Digestive Disorders / Gastroenterology Expert Forum
Hiatal Hernia and Movement
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Hiatal Hernia and Movement

  Do any types of exercise or physical movement affect the
  condition of a hiatal hernia?  For instance, does weight-lifting
  or situps, worsen or aggravate a hiatal hernia?  How about
  aerobic exercise?  Does lifting the knees to the chest worsen or
   aggravate a hiatal hernia? Or do any movements help a hiatal
  hernia?  Are there any certain types of movement or exercise
  that are recommended to avoid if you have a hiatal hernia?
  Thank you very much for providing information on this forum.
  Neil Tuchin
Dear Neil Tuchin,
Thank you for your letter regarding hiatal hernia and exercise.  As you know, a hiatus hernia is a condition in which a portion of the stomach is displaced into the chest.  The condition is very frequent.  It has been estimated that 250-500/1000 population in the North America have a hiatus hernia. Hiatal hernias are considered important, because of the erroneous perception that a hiatus hernia predisposes to esophageal reflux.  We now know that acid reflux into the esophagus is usually due to inappropriate relaxation of the lower esophageal sphincter, the muscle barrier between the stomach and esophagus.  The hiatus hernia is an incidental finding that is not related to the development of the clinical problem.  
Individuals who exercise will often have heartburn due to acid or food refluxing into the esophagus.  When you lift weights or do situps you strain and bear down increasing the pressure in the abdomen.  This increased pressure can overcome the pressure in the lower esophageal sphincter causing material to reflux into the esophagus.  Therefore, although exercise does not make a hiatus hernia worse, it can cause symptoms that are often considered by the lay public to be associated with a hiatus hernia.  
The only way that you can prevent reflux is to avoid exercises that increase intraabdominal pressure, not a realistic option for most people who exercise.  The good news is that the reflux episode usually lasts a short time and there is no long term consequences of the reflux.  However, if you are in the minority of patients who have severe reflux symptoms associated with exercise, you may consider taking one of the over-the-counter H2 receptor antagonists e.g. Pepcid AC, Tagamet HB etc.  If your symptoms are very bad, you should be evaluated by your physician.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question pertaining to your health.
*keywords: hiatus hernia, esophageal reflux

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