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Life Sciences => Physiology & Medicine => Topic started by: Karen W. on 04/02/2009 08:37:38

Title: Exactly what treatment options are there for Hiatal hernias?
Post by: Karen W. on 04/02/2009 08:37:38

I have been diagnosed with a Sm. to Md.size Hiatal hernia..sorry bout the spelling!

Not a huge deal but I am having some real discomfort with it .. I believe it is the pain and popping out feeling and lump I feel when coughing.... hurts like crazy...
This is what I know at this point..but I am having discomfort and pain when coughing so hard...:

Doc is out of town so is there any home things or helpful hints, I can do to help when coughing to ease the pain and tearing bulging feeling...

http://www.healthscout.com/ency/68/57/main.html#TreatmentofHiatalHernia


Treatment of Hiatal Hernia
If you have a hiatal hernia, your doctor will probably suggest one of these three approaches to manage your condition:

No treatment - if you do not have any symptoms from a hiatal hernia, and most people do not, you probably do not need to do anything about it.

A combination of lifestyle changes and medications - if you have recurrent gastroesophageal reflux, eliminating coffee, alcohol and smoking, combined with weight reduction if you are overweight, may do a great deal to relieve the heartburn and prevent esophagitis.

The great majority of patients can be managed by a conservative program. Every effort must be made to enlist the aid of gravity in preventing reflux at night. The patient should not lie down after meals and should not eat a late meal before bedtime. The head of the patient's bed should be elevated on six inch blocks; attempting to sleep propped up on pillows almost never succeeds.

Also, antacids or antacid combinations containing alginic acid can help neutralize stomach acid. If these changes do not help, your doctor may prescribe drugs such as cimetidine, ranitidine or omeprazole to reduce stomach acid secretion.

Surgery - when severe symptoms of reflux persist despite the combination of lifestyle changes and medications, or if the complications such as stricture, chronic bleeding or obstruction develop, surgery may be necessary. The surgeon's goal is to "rebuild" the esophageal sphincter and repair the hernia.

There are two types of esophageal hiatal hernia: paraesophageal and sliding. Symptoms from an uncomplicated paraesophageal hernia usually develop in adult life and may consist of a sense of pressure in the lower chest after eating and occasionally palpitations, due to cardiac arrhythmias. All of these are pressure phenomena, caused by the enlargement of the herniated gastric pouch when food displaces the fundic (stomach’s) air bubble.

Since complications are frequent in paraesophageal hiatal hernias, even in the absence of symptoms, operative repair is indicated in most cases. The usual method is to return the herniated stomach to the abdomen and affix it with sutures to the posterior rectus sheath (anterior gastroplexy). The enlarged hiatus is closed snugly around the gastroesophageal junction with interrupted sutures. It is unnecessary to excise (cut out) the hernia sac. The results of surgical management are generally excellent.

Most patients (80 percent) with clinically significant reflux have a sliding hiatal hernia. In these patients, the cardioesophageal junction and the fundus of the stomach are displaced upward into the posterior mediastinum, exposing the lower esophageal sphincter to intrathoracic pressure. At least half of all sliding hiatal hernias are asymptomatic and require no treatment.

Title: Exactly what treatment options are there for Hiatal hernias?
Post by: Karen W. on 04/02/2009 09:26:51

What is Stricture..by the way?

Title: Exactly what treatment options are there for Hiatal hernias?
Post by: Chemistry4me on 04/02/2009 09:31:00

A constriction or narrowing of a body passage.

Title: Exactly what treatment options are there for Hiatal hernias?
Post by: Karen W. on 04/02/2009 09:41:23

so do they mean a stricture of the hernia itself.. is that what happens when it gets squeezed up into the wrong part of the muscle or chest cavity.. or wherever it is?

Title: Exactly what treatment options are there for Hiatal hernias?
Post by: DoctorBeaver on 04/02/2009 13:07:49

I've got that but fortunately it doesn't give me much trouble. I sometimes feel bloated even if I've had nothing to eat and very occasionally it hurts a bit.

In my case what has happened is that things have "loosened up" where the oesophagus joins the stomach so instead of being a rigid connection there is some movement.

Title: Exactly what treatment options are there for Hiatal hernias?
Post by: iko on 04/02/2009 18:23:34

Quote from: DoctorBeaver on 04/02/2009 13:07:49

I've got that but fortunately it doesn't give me much trouble. I sometimes feel bloated even if I've had nothing to eat and very occasionally it hurts a bit.

In my case what has happened is that things have "loosened up" where the oesophagus joins the stomach so instead of being a rigid connection there is some movement.

It's exactly like this. A major problem is that oesophagus and stomach have different linings, called "mucosae": the stomach one produces acids (HCl) that irritate the oesophagus...creating problems.
The special 'one-way' valve between oesophagus and stomach (cardias: a burping device) cannot work properly anymore.
Antiacids help.

(https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fwww.robertmorrison.info%2Fwp-content%2Fuploads%2F2008%2F03%2Fschema.png&hash=ad4b0ea87fe395e0d3ef4a0d8f9675e4)(https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fimages.encarta.msn.com%2Fxrefmedia%2Fsharemed%2Ftargets%2Fimages%2Fpho%2Ft979%2FT979074A.jpg&hash=f259adb05651942bf9ef13e7b48be2f9)
http://www.robertmorrison.info/wp-content/uploads/2008/03/schema.png
http://images.encarta.msn.com/xrefmedia/sharemed/targets/images/pho/t979/T979074A.jpg

Title: Exactly what treatment options are there for Hiatal hernias?
Post by: Karen W. on 05/02/2009 06:53:10

I have only started having heartburn recently again... Things feel like they are going to come back.....

Antacids are on the list for no no with my some of my meds.. I will check again to see which one though!. Seems like straining hurts it more.. especially deep coughing..

Title: Exactly what treatment options are there for Hiatal hernias?
Post by: Karen W. on 05/02/2009 06:55:50

I have already been told by the doctor to not lift anything.. aneurysm and hernia wise.. but  She won't be back until.. 11th... do you think baking soda and water would help..safely..?

Title: Exactly what treatment options are there for Hiatal hernias?
Post by: lancenti on 05/02/2009 09:53:34

My home remedy for heart-burn is actually coke or some other carbonated drink to dislodge whatever's stuck, but I don't think that's the case for you...

I would advise against the baking soda, since that'd create a lot of gas to evolve and we're not exactly sure what the interaction with your other meds are though sodium can't be too bad.

I'll go with lots of water. That always works, somehow. Diluting the acid, I guess.

Title: Exactly what treatment options are there for Hiatal hernias?
Post by: Karen W. on 05/02/2009 10:08:10

OH.. I am late welcome to the forum.. and thanks..I hate water but have to drink plenty because of the meds.. I take potassium to replace what the other medications steel away.. so maybe I will try a tad more water to see if it helps.. couldn't hurt as long as I keep a careful eye on whats coming out too!