Hiatal hernia

Hiatal hernia means that the aperture in the diaphragm through which the esophagus passes, is widened because of a partially-, or completely weakened diaphragm.

Common symptoms include acidic indigestion, reflux, heartburn, chronic cough, a feeling of ‘lump in the throat’ or of a blockage in the chest or difficulties in swallowing solid food e.g. dry meat.

If you have swallowing difficulties it is important to contact your GP to find out the reason behind your problems and rule out any illnesses.

This is the reason for the most common type of dysphagia, so-called intermittent esophageal dysphagia. This form of dysphagia affects around 10 percent of the population[1] irrespective of age: young and old.

In this section we explain what hiatal hernia (sometimes called diaphragm hernia) is, its common symptoms, what actually happens in the body, and how the condition can be diagnosed.

We also show how nowadays the condition can be treated effectively in a natural way with the unique neuromuscular treatment method IQoro which has a scientifically proven treatment effectiveness.

In many countries, until the summer of 2014 only anti-acid medication was offered to counter the symptoms of the problem, with surgery as the only alternative – with all the risks associated with it.

Common symptoms of a hiatal hernia

Those affected seldom relate their problem directly to swallowing difficulties (dysphagia) but instead highlight and seek help for the symptoms and problems that hiatal hernia causes; as described below.

If you are suffering from hiatal hernia you may experience one or more of the following symptoms during or after swallowing. These troubling symptoms may not be present every day, but can come and go:

  • Acid indigestion, heartburn, reflux.
  • Chronic cough.
  • Lump, or cramp in throat, or in the fossa jugularis.
  • An intermittent feeling of a blockage in the chest.
  • Difficulties in swallowing some solid food: including chicken, dry meat, rice or soft dry bread.
  • Food stuck in the throat more often than normal.
  • Feeling ’full up’ earlier than was normal.
  • Frothy, thick, or excessive saliva that can be difficult to swallow away, which leads to a frequent need to try to swallow.
  • A need to drink a lot of liquid to be able to swallow food.
  • Food that you have swallowed sometimes comes back up to your mouth a while after your meal, sometimes as a violent vomit attack with very thick phlegm.
  • Breathing difficulties.
  • Hoarseness.
  • Bubbly, unclear voice.
  • Gassy, burping often.
  • Pain in the chest or throat: some people experience the pain so intensely that they confuse it with a heart-attack.
  • Pain in the stomach – gaseousness.
  • Pain in the skull behind the ears.
  • Pains in the back.
  • Taking a long time to eat, often worse in the company of others, or in noisy or stressful environments.
  • The problem can become so invasive that you avoid food and drink in social circumstances.

Hiatal hernia is in itself a benign condition of the esophagus but, if untreated, the unpleasant symptoms become more intense over time. More of the above symptoms start to occur and create problems more frequently.

Therefore it’s good to start treatment as soon as possible. If you wait too long before treating the problem there is a risk that the musculature will weaken further, which will mean that it will take a longer time to build it up again.

Read about the treatment

This is how hiatal hernia occurs

Hiatal hernia is caused by a weakening of the diaphragm, which is a so called skeletal striated muscle (the same muscle type as in your arms and legs) which forms a partition across the lower part of the rib cage up to the breastbone, and separates the chest cavity from the abdominal cavity below (see the horizontal orange line in the diagram).

The diaphragm is involved, amongst other things, when we breathe or need to be sick.

The esophagus passes through the chest cavity behind the heart and down through a small hole in the diaphragm where it leads to the stomach, which is situated just underneath.

When we need to be sick and empty our stomach, our stomach should normally slide up through the hole in the diaphragm. When we have been sick the stomach should return to its normal position below the diaphragm.

In hiatal hernia the diaphragm’s musculature is weakened around the hole where the esophagus flows into the stomach. This leads to the condition where the stomach can randomly slide up and down through the hole and in this way affect both the esophagus’ function and the upper stomach sphincter’s (Lower Esophageal Sphincter, LES) ability to close off tightly.

At the same time the upper esophagus sphincter or PES (Posterior Esophageal Sphincter) is also affected, so that it does not open completely to allow food down into the esophagus.

The underlying causes of the symptoms

To transport food smoothly via the esophagus and down to the stomach the longitudinal musculature in the esophagus is flexed or tensed. This creates a stiff tube, and the upper esophagus sphincter opens to allow the food down, see the right hand illustration.

The upper part of the stomach is in the chest cavity

With a hiatal hernia a part of the stomach lies in the chest cavity instead, see the left hand illustration. The esophagus crumples like a concertina and the longitudinal muscles are relaxed. As a result, the esophagus’ muscles lose the ability to create a stiff pipe and to open the upper esophagus mouth (Posterior Esophagus Sphincter) when swallowing.

This is the reason for the symptoms of:

Because the upper esophagus mouth does not open correctly there is also a risk that food will become stuck there and then slip into the air pathways. Food becomes stuck in your throat, you will cough, and may have other air pathway problems too.

Upper stomach sphincter remains open and leaks stomach acid

It is necessary that the entire stomach remains below the diaphragm in the abdominal cavity in order for the upper stomach sphincter to be able to close tightly: the sphincter only opens then in one direction – like a door, and the stomach acids are prevented from leaking upwards.

If the stomach mouth is in the chest cavity it instead becomes like a swinging door that opens in either direction.  The upper stomach sphincter opens and stomach acids leak up to the mouth and can even run into the air pathways.

This leads to the symptoms of chronic coughing, gurgling and indistinct voice, acidic reflux, and viscous frothy saliva. This bubbly saliva is caused by the air pathways creating a thick frothy phlegm to protect the mucous membrane and the vocal cords from the caustic stomach acids.

Because the breathing pathways are affected the symptoms are sometimes misinterpreted as asthma. In such cases asthma medicine does not help. The thick frothy phlegm can be difficult to swallow and in some cases can cause pain behind the ears; a consequence of the repeated attempts to swallow.

Other organs are pushed aside

The stomach, which has slid up into the chest, pushes on other organs like the lungs and heart and can cause pain in the chest. This pain can sometimes be so severe that it is misinterpreted as a heart attack.

Treating hiatal hernia

IQoro is a new and unique neuromuscular treatment method that takes just 30 seconds’ exercise, three times per day. It is CE marked according to the relevant health, safety, and environmental standards, and is a patented medical device and treatment regime.

The treatment is based on more than 20 years’ research and cooperation with the university hospitals of Umeå, Uppsala and Linköping in Sweden.

IQoro is unique in being able to simply, naturally, and effectively train the musculature from the mouth down to the diaphragm and treat hiatal hernia.

The exercise regime takes 90 seconds per day, typically for 6–8 months. IQoro acts against the fundamental causes of why the hiatal hernia and its symptoms have arisen, it does this in a natural way and without negative side-effects.

Once the desired result has been reached, exercise training a couple of times a week is still be required to maintain muscle strength.

Exercising with IQoro brings into play the lip-, cheek- and pharynx musculature down to the upper third of the esophagus (the buccinator mechanism – a skeletal striated muscle chain), and the stronger muscles at the upper stomach mouth, and the diaphragm.

The training results in an increased pressure around the hole in the diaphragm where the esophagus passes through to flow into the stomach.

This means that the diaphragm’s strength is improved so that it can hold the stomach down in its correct position, below the diaphragm. As the diaphragm becomes stronger the symptoms shown above are naturally reduced or disappear completely.

How quickly will I notice the results?

According to a study published in the World Journal of Gastroenterology, all patients with diagnosed hiatal hernia, or symptoms of ‘esophagal dysphagia’, improved after 6 to 8 months’ training with IQoro for just 90 seconds per day.

The people that participated in the study were from 19–85 years old and had shown the symptoms for between 1 to 15 years – median 3 years – before treatment with IQoro commenced.

Because hiatal hernia is caused by a weakened musculature it means that the longer you suffer from the symptoms, the longer time it can take to rebuild the musculature. Compare this with taking a long break from jogging, running, or visits to the gym.

It is therefore important to start the treatment as early as possible to prevent further uncomfortable symptoms starting. The improvements will be noticed successively: some feel the difference after a few weeks, whilst others may need the entire training period of 6 to 8 months or more.

Read more about training with IQoro.

IQoro – a readily available treatment that can replace a surgical operation

Research shows that training with IQoro is a simple, cost-effective treatment that can replace an operation for hiatal hernia. [2] This that means that everybody, either with diagnosed hiatal hernia, or symptoms, can get treatment immediately.

General advice for relief before the full effect of IQoro is achieved

IQoro treats the causes of hiatal hernia with scientifically proven effect, note however that the following general advice is only for relief of the symptoms.

  • Raise the head of your bed about 15 cm and lie on your left side, that way the stomach contents cannot come up into your esophagus as easily.
  • If you are overweight, try to slim.
  • Avoid types of food and drink that you know cause you problems.
  • Drink water after every bite.
  • Avoid bending forwards and lifting heavy weights.

Children – hiatal hernia is often misunderstood as a refusal to eat

Refusal to eat often caused by hiatus hernia

In all babies, the upper stomach mouth is naturally situated in the upper position above the diaphragm in the chest cavity.

That is why the stomach contents can easily come back up to the child’s mouth with light pressure on the stomach after a meal. Babies born prematurely, or with some other conditions, can often have extra weak digestive tracts. 

It is usual that this manifests itself in cascade vomiting after the child has swallowed just a few mouthfuls of breast milk. Feeding the child can be made even more difficult by the fact that the muscle functions in the face, lips and oral cavity are also weakened.

Normally at around six months of age the esophagus begins to grow in length so that at about one year old the stomach has come down to its normal position under the diaphragm, and the digestive tract slowly begins to function normally.

In a few cases the stomach mouth remains above the diaphragm and these children experience the same difficulties as an adult with a hiatal hernia.

Hiatal hernia in very small children is often confused with a refusal to eat. For example hiatal hernia can be the reason why a child will drink liquids without a problem, but turn their head away from solid consistencies like meat, soft dry bread, rice or chicken.

If it is always difficult to swallow food bites above a certain size

If it is always difficult to swallow food portions (bolus) larger than a certain size, and you have suffered from repeated pneumonia or sudden weight loss, read the section on Achalasia Achalasia cardiae.

Hiatal hernia is sometimes confused with the rare esophagus sickness: achalasia. When diagnosed, the condition should always be called by its full Latin name Achalasia cardiae; and nothing else.

If you can always feel a blockage in the chest when swallowing bolus above a certain size, this can also be caused by some form of narrowing of the esophagus, for example from a build up of scar tissue, the formation of pockets in the esophagus, or a tumour –  so-called constant dysphagia.

If you suspect this type of problem you should be referred to a specialist doctor, surgeon or gastroenterologist.  

Sought help earlier?

If you have sought help earlier for your symptoms, but have only been offered anti-acid medicine to relieve the problems that hiatal hernia causes, there is now a proper treatment.

The IQoro product and its exercise regime has been available in the Swedish system since the summer of 2014, but it is still widely unknown in most parts of the world.

Therefore we recommend that you take information about treatment with IQoro on your next visit to your healthcare professional.

Anti-acid medication

Earlier, anti-acid medication was the first step in treatment to relieve the symptoms of acidic indigestion, heartburn and reflux. If that didn’t help, which it seldom did completely with hiatal hernia, a surgical operation was the only alternative available.

In such an operation – which is expensive and always carries a risk – the stomach is sewn fast under the diaphragm, which contributes to unwanted side-effects. [2] If, for example, a person needs to vomit after such an operation this cannot happen in a natural way, hospitalization is required and a catheter is inserted down to the stomach to empty the contents [5].

Surgical operation of hiatal hernia

The operation has therefore only been offered to those that are worst affected, which means that many suffer, and have suffered for a long time, from these serious symptoms. Symptoms that affect everyday quality of life and the possibility to enjoy mealtimes with others.

Now IQoro is available to offer a simple treatment which is cost effective, simple to administer, and without any negative side effects. People with hiatal hernia and its troublesome symptoms do not need to suffer any longer.

Read more here on how the treatment method works

Translation from the original Swedish text by T. W. Morris, MYoroface

Reference sources

  1. Kjellén G, Tibbling L. Manometric oesophageal function, acid perfusion test and symptomatology in a 55-year-old general population. Clinical Physiology. 1981; 1:405-15 
  2. Hägg M, Tibbling L, Franzén T. Esophageal dysphagia and reflux symptoms before and after oral IQoro training. World J Gastroenterol 2015; 21(24): 7558-7562. 
  3. Hägg M, Tibbling L, Franzén T. Effect of IQoro training in hiatal hernia patients with misdirected swallowing and esophageal retention symptoms. Acta Otolaryngol. 2015 Jul; 135 (7):635-9. 
  4. Nin CS, Marchiori E, Irion KL, Paludo Ade O, Alves GR, Hochhegger DR, Hochhegger B. Barium swallow study in routine clinical practice: a prospective study in patients with chronic cough. J Bras Pneumol 2013; 39: 686-691 [PMID: 24473762 DOI:10.1590/S1806-37132013000600007] 
  5. Tibbling-Grahn L, broschyr 03 Svenska Dysfagiförbundet, Stoppar maten upp i bröstet när du äter?Mellangärdesbråck – En vanlig matstrupssjukdom i alla åldrar. (pdf).
    (English translation, “Does your food get stuck in your chest when you eat? Hiatal hernia – a common esophagus condition that affects people of all ages”)