Is there a link between acid reflux, bloating and a hiatus hernia?

Hiatus Hernia

When someone contacts me who suffers with acid reflux, one of the questions I often ask is ‘Do you have a hiatus hernia?’ I also ask if they suffer with chronic bloating, which may be worse after food. I ask these questions as there is a link between intestinal bloating, hiatus hernia and acid reflux. In about 8 out of 10 cases, the answer is ‘Yes’.

Hiatus hernia or hiatal hernia, is when part of the stomach squeezes up into the chest through an opening (hiatus) in the diaphragm. It tends to affect the over 50s, overweight people and pregnant women. The number one cause of hiatus hernia is ageing. As we age, tissues in the diaphragm become weaker, slacker, just like the tissues on our face, and this weakness in connective tissue causes an opening to form at the top of the diaphragm and allows the stomach to move up into the chest cavity. The weakening of the diaphragm can cause gastro-oesophageal reflux disease (GORD), and the most common symptom, acid reflux.

The diaphragm is a thin dome-shaped muscle that separates the abdomen from the chest. It moves upwards and downwards when we inhale and exhale. It also helps keep acid and acid-drenched food in the stomach, preventing it from moving up into the oesophagus. Think of the diaphragm as a kind of lid, keeping the contents of the stomach, acid and acid-drenched food in the stomach and enabling it to move in a downward motion towards the intestines, not regurgitating upwards into the oesophagus, sometimes further into the throat and pouring down the trachea into the lungs.

Over half of the UK population over the age of 50 have a hiatus hernia, but many of them have no symptoms. This is not necessarily a good thing as symptoms alert us when something is wrong enabling us to then do something about it. Lack of symptoms may indicate that the tissues in the oesophagus have been so damaged by acid that they have lost any feeling.

Very often palpitations can be a symptom of a hiatus hernia; this is because the vagus nerve, one of the cranial nerves, passes through the stomach and if it’s irritated with acid, we can get frightening palpitations. Many people go to A&E thinking they may be having a heart attack.

There are two main types of hernia:

  • a sliding hiatus hernia, where the oesophagus and stomach slides up and down, in and out of the chest/abdominal cavity.
  • a paraoesophageal hiatus hernia, where the hiatus, the hole at the top of the diaphragm, has widened, allowing the oesophagus and stomach to pass through this hiatus and into the thorax (chest cavity).

Hiatus hernia can be caused by lifting heavy things, prolonged bouts of coughing, ageing, pregnancy and excessive intestinal bloating.

When all 23ft (7m) or so of intestines are stretched and expanded due to inflammation and excess gas, the intestines can push outwards causing visible bloating, push backwards, putting pressure on the lower back, push downwards putting pressure on the bladder and causing frequency of urination, not to mention retention of urine, increasing the risk of UTIs, and push upwards too, towards the stomach. If the pressure being exerted by bloated intestines is excessive or the diaphragm is weakened due to ageing, then it can push the stomach upwards and squeeze it into the chest cavity through the hiatus in the diaphragm.

Very often, people find that once they’ve reduced their bloating, not only do their GORD symptoms improve, but they can breathe better too because the lungs are not being crushed by the contents of the abdomen.

I talk about more about hiatus hernia and acid reflux, how bloating can cause a hiatus hernia, and how anyone with acid reflux needs to tackle their bloating – to take the pressure off the stomach so that it can fall back into the abdominal cavity to stop acid-drenched food pushing up into the oesophagus – in this video.

If you suffer with acid reflux, remove the following from your diet: alcohol, caffeine, citrus fruits, chocolate, anything with mint in, all processed food. Processed food contains artificial ingredients that are very acidic and that will irritate the stomach, especially if gastritis is already a symptom. All food should be prepared and cooked from scratch. Eat smaller meals, chew food until it’s like a paste before swallowing and try not to eat after 7pm.

Supplementation tips for managing acid reflux:

  • Take a Digestive Enzymes tablet just before meals to manage your bloating
  • If you are not already, take Live Bacteria capsules twice daily, one capsule before breakfast and one before bed, with a little water, not only for digestive and gut health, but for immune health too.
  • Activated Charcoal capsules are very helpful for managing bloating and trapped wind. Take two capsules at the first signs of wind building up.

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