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Hiatal Hernia or IBS??

Hello,  i need your help. for a very long time i suffered horrible pain that last for a a good party of the night if not all night. i now can tell when i will have the pain as symptoms start during the day. breathing problems and disconfort in the abdomen region.the pain is so intense that it brings tears and god i prefer to give birth (which i did) than to go thru it!! GPs in England mentioned IBS.
I remembered when i was between 6 and 8 was to be diagnosed with a Hiatal Hernia.
By pure luck as i am studying everything on lumbar & thoracic herniathion, i came across the symptoms of the Hiatal Hernia and they are similar from the IBS ones. Thank you for your help.
Best Answer
82861 tn?1333453911
IBS is supposed to be a diagnosis of exclusion, meaning that after testing for everything else comes out normal, the docs throw up their hands and declare Irritable Bowel Syndrome.  Any doctor who diagnoses a patient with IBS without doing some basic testing like imaging studies, blood work, and even a colonoscopy is a lazy doctor.  IBS doesn't cause upper GI pain and symptoms.  It just means that there is something going on with the colon (large bowel) but medical science has figured out what it is yet.

Hiatal hernia is usually not a big deal, and most people have one and never know about it.  It's a common incidental finding during a barium swallow exam or endoscopy.  If the hernia gets very large, the problem is that stomach acids can collect in the pouch and cause terrible pain and sometimes ulcerate entirely through the tissue.  In rare cases, I've read that the stomach can actually slide up into the herniated portion of the esophogus.  

Has your doctor ever talked to you about GERD?  Gastroesophagheal Reflux Disease is an easily treated condition, and it can be made much worse if a decent-sized hernia is present.  

You need to avoid alcohol and caffeine and acid-producing foods like tomatoes.  Don't eat anything at least two hours before bedtime and eat smaller meals but more frequently throughout the day.  The idea is to avoid large amounts of food taken in one sitting.  Use an extra pillow to keep the upper part of your body elevated.  That technique uses gravity to help keep stomach contents from refluxing back up into your esophagus.  Since you mention breathing difficulties, it's possible that you are aspirating small amounts of stomach contents into your lungs.  This can also happen while you sleep leaving you completely unaware that it's happened.

GERD can be so painful that people believe they are having a heart attack because of the continuous and sometimes extremely sharp pain of the esophagus getting burned up with stomach acid.  Typical over-the-counter antacids don't usually help with a bad case of GERD.  You need the big guns in the form of proton pump inhibitors like Nexium, Protonix or Aciphex.  We have a couple of PPI drugs available here in the US, Prilosec OTC being one of them.  Have you checked your local pharmacy for something like that?  If a two-week course makes you feel better, you'll know that GERD is part of your problem.

You really need to see a gastroenterologist, but I realize it's not easy to get in quickly with a specialist in the UK.  I can pretty much guarantee that any gastro doc here in the US would have you on the table for endoscopy very quickly.  While GERD is treatable, it's not something you want to leave go for long. In trying to heal itself, the cells of the esophagus begin to mutate.  They try to form into cells that resemble the lining of the small intestine, which are more than capable of dealing with stomach acid.  Hard as the body tries, those changes don't help, and given enough time they can mutate into cancer.  My husband has a pre-cancerous condition called Barrett's Esophagus.  It's entirely a result of a lifetime of acid reflux.  Given the kind of pain you're experiencing, you could also have an ulcer or something entirely different going on.  

The whole point of all this is that you really must see a doctor.  Have you ever noticed if your pain gets worse if you eat or not?  Do certain foods or alcohol make a difference?  Is your pain right in the middle of your abdomen like where your ribs begin, or is it on one side or the other; upper or lower?  Does a change in body position help or make it worse?  Is the pain sharp, burning, dull or crampy?  Does a bowel movement make any difference?  Do you have any nausea or vomiting?  That's the kind of information your doctor will need to know so he knows what direction to focus on.

Please don't put off making an appointment. I really feel for you having been through the diagnostic wringer too many times.  Keep on looking for answers and don't let them fob the old "IBS" bullshite off on you.  :-)
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6569796 tn?1382529448
i am 23 years old and i have had abdominal pain since i could remember its been so long it feels like forever i have been seeing doctor after doctor and i finally thought i had gotten my answer when he had told me i had ibs he told me to stay away from red meat and watch my fiber intake i found that taking miralax its over the counter and it works but im still having the pain i take aleve to ease the pain well most of my symptoms are hit and miss some days are better then others i have had a belly button hernia and a miscarriage ever since my loss all of done is been on an up and down scale with my weight ive changed my diet and still no change any ideas or advice since ive seen about 20 doctors (not exaggerating) thanks for reading
Helpful - 0
82861 tn?1333453911
You poor girl!  I'm so sorry you have to deal with NHS.  I have many friends from the UK and they all say the same thing: NHS is great - as long as you don't get sick.  If at all possible, I think you should see someone privately, although I imagine it's pretty expensive.  Again, I'm not a doctor, but your symptoms sound like classic reflux.  

Endoscopy is no big deal.  Here in the States, they generally use a twilight anesthesia mix of propofol and versed.  Some still use fentanyl and versed, which is fine, but the propofol wears off a whole lot faster.  I've had several scopes and never remembered a thing.  IF there is something going on with your esophagus, stomach or duodenum, endoscopy is the surest way to find out immediately.  Your doctor can take photos and go over them with you at your followup appointment, which makes things a whole lot easier to understand.  If he finds any areas that look suspicious, he can take biopsies right there and then, which is great because you don't have to undergo another procedure.

Were you able to find any PPI medications at your pharmacy?  It's worth a try, and if they help, then your doctor should wake up and pay attention.  My husband's gastroenterologist did not need to see him in the middle of a reflux attack.  His description of the symptoms (VERY much like yours) were enough to get him into endoscopy in a few days.  I'm appalled that your symptoms are being ignored by the UK doctors.  Is there anything you can do to get your GP to refer you to a gastroenterologist?  Meanwhile, do some research on GERD and try some of the recommendations like diet changes and sleep position changes to see if they help.  Hope you get somewhere with the medical system sooner than later.  :-)
Helpful - 0
Avatar universal
Hi Jaybay,

Thank you so very much for your post. You seem to know a great deal about it. I have to say that i have trust issues on the medical system here in England. They tell you what you have just by what you can tell them about symptoms. not that long ago, i went to see my GP and mentioned a pain on both of plant of my feet and without even touching them he knew exactly what i had. I am French and i am used to be thouroughly checked for anything even when i don't think it was necessary. I have been living in the UK for the past 7 years and only 3 times i have been check internally and that was because every 3 years you should have a smear and when i gave birth! in France, i was used to see my gynecologist every 6 months and being check entirely. Anyway, to come back to my problem, the inflation start just below my sternum where my floating ribs are. i can feel a horrible pain on the posterior as well on the anterior part of the sternum. i cannot move. If i lay down, it gets worse, i feel like i am missing air. my abdomen swells. i don't feel like vomiting or else. it feels like i have breathing problems,hardly can talk as it is so painfull and i am walking very slowly when it does happen. i might have to see someone privatly but i always heard that it is always best to have it checked when you are actually going thru the pain and when the pain  occurs at it most it is always in the middle of the night. i feel what feel like bruises for a couple of days afterwards.
i know i have to go and see someone but the idea of having that tube going down my throat. my mom told me I had an endoscopie but cannot remember really. Thank you. Didine
Helpful - 0
Avatar universal
Good Afternoon!!

Thank you all very much for your answers. I really appreciate your post.

Kind Regards
Didine
Helpful - 0
Avatar universal
If the pain is that intense I would lean toward the hernia. Either way I would get checked for the hernia as it is more serious than the IBS.  
Helpful - 0
1035252 tn?1427227833
I am also limited in what medications I can take because some of them exacerbate the hiatal hernia to the point of being intolerable...toradol I can rarely take, in fact most NSAID's tear my stomach up because of the hernia...have you recently taken a new medication?
Helpful - 0
1035252 tn?1427227833
Hello! I have both IBS and a hiatal hernia, and by far the hiatal hernia causes me more pain. It's not frequent but when it hurts, it feels like a dagger in my belly. the IBS just causes uncomfortable or slightly painful cramping lower down....the hiatal hernia is always up right below my ribs in the center (for the most part) and it's just a sharp, stabbing, throbbing pain. It may be time to get another upper/lower GI to rule out any worsening of your condition....otherwise, it may be IBS which can SOMETIMES be controlled through diet (nothing too fatty or spicy), but I don't think it shows up on the GI tests..I don't remember. I've always had it so I don't remember how they found mine..I think it was because I kept having blood in my stool.

but I do know that the hiatal hernia can occasionally cause severe pain so it's possible that that's it. I'm not a doctor either but that's my experience..I would go to my GP and request some more GI tests! good luck :)
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Avatar universal
We're not doctors on this forum, just people dealing with chronic pain who support eachother and answer questions to the best of our knowlege.
I am not familiar with either but hopefully someone else will be along who has experience with that.  I would recommend seeing the GP and asking for testing to determine whether or not it's a hernia.  You may also want to ask for a referral to a specialist who is familiar with that type of hernia.  I have heard the referral process can be somewhat long in England and it would be good to get the ball rolling now while they are running test.
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