A hiatal hernia (HH) occurs when the upper part of the stomach pushes up into the chest cavity through the esophageal hiatus, an opening in the diaphragm. The diaphragm is the large muscle separating the abdomen from the chest and plays a fundamental role in breathing. While many small hiatal hernias cause no noticeable symptoms, a larger protrusion can interfere with nearby organs and bodily functions. This article explores the relationship between a hiatal hernia and difficulty breathing, along with common symptoms and treatment options.
Understanding the Breathing Connection
Yes, a hiatal hernia can make it hard to breathe (dyspnea). This difficulty typically arises from two main physiological mechanisms. The first is direct mechanical interference, primarily associated with larger hernias, such as paraesophageal types. When a significant portion of the stomach bulges into the chest, it occupies space normally reserved for the lungs and heart.
This physical crowding restricts the full, downward movement of the diaphragm necessary for deep inhalation. Individuals may experience shortness of breath, especially after eating a large meal or when lying flat. This compressive effect on the cardiopulmonary system is often seen in patients with large paraesophageal hernias.
The second mechanism involves acid reflux, medically termed gastroesophageal reflux disease (GERD), which frequently accompanies a hiatal hernia. Stomach acid flowing back into the esophagus can sometimes be micro-aspirated, where tiny droplets enter the airways and irritate the respiratory tract. This irritation can trigger chronic coughing, hoarseness, laryngitis, or worsen pre-existing conditions like asthma.
This acid-induced irritation can lead to bronchospasm—the tightening of the muscles lining the airways—mimicking or exacerbating asthma symptoms. The breathing difficulty is often an indirect consequence of severe acid reflux rather than solely the physical presence of the herniated stomach. Shortness of breath may be most pronounced at night or when bending over, as these positions facilitate the backflow of stomach contents.
Other Symptoms of a Hiatal Hernia
The most common symptoms of a hiatal hernia are related to the chronic acid reflux it facilitates. Heartburn is the hallmark symptom, presenting as a painful, burning sensation in the chest, often occurring after eating or upon lying down. Regurgitation of food or sour liquids back into the throat or mouth is a frequent complaint, directly related to the lower esophageal sphincter being compromised by the hernia.
Individuals often report non-cardiac chest pain, which can be sharp or dull and may radiate to the back, sometimes leading to confusion with heart issues. This pain is due to the acid irritating the esophageal lining. The hernia can also cause a feeling of fullness after only a few bites of food, or uncomfortable bloating in the upper abdomen.
Difficulty swallowing (dysphagia) may occur if chronic inflammation from acid reflux causes scarring and narrowing of the esophagus, known as an esophageal stricture. Other effects include a persistent sore throat or hoarseness, resulting from stomach acid repeatedly irritating the vocal cords.
Lifestyle Management and Treatment Options
Managing hiatal hernia symptoms, including associated breathing difficulties, often begins with targeted lifestyle and dietary modifications. Eating smaller, more frequent meals reduces stomach volume and pressure, minimizing the chance of contents being pushed up through the hiatus. Avoiding specific trigger foods can significantly decrease acid production and reflux episodes:
- Fatty or fried items
- Spicy dishes
- Tomato-based products
- Caffeine
- Alcohol
Positional changes are an effective strategy, particularly elevating the head of the bed by six to eight inches, which uses gravity to help keep stomach acid down. It is recommended to avoid lying down for two to three hours after eating, as this facilitates reflux. Maintaining a healthy weight also lessens abdominal pressure, which can worsen the hernia.
When lifestyle changes are insufficient, medical treatment focuses on controlling stomach acid production. Over-the-counter options include antacids for neutralizing existing acid and H2 receptor blockers (like famotidine), which reduce acid secretion. For persistent or severe symptoms, physicians may prescribe stronger medications called Proton Pump Inhibitors (PPIs), such as omeprazole, which effectively block acid production and allow the esophagus to heal.
Surgery, typically fundoplication, is reserved for cases where symptoms are severe, complications like significant esophageal damage occur, or when hernias are large and unresponsive to medical therapy. This procedure involves pulling the stomach back into the abdominal cavity, repairing the opening in the diaphragm, and often wrapping the top of the stomach around the lower esophagus to reinforce the sphincter. Surgical intervention is considered the most effective long-term solution for patients whose breathing is severely compromised by the hernia’s size or persistent reflux.