeze” and function as a barrier to reflux. As this happens, the lower esophagus at the site of the LES dilates and the shape of the upper stomach is altered. The result is the enlargement of the opening in the diaphragm discussed above, leaving room for the top of the stomach to move upward into the chest. In this case, a hiatal hernia is a consequence of longstanding GERD. In addition, due to the difference in pressure between the chest cavity and the abdomen, movement of the stomach and lower esophagus upward causes an already poorly functioning LES to get even worse. A hernia makes the preexisting “bad” valve worse and consequently, GERD symptoms worsen.”
What can be done to manage your symptoms?
For those with severe acid reflux and hiatal hernia, antireflux surgery is often recommended. The most widely used procedure is a Nissen fundoplication. To determine if you are a candidate for antireflux surgery, we recommend that you work with a GERD expert who can help you evaluate all of your treatment options.
Nighttime symptoms are natural since you no longer have the benefit of gravity helping to keep the contents of the stomach where they belong – in the stomach. When lying down, the stomach contents can more easily flow up into the esophagus, causing the symptoms you’re all too familiar with. Swallowing, which typically clears these fluids from the esophagus, does not occur during sleep, so the fluids can pool, potentially doing more harm.
Here are some things you can try to reduce your nighttime symptoms:
- Eat dinner at least 2-3 hours before going to bed. Give your dinner adequate time to digest.
- Follow a GERD-friendly diet and avoid fatty foods for dinner.
- Try elevation therapy. Raise the head or your bed 6 inches or more.
- Maintain a body mass index (BMI) of 25 or less.
- Use antacids and H2 blockers when you have symptoms.
- Sip alkaline water when you have symptoms. This might help clear your esophagus of acid.
- Work with your GERD expert. Follow his/her instructions and discuss various treatment plans until you achieve satisfactory symptom control.
I hope this helps!
This article is from Reflux MD - https://www.refluxmd.com/hiatal-hernia-pain/