So what is a hiatus hernia?

I was asked the other day exactly what is a hiatus hernia & why does it cause me grief.

Basically a hiatus hernia is where part of the stomach moves (herniates or protrudes) upwards into the chest cavity via an enlarged hole (the hiatus) in the diaphragm.

The vast majority of people with a hiatus hernia don’t experience any problems.

But a lot of us do.

It’s probably easier to use a few diagrams to illustrate.  Let’s start with normal anatomy.

There is no hiatus hernia here. The lower oesophageal sphincter can function like a valve with the help of the diaphrgam's pressure.

Notice that for most people the junction between the oesophagus & stomach (called the lower oesophageal sphincter) sits BELOW the diaphragm. This allows the sphincter to act as a valve & prevent reflux of food and acid back up the oesophagus.

Here’s what happens if you have an hiatus hernia, and there are a couple of varieties.

This is the most common hiatus hernia type, a sliding one. See what's happened to that lower oesophageal sphincter? Can't work as well if it's up in the chest cavity.

A different type of hiatus hernia, the rolling one. Not so common. It is possible to have a combination of rolling & sliding.

Notice this time that sphincter is now above the diaphragm, where it can’t function as a valve anywhere near as well. And the diaphragm isn’t able to assist with keeping pressure on the sphincter if it’s sitting above instead of below.  The result can be GORD or GERD (reflux disease).

In my case it means a lot of GORD symptoms & I have to take care when bending over (not good) & with heavy lifting (and that means being careful even when lifting a bag of groceries).

I have adopted some of the “lifestyle” advice: no alcohol, no fatty foods, no hot spices, no fizzy drinks etc. I eat a low-fat vegetarian diet with very small servings & watch my nutritional intake carefully. I use the services of qualified dietician to guide me in food choices.

No, it can’t be treated with alternative therapies. And if you try to do “Visceral manipulation” as per the photo at Figure 5, I will scream. In pain.  Within hours I’ll have very nasty & painful reflux for a few days. And then I will commence litigation proceedings against you. Just saying.

Further information on hiatus hernias can be found at Patient UK, & that same site has some good info on acid reflux & oesophagitis which often accompany hiatus hernia. I particularly like that site’s information as it provides clinical references.

Note on treating GORD (GERD) & hiatus hernias with alternative therapies:

When I was first diagnosed I was a great user of an assortment of alternative therapies to treat any ailments I might have. I look back at those years & see that most of those ailments were self-limiting. They were going to get better with or without any complementary therapies I might choose to swallow or dabble with.

Initially I used herbal medicine to complement my medical treatment. In the first few weeks it worked, it eased my painful symptoms. But I continued to get symptoms and the herbal treatments were doing nothing (yes my doctor knew I was using). The sheer cost of alternative therapies was such that I felt I had to go with the treatment that was having a positive impact on me. That was the scientifically proven, evidence-based MEDICINE.

I do however continue to use peppermint oil to massage lightly over my stomach & abdomen most nights as it takes the edge off the painful bloating pain (& feels nice).  And if I am experiencing oesophagitis (with throat/voice pain) I will drink slippery elm powder mixed with a little apple juice. Because that temporarily eases that pain.  But they are adjuncts to my medical therapy. And I won’t have it any other way.

Alternative & Complementary Therapies

Like most people I’ve experimented with alternative and complementary health therapies over the years.

Attracted by the phrases “natural”, “not addictive” and “no side effects”, I was seeking to avoid having to use drugs and doctors to maintain good health. I used reflexology, massage therapy, aromatherapy, homeopathy, herbal medicine, naturopathy and reiki. I’ve also used meditation and yoga.

I used these modalities to treat everyday ailments. I even have qualifications in some of them.

But how many of these therapies do I continue to use regularly because I actually feel them doing me good?

Aromatherapy

I use 3 essential oils – lavender (antiseptic, burns), aniseed (mucolytic – GORD, nausea), peppermint (GORD – nausea or bloating).

Occasionally I’ll heat an essential oil in a tea light vaporiser, this is because I like the smell. Nothing more.

Homeopathy

Arnica ointment or oil (not the pilules prescribed in homeopathy), for bruises as part of first aid treatment.

The scientific part of my brain screamed that there is no way homeopathic pilules could possibly work. But, sometimes, I don’t know, they did seem to do their alleged job. But not always and not enough to keep me using the therapy long term. I didn’t like the fact that homeopathy treats the symptom picture, nor the fact that as the symptoms change during the course of a disease process, you needed to change the prescription. Costly, and hard work if self-treating. Very costly if seeing a practitioner.

However, I must say that my experiences with classically trained homeopaths in the UK (on the NHS!) and in Australia has always been conservative and honest, with an insistence that you also consult a medical doctor. In recent years I have noticed the trend to the “I can cure everything!” style of homeopath, the ones that charge hefty fees. Alas, most people do not have the skills to research & critically analyse their illness and treatments adequately and hence get taken for a ride by some very dodgy practitioners.

But I am happy with my arnica ointment.

Massage Therapy

Occasional massage for relaxation of tight, stressed muscles. I prefer to see a physiotherapist for muscle & skeletal injuries. Cheaper. I don’t like chiropractors. Sorry.

Herbal Medicine & Vitamins and Minerals

When my oesophagitis flares up, or when my vocal cords are damaged from GORD, I will drink the powdered bark of the Slippery elm tree.

Smells like tree bark. Tastes like tree bark. Even when mixed with apple juice. But it does give immediate, short term pain relief for the mucus linings of the upper digestive tract. Slippery elm is also used to treat the symptoms of stomach ulcers.

When you research slippery elm and study how it works in the human body, you will see that popping the pill variety will do you little good at all. It is the powder, mixed with water or juice, that coats the inside of your oesophagus and stomach, that will mask the pain for a while.

I take vitamin & mineral supplements IF and only IF I have a demonstrated deficiency. There is no point to do otherwise. Far easier and tastier, not to mention healthier, to eat a nutritionally balanced diet containing a whole pile of fresh fruit and vegetables.

Propolis tablets or tincture are made from bee pollen. I stick with the original New Zealand sourced product for when I have a serious chest cold. Gives a bit of relief to the congestion, that’s all. If I don’t have any in the cupboard when I catch that cold, doesn’t matter. If I do, I use it.

Yoga & Meditation

I enjoy doing the yoga asanas, for exercise & relaxation. And meditation I also do for relaxation.

Accupressure & puncture

Together with shiatsu massage, I’ve used acupressure to treat odd, mild symptoms. Travel sickness, an upset stomach, period pain, those sorts of things.

I’ve resorted to applying pressure on the designated points usually because the pain killing drugs are not quite enough to give relief, or because I can’t find any panadol or panadeine in the house.

Accupressure sort of works for me, and it’s not a bother to try it out, but I wouldn’t want to depend upon it as my only treatment.

The only times I’ve used acupuncture, it didn’t do anything apart from making me feel quite relaxed for a short time. Then I reached for the panadol when I got home. J

Naturopathy

Initially I thought naturopathy was quite a sound therapy. Appears to focus on vitamins, minerals and basic nutrition. But it seemed to me that where a dietician or nutritionist will give you a list of foods, recipes and a diet plan, the naturopath will hand you a very expensive bottle of their own specially prescribed pills.

Western Medicine

I came to terms with having to use a lot of western medicine after I developed GORD & oesophagitis. The above complementary therapies didn’t relieve my symptoms at all (with the exception of the slippery elm, and that only worked on one of my symptoms). I got to the stage where, after having yet another relapse, I was so tired of trying so many alternative therapies that were obviously not working. I don’t care, but it’s not right for the patient to have to go on experiencing high levels of pain and other uncomfortable symptoms for months on end just because the complementary therapist says “oh but you need to give it about 3 or 4 months to work properly”.

I began researching the journals for evidence based best practice with treating GORD. My doctors have prescribed the optimum treatment protocol for me. And whilst I may experience constant breakthrough pain and other GORD symptoms, the medications are working and they are safe. I consult a nutritionist for help with diet.

Since I stopped playing around with the complementary therapies, and been content to pop my prescription drugs at the required times and just use those adjunctives that work for me, I’ve been a lot more relaxed. Not cured. But I’ve stopped searching too wide for answers. I’m happy restricting my research to the narrow field of medical science. It’s given me more time to spend on myself, on coping with the constant pain and nausea. And still manage to have some energy left over at the end of the day to smile and take pleasure with my partner and family.