A hiatal hernia is common and the frequency increases with age, although younger people get them too. What are they, anyway? A hiatal hernia is where the upper portion of the stomach pushes through the opening in the diaphragm. The diaphragm is the muscle that separates your chest cavity and abdomen and signals your lungs to breathe. Normally, the esophagus runs through this opening, but the stomach does not. In the case of a hiatal hernia, the stomach slips up through the hole in the diaphragm, where it shouldn’t be.
Hiatal hernias come in several varieties and sizes. The most common is called a sliding hiatal hernia. More than 95% of all hiatal hernias are of this type. You also might also be surprised at how common they are. Between 10 and 80% of the population has a sliding hiatal hernia. According to one study, 60% of people will have a hiatal hernia by the time they reach the age of 60. Sliding hiatal hernias get their name from the fact that the upper portion of the stomach “slides” through the opening in the diaphragm. Usually, this happens because there’s a weakness in the muscle tissue that surrounds the opening of the diaphragm.
Where Do They Come From?
No one knows exactly what causes a hiatal hernia. Some people are anatomically more susceptible to developing one and certain types of abdominal injuries increase the risk. Being overweight or obese, particularly abdominal obesity increases pressure in the abdominal cavity and boosts the odds of one forming. Coughing spells, vomiting, lifting something heavy, or straining also raises the likelihood of developing one. Smokers are at a higher risk as well.
How do you know if you have one? Many people with hiatal hernias experience symptoms of gastroesophageal reflux or GERD. These symptoms might include burning discomfort in the throat or chest, especially when lying flat in bed or bending over. If you have GERD with or without having a hiatal hernia, the symptoms are similar: reflux of acidic liquid into your esophagus and mouth, burning in the chest, belching, a sense of fullness, and, sometimes nausea. Many small, hiatal hernias cause few or no symptoms and you may have one without being aware of it.
Hiatal Hernia and Acid Reflux Sometimes Occur Together
As many as 20% of people suffer from acid reflux or GERD, but not all have hiatal hernias. You can also have a hiatal hernia without having symptoms of GERD. Sometimes, people find out they have a hiatal hernia when they undergo an endoscopy (a procedure that looks into your esophagus) and stomach for other reasons.
But, what if your physician tells you that you have a hiatal hernia? If so, you might wonder whether it’s safe to train with weights, particularly heavy weights since lifting heavy weights increases pressure within the abdominal cavity.
Hiatal Hernias and Weight Training
Here’s the good news. If you have a small sliding, hiatal hernia, lifting weights probably won’t cause damage, although it may worsen your acid reflux symptoms. When you lift weights, you increase intraabdominal pressure, and this can cause stomach acid to move back into your esophagus and trigger classic reflux symptoms – burning in the chest, a sour taste in the mouth, nausea, bloating, or regurgitation of stomach acid. Still, check with your physician before weight training, especially if you have a large hernia or significant reflux symptoms, and follow their recommendations.
As mentioned, most hiatal hernias are sliding ones where the upper portion of the stomach slides upward through the opening of the diaphragm. A smaller percentage, around 5%, are called para-esophageal hernias. This is where the stomach slides through the opening and doesn’t slide back as easily. This type is more serious in that blood supply to the stomach can be reduced.
Before weight training with a hiatal hernia, talk to your physician. Depending on the type of hiatal hernia you have and the severity of your symptoms, they may recommend that you modify your routine so that you’re not lifting at a high percentage of your one-rep max, which could cause you to strain. Instead, they might suggest using lighter weights and doing higher reps. They may also recommend not doing exercises that increase the pressure in your abdominal cavity, like sit-ups, crunches, and leg raises.
If your physician does give the okay to keep lifting weights, use impeccable form and remember to breathe properly and not hold your breath. When you hold your breath, it increases pressure within your abdominal cavity and can aggravate the symptoms of a hiatal hernia. Also, bend at your knees rather than from your waist.
Other Ways to Relieve Hiatal Hernia Symptoms
Avoid eating large meals as these expand your tummy and increase pressure in your abdominal cavity. It’s especially important, if you have a hiatal hernia, not to eat a large meal before exercising. Wait at least two hours after a meal before doing any form of exercise. Certain foods can trigger symptoms. Foods and beverages that can aggravate hiatal hernia symptoms include caffeinated beverages, chocolate, acidic foods, alcohol, and greasy foods.
If you have persistent acid reflux symptoms (GERD), your physician may recommend taking acid-reducing medications. Doing so can lower your risk of developing damage to the lining of the esophagus due to long-term exposure to acid. Such damage, when it occurs, may place you at higher risk of developing cancer of the esophagus. That’s why it’s important to treat acid reflux if you have it. If you have severe or persistent acid reflux symptoms, due to a hiatal hernia, that doesn’t respond to medications, there is a surgical procedure to repair it, although fewer than 5% of people require surgery. These are all issues to discuss with your physician.
Don’t forget, lifestyle changes, particularly losing weight, can reduce the severity of acid reflux related to a hiatal hernia. We know that weight training helps with weight control, so get guidelines from your physician about how heavy to lift. Assuming you have a small, sliding hiatal hernia, they’ll probably give you the okay to lift, as long as you don’t lift so heavy that you strain.
Also, if you experience shortness of breath, chest pain, or difficulty swallowing, see your physician immediately. If you have a large hiatal hernia, so much of the stomach can poke through the diaphragm that it places pressure on your lungs. Such cases sometimes require surgery.
Healthline.com. “GERD by the Numbers: Facts, Statistics & You”
UptoDate.com. “Hiatus Hernia”