Hiatus Hernia

Hiatus hernia can be defined as displacement of a portion of the stomach through the opening in the diaphragm through which the oesophagus passes form the chest to the abdominal cavity. In this disease, a part of the upper wall of the stomach protrudes through the diaphragm at the point where the gullet passes from the chest area to the abdominal area.

The diaphragm is a large dome-shaped muscle dividing the chest from the abdominal cavity. It is the muscle concerned with breathing, and the muscles between the ribs during exertion assist it. It has special openings in it to allow the passage of important blood vessels and for the food channel, the oesophagus. Hiatus hernia occurs at the oesophageal opening.

This disease is quite common after middle age. It is estimated that about half the people above 60 years of age suffer from it, although most of them may not have any symptoms. The correct diagnosis of hiatus hernia can be arrived at by means of barium meal x-ray test.

Symptoms of Hiatus Hernia are:
Hiatus hernia is characterised by pain in certain areas. The most common areas are behind the breastbone at the nipple level and lower, at the end of the breastbone. Pain may also occur on the left chest and this is often mistaken for angina.

Other areas of pain are the base of the throat, right lower ribs and behind the right shoulder blade. The pain increases when the patient stoops with effort and lies down. Other symptoms of this disease are heartburn, especially after a meal, a feeling of fullness and bloatedness, flatulence and discomfort on swalloaing.

Causes of Hiatus Hernia:
The chief cause of the mechanical defect associated with hiatus hernia is faulty diet. The consumption of white flour, refined sugar and products made from them, such as cakes, pastries, biscuits and white bread as well as preservatives, and flavourings devitalize the system and weaken the muscle tone. As a consequence, the muscles become less resilient and connective and fibrous tissue suffers through poor nourishment, and thus become more prone to decomposition and damage. This ultimately leads to diseases like hiatus hernia.

Drinks like tea, coffee, alcohol also affect the mucous lining of the stomach and irritate the digestive tract. These drinks, when taken with meals, encourage fermentation and produce gas. This greases the distension of the stomach, causing pressure against the diaphram and the esophageal opening and greatly increasing the risk of herniation. Other causes of hiatus hernia include sedentary occupations, without sensible exercise, over-weight resulting from overeating, smoking, shallow breathing and mental and emotional tensions.

Treatment of Hiatus Hernia:
In the beginning of the treatment, it would be advisable to raise the head end of the bed by placing bricks below the legs of the bed. This will prevent the regurgitation of food during the night. More pillows can also be used for the same purpose.

The next important step towards treating hiatus hernia is relaxation. An important measure in this direction is diaphragmatic breathing. The procedure is as follows: lie down with both knees bent and feet close to buttocks. Feel relaxed. Put both the hands lightly on the abdomen and concentrate the attention on this area. Now breathe in, gently pushing the abdomen up under the hands at the same time, until no more air can be inhaled. Then relax, breathing out through the mouth with an audible sighing sound and allow the abdominal wall to sink back. The shoulders and chest should, remain at rest throughout.

It is important to be able to relax at any time and thereby prevent building up of physical and mental tensions, which may cause actual physical symptoms. The best method for this is to practice shavasana or `dead body` pose.

The patient of hiatus hernia should observe certain precautions in their eating habits. The foremost amongst these is not to take water with meals, but half an hour before or one hour after a meal. This helps the digestive process considerably and reduces the incidence of heartburn. Drinking water with meals increases the overall weight in the stomach, slows down the digestive process by diluting the digestive juices and this increases the risk of fermentation and gas formation, which distends the stomach and causes discomfort and pain. Another important factor in the treatment of this disease is to take frequent small meals instead of three large ones. Thorough mastication of food is also essential both to break up the food into small particles and to slow down the rate of intake.

The diet of the patient should consist of seeds, nuts, whole cereal grains, vegetables and fruits, with emphasis on fresh fruits, raw or lightly cooked vegetables and sprouted seeds. The foods, which should be avoided, are over-processed foods like white bread and sugar, cakes and biscuits, rice puddings and overcooked vegetables. At least 50 per cent of the diet should consist of fruits and vegetables, and the remaining 50 per cent of protein, carbohydrates and fat.

Raw juices extracted form fresh fruits and vegetables are valuable in haitus hernia, and the patient should take these juices half an hour before each meal. Carrot juice is specially beneficial as it has a very restorative effect, and is rich in vitamin A and calcium. It is an alkaline, food, which soothes the stomach. All juices should be diluted with water on a 50:50 basis as they are concentrated.

The hot drinks should always be allowed to cool a little before taking. Extremes in temperature, in both food and drink should be avoided, drinks should not be taken hurriedly, but sipped slowly. The patient should avoid condiments, pickles, strong tea, coffee, alcoholic beverages and smoking.