Hiatal hernia, described as the ascent of the stomach into the thorax through the oesophageal orifice of the diaphragm, also known as the“hiatus” or ” hiatalorifice “, is a condition that deserves our attention. In the diaphragm, this hiatus plays an essential role in allowing the oesophagus to pass through. It is precisely at this level that the upper part of the stomach can make its way and protrude into the thoracic cavity. Although most hiatal hernias are benign, it is important to note that some can lead to gastro-oesophageal reflux disease (GERD) and, in the most serious cases, oesophagitis, oesophageal ulcers and even cardiorespiratory problems.
It is interesting to note that hiatal hernia is the most common injury to the digestive tract. What’s more, statistics show that between 10% and 15% of people with signs of gastro-oesophageal reflux have a hiatal hernia.
The various types of hiatal hernia
When discussing hiatal hernia, it is essential to understand that there are several variants of the condition (1), each with its own specific characteristics. These different typologies allow healthcare professionals to better diagnose and implement appropriate treatment approaches.
1. Type 1 hiatal hernia (sliding hernia) :
Type 1, also known as sliding hiatal hernia, is by far the most common type, accounting for up to 95% of all hiatal hernias. In this condition, the part of the oesophagus that connects to the stomach periodically slides through the enlarged hiatus and then returns to its normal position.
2. Type 2 hiatus hernia (paraesophageal hernia or rolling hernia) :
Types 2 to 4 are grouped together under the term paraesophageal hiatal hernias. “Paraesophageal” means “next to the oesophagus”. In Type 2, the upper part of the stomach pushes through the hiatus alongside the oesophagus, forming a protuberance next to it. It is also known as rolling hiatal hernia.
3. Type 3 hiatal hernia:
Type 3 is a combination of the first two types. The part of the oesophagus that connects to the stomach, the gastro-oesophageal junction, periodically slips through the hiatus. In addition, another part of the stomach also protrudes next to the gastro-oesophageal junction at certain times.
4. Type 4 hiatus hernia:
Type 4 is rare, but can be more complicated. In this variant, the hiatus is wide enough to allow two different organs to herniate through it. The hernia usually involves the stomach as well as another abdominal organ, such as a portion of the intestine, the pancreas or the spleen.
By understanding these distinctions between the different types of hiatal hernia, we are better prepared to address the specific needs of each patient and develop appropriate treatment strategies. This information is essential for making informed decisions about the management of this common condition.
What causes hiatal hernia?
The cause of hiatus hernia can be multifactorial, and it is not always clear why it develops. However, there are a number of factors that can contribute to its onset:
1. Age-related changes in the diaphragm:
The diaphragm is a crucial muscle involved in breathing and keeping the stomach in its normal place. With age, it can undergo changes that make it weaker, thus favouring the development of hiatal hernia.
2. Injuries to the area :
Injuries to the abdominal region, such as those resulting from trauma or certain types of surgery, can damage the structures of the diaphragm and oesophageal hiatus, thus increasing the risk of hiatal hernia.
3. Congenital malformation :
In rare cases, some people may be born with an abnormally wide oesophageal hiatus, creating a favourable breeding ground for the development of hiatal hernia early in life.
4. Constant and intense pressure on the surrounding muscles:
Repeated and intense pressure on the muscles surrounding the oesophageal hiatus can also play a role in the formation of hiatal hernia. This can occur withfrequent coughing, vomiting,excessive straining during bowel movements,strenuous exercise or lifting heavy objects.
Risk factors :
Certain risk factors can increase the likelihood of developing hiatal hernia. The main risk factors include
- Age: Hiatal hernias are more common in people aged 50 and over, due to age-related changes in the diaphragm.
- Obesity: People who are obese have an increased risk of developing hiatal hernia, as excess weight puts extra pressure on the abdomen and diaphragm.
Understanding these causes and risk factors can help raise awareness of hiatal hernia and take preventative measures to reduce the risk, including adopting a healthy lifestyle and avoiding risky behaviours.
Naturopathic advice for reducing hiatal hernia problems
Here are a few practical tips for managing your hiatus hernia naturally and improving your quality of life.
Food hygiene
- Weight Management: If necessary, consider losing weight to reduce pressure on the diaphragm.
- Balanced Meals: Replace heavy meals with five lighter meals throughout the day.
- Avoid Irritants: Limit spices, coffee, fats, alcohol, tobacco and fizzy drinks as they can worsen hiatal hernia symptoms.
- Meal Timing: Eat your evening meal at least a few hours before going to bed to reduce the risk of gastro-oesophageal reflux.
- Raising the bed: Raise the head of your bed slightly to minimise night-time reflux.
- Stress Management: Practice stress management techniques such as meditation or deep breathing to reduce tension.
- Comfortable Clothing: Choose loose, comfortable clothing to avoid excessive pressure on the abdomen.
- Flexion Technique: When you have to bend down, flex your legs instead of bending your torso forward to avoid putting extra pressure on your stomach.
Feeding
- Careful chewing: Take the time to chew your food well to aid digestion.
- Healthy Hydration: Drink preferably outside of mealtimes and avoid using a straw to minimise air intake.
- Reducing Foods to Avoid: Quickly reduce your consumption of cold meats, fatty meats, butter, vegetable oils, margarine, cream, fatty sauces, cheeses, pastries, pastries and chocolate.
- Protein foods: Choose foods that are high in protein but low in fat, such as lean meats like skinless poultry, lean fish (hake, dab, cod), low-fat dairy foods, lentils and beans.
- Fibre in the diet: Increase your fibre intake by including vegetables and fruit (in reasonable quantities, avoiding cabbage and onions in excess, as they can promote gas formation), pulses and dried fruit, as well as wholegrain starchy foods such as wholemeal bread, wholegrain rice and wholegrain pasta.
- Therapeutic basil: Use basil to season your dishes, as this plant has therapeutic value in the case of hiatus hernia.
Exercise and Strengthening
- Diaphragm Strengthening Exercise: In addition to your osteopathy sessions, practice a daily diaphragm strengthening exercise to maintain your health.
Here’s how to do it:
- Lie comfortably with an empty stomach, knees bent and feet flat on the floor.
- Inhale deeply, inflating your stomach.
- Very slowly exhale the air breathed in, making a small hole with your mouth. Try to hold it for several tens of seconds.
- Repeat the exercise at least three times in a row.
What plants should I use for hiatal hernia?
Nature offers a variety of plants and natural substances that can help relieve the symptoms associated with hiatus hernia. Among them, apple cider vinegar, cinnamon, aloe vera, slippery elm and camomile stand out for their specific therapeutic properties. Here’s how these natural remedies can be used:
- Homeopathic dilution of Spruce: Used primarily to alleviate spasms of the oesophagus and cardia, as well as retrosternal compression, spruce in homeopathic dilution is a therapeutic option for these specific symptoms.
- Verbena officinalis infusion: Recommended for a variety of digestive disorders, including gastritis, ulcers and hiatus hernia, verbena officinalis infusion can be taken after meals. It should be noted, however, that it can affect the absorption of iron and should be avoided in cases of iron deficiency.
- Liquorice EPS: Helps to increase gastric mucus secretion and reduce pepsinogen secretion. Liquorice is effective both in preventing and treating gastric ulcers, and may be beneficial in the treatment of hiatus hernia. However, it may interact with certain medicines, including omeprazole and oral contraceptives. It is advisable to consult a pharmacist before use.
- Infusion and decoction of Marshmallow, Mallow, White Broth and Plantain EPS: These plants, rich in pectin and mucilage, are traditionally used to soothe irritations of the digestive mucosa. They protect tissues from acidic attack and can offer significant relief.
- Apple Cider Vinegar: Despite its acidic nature, it is often used to rebalance stomach acidity. Apple cider vinegar can improve digestion and reduce acid reflux symptoms associated with hiatal hernia.
- Cinnamon: Known for its anti-inflammatory and digestive properties, cinnamon can help reduce feelings of heaviness and bloating, common symptoms in hiatal hernia sufferers.
- Aloe Vera: Thanks to its soothing and healing properties, aloe vera can reduce inflammation of the oesophagus and relieve reflux symptoms. Its consumption in juice form is particularly recommended.
- Slippery elm: This plant is rich in mucilage, which forms a protective gel that can help protect the oesophagus and stomach from acids. Usually taken as a powder mixed with water, slippery elm can provide effective relief.
- Chamomile: Chamomile, known for its calming and anti-inflammatory properties, can help relax the digestive system. Chamomile tea can reduce the spasms and pain associated with hiatus hernia.
FAQ
- 1. What is hiatus hernia?
A condition where part of the stomach rises into the chest through the oesophageal orifice of the diaphragm, called the “hiatus” or “hiatal orifice”.
- 2. What are the different types of hiatal hernia?
There are two main types of hiatal hernia: sliding or type 1 hiatal hernia, where the abdominal oesophagus and cardia move up into the thorax, and rolling or type 2 hiatal hernia, where a large part of the stomach passes into the thorax.
- 3. What causes hiatal hernia?
The cause of hiatal hernia is generally unknown, but it may be due to stretching of the bands of tissue that are attached between the oesophagus and the diaphragm. It is more common in people over 50, who are overweight or smoke, or in cases of pregnancy, obesity and congenital shortening of the oesophagus.
- 4. What advice do you have to limit hiatal hernia problems?
It is advisable to follow dietary hygiene rules such as losing weight if necessary, avoiding irritating foods such as spices, coffee, fats, alcohol, tobacco and fizzy drinks, elevating the head of the bed, loosening clothes, chewing food properly and doing daily exercise to strengthen the diaphragm.
- 5. What plants are recommended for hiatal hernia?
Certain plants can help relieve the symptoms of hiatus hernia. Spruce in homeopathic dilution can help relieve spasms of the oesophagus and cardia. Vervain is useful for digestive disorders and hiatus hernia. Liquorice can help prevent and treat gastric ulcers and hiatal hernia. Marshmallow, mallow, mullein and plantain can also relieve mucosal irritation.
Source:
- (1) https://my.clevelandclinic.org/health/diseases/8098-hiatal-hernia
- https://www.snfge.org/content/hernie-hiatale-0
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6955185/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6853045/
- https://pubmed.ncbi.nlm.nih.gov/3518340/
- https://pubmed.ncbi.nlm.nih.gov/10520831/
- https://pubmed.ncbi.nlm.nih.gov/16246942/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8356952/
