A hernia is the protrusion of an organ or tissue through a weakness or abnormal opening in the wall of the cavity that normally contains it. While many hernias occur in the lower abdomen or groin, certain types and sizes can impact a person’s ability to breathe comfortably. Respiratory symptoms typically result from direct anatomical interference with the diaphragm or complications arising from the displacement of abdominal contents. Understanding the specific mechanism is helpful because treatment varies significantly based on the hernia’s location and size.
Hiatal Hernias and Direct Respiratory Symptoms
A hiatal hernia occurs when the upper part of the stomach pushes upward through the hiatus, the opening in the diaphragm through which the esophagus passes. The diaphragm is the primary muscle responsible for breathing, separating the chest cavity from the abdomen. When a portion of the stomach is displaced into the chest, it mechanically interferes with the full downward movement of the diaphragm during inhalation, potentially leading to shortness of breath.
This type of hernia is associated with gastroesophageal reflux disease (GERD) because the displacement compromises the lower esophageal sphincter. Severe acid reflux can trigger a neurogenic response, where irritation of the esophageal lining causes the airways to constrict, mimicking asthma. This mechanism can lead to chronic coughing, hoarseness, and wheezing, especially when lying down.
In more serious cases, refluxed stomach contents can be inhaled directly into the lungs, a condition known as aspiration. Aspiration introduces foreign material that irritates the airways, resulting in recurrent pulmonary infections or asthma-like symptoms. Dyspnea, or breathlessness, is a common symptom with large hiatal hernias, sometimes due to silent aspiration or compression of the heart and lungs.
How Large Abdominal Hernias Restrict Lung Capacity
Large abdominal wall hernias, such as incisional or ventral hernias, impair breathing through a different mechanical process. These hernias can grow massive, a condition sometimes called “loss of domain,” where a significant volume of abdominal organs resides outside the abdominal cavity. As contents herniate outward, the abdominal wall loses containment, and the abdominal cavity shrinks over time.
This situation indirectly affects respiration by pushing the diaphragm upward from below, reducing the space available for the lungs to expand. The result is a restrictive breathing pattern, decreasing the total volume of air the lungs can hold. For patients with very large hernias, this upward pressure can cause paradoxical respiratory motion, where the abdomen moves inward during inhalation, further compromising lung function.
Repairing a large hernia can temporarily increase intra-abdominal pressure when the contents are returned to the cavity, which may initially impair breathing further. Pre-operative techniques like progressive pneumoperitoneum are sometimes used to gently stretch the abdominal wall and prepare the respiratory system for this change. The goal of repair is to restore the abdominal wall and improve long-term pulmonary function by allowing the diaphragm to return to its proper position.
Warning Signs and When to Seek Emergency Care
While many hernia-related breathing issues are chronic, acute changes can signal a life-threatening medical emergency. Two serious complications, incarceration and strangulation, require immediate medical attention, especially if respiratory distress is present. An incarcerated hernia occurs when the herniated tissue becomes trapped and cannot be pushed back into the abdominal cavity, causing severe pain and swelling.
Strangulation is a progression of incarceration where the blood supply to the trapped tissue, often a loop of intestine, is cut off. This process leads to tissue death, resulting in gangrene, sepsis, and a potentially fatal infection. Respiratory symptoms in this context are alarming because they may indicate the body is going into shock or struggling against systemic infection.
Seek immediate emergency care if new or worsening shortness of breath is coupled with sudden, excruciating pain at the hernia site. Other urgent warning signs include:
- The inability to pass gas or have a bowel movement.
- Persistent nausea and vomiting.
- Visible color changes in the skin over the hernia, which may turn reddish or darker.
- A fever or a rapid heart rate, indicating severe distress or infection.