In Part 1 of this series I discussed the many causes of heartburn and how to effectively treat those using Ayurvedic principles, foods and herbs. However, in some cases, heartburn is caused by a mechanical issue that can lead to hiatal hernia.

A hiatal hernia is when a small part of the stomach herniates or squeezes above the diaphragm, causing chronic reflux and indigestion that typically does not respond well to the therapies I described in Part I of this series on heartburn.

Below I describe this imbalance in more detail and offer at-home strategies that I feel should be part of addressing all cases of heartburn or GERD.

Additionally, I will demonstrate a visceral massage technique that you can actually perform on yourself at home that has been incredibly effective for relieving this type of heartburn in my patients.

If you don’t have heartburn symptoms, I recommend doing this technique a few times per year, especially if you tend to breathe shallowly, are a chronic mouth breather, or go long periods without exercise.

What Is Hiatal Hernia?

The word hernia refers to the protrusion of an organ through an opening in its surroundings, effectively putting it out of its correct positioning and thereby causing a litany of other problems. A hiatal hernia is when the lower esophageal sphincter (LES), which connects the stomach to the esophagus and is normally located below the diaphragm, slips above the diaphragm – often bringing a portion of the stomach with it. With part of the stomach squeezing through the diaphragm, the LES commonly breaks down and lets stomach acid up into the esophagus, causing gastro esophageal reflux disease, or GERD.

There is no proven therapy for this condition short of surgery, which is not a statistically successful surgery. Many cases of heartburn are either mild forms of hiatal hernia or something similar, which do respond to therapy.

A Stone Unturned!

It is interesting that, in a certain percentage of heartburn cases, difficulty breathing is one of the symptoms indicating that the diaphragm may be involved. Let’s take a look.

The diaphragm is a big flat dome-shaped muscle that sits under the lungs and above the digestive organs. When we breathe in, the diaphragm contracts downwards and sucks air into the lungs. When the diaphragm relaxes, the air is released from the lungs by the elastic recoil or natural tension of the rib cage.

The problem is that most folks do not breathe well or deeply into the lower lobes of the lungs, which come in contact with the diaphragm. Due to stress, lack of exercise or yoga, and chronic mouth breathing, most people become shallow breathers.

Shallow Breathing Can Make Your Diaphragm Sticky

As a result, the diaphragm, which is a huge muscle, is rarely completely contracted and relaxed. Without deep breathing, the rib cage, which is naturally squeezing the heart and lungs, becomes rigid and cage-like over time. So instead of the rib cage breathing and massaging the lungs, heart and diaphragm 26,000 breaths per day, it becomes a rigid cage constricting the diaphragm, and the diaphragm becomes tight.

Here is the problem: When a muscle is not being fully expanded and contracted it will not pump in adequate blood supply that is needed to keep the muscle supple, elastic and functional. Soon the muscle – in this case the diaphragm – loses adequate blood flow and begins to lay down a layer of protective tissue that does not require much blood flow. This is called scar tissue or fibrous tissue and it is sticky and non-elastic.

A Sticky Diaphragm May Actually Adhere to the Stomach

Over many years of bad foods, lots of stress, little exercise and less than efficient breathing, the diaphragm may become contracted, sticky and rigid. When this happens, the stomach can be pulled up tightly to the diaphragm and even be pulled through the diaphragm, causing a hiatal hernia.

In some cases the stomach does not herniate through the diaphragm – it just adheres to it.  In this case, the stomach which naturally hangs just underneath the diaphragm can begin to adhere to the underside of the diaphragm when the diaphragm is contracted. When the stomach adheres to the underside of the diaphragm it can cause symptoms of heartburn.

While this adhesion is not technically a hiatal hernia, it is way more common and often treatable with a visceral self -massage which I will describe below and demonstrate on the video associated with this article.

Self Hiatal Hernia or Heartburn Therapy

1. Lie on your back.
2. Slowly start breathing deeply in and out through your nose.
3. With your right hand, backed up with your left – drive your fingers up under the rib cage just to the left of center.
4. Press in and try to gently wedge your fingers up under the rib cage during each exhale. Remember to exhale as you press your fingers up and under the rib cage as if you were going up to grab the stomach which is adhered to the diaphragm.
5. During each inhale, as the rib cage moves up, pull the stomach – which you should have a fairly good grip on – down.
6. With each exhale, dig in deeper to reach up and under the rib cage.
7. With each inhale, pull down on the stomach, breaking the adhesion between the stomach and diaphragm.
8. Do this for 5-10 breaths, then slide your hands to a new section under the rib cage and repeat for 5-10 more breaths. Do this in each section across the rib cage on both sides. While the stomach is only on the left side, working the right side can help decongest the bile ducts, which is also a common cause of heartburn.
9. Do this technique twice a day, once in the morning and once in the evening for two weeks, until soreness in the area goes away.

Please see the video above for a step-by-step demonstration of this technique.

Other Effective Hiatal Hernia Strategies

1. Nasal Breathing exercise to activate the lower lobes of the lungs and full respiratory capacity. Read: Body, Mind and Sport.

2. Perform the Sun Salutation 2x/day for 10-15 minutes each with deep coordinated breathing.

3. Sleep with a small pillow between the mattress and box spring, raising the head of the bed up 1-2 inches to reverse any acid reflux into the esophagus.

4. Read and apply heartburn techniques from Part I in this series. This mechanical technique is typically most effective when combined with the appropriate herbal and dietary strategy.