Hiatal Hernia

I have a student with a hiatal hernia and am wondering what asanas would or would not be good for it. If any of you have some information or suggestions I would appreciate it. My own feeling is that inversions should probably be avoided.

BACKGROUND FROM AYSUTRA HOME:

There are a number of different kinds of hernia, and that may have caused minor confusion in some of the comments offered below by AYSutra participants.

In addition to hiatal hernias, there are ventral/epigrastric hernias, umbilical hernias, inguinal/femoral hernias, inguinal/scrotal hernias, the list goes on. They share a common feature: an organ has poked out past the muscle wall that is supposed to hold the organ in place. The different names are more about bodily locations than anything else, but the hiatal hernia does have some unique features. If you want to know more about hernias -- and if you have a sense of humor -- visit www.hernia.org. In fact, the site probably offers more than you want to know about hernias.

The National Digestive Diseases Information Clearinghouse says this about hiatal hernia:

A hiatal hernia occurs when the upper part of the stomach pushes through an opening in the diaphragm, the muscle that separates the abdomen from the chest. This opening is called the esophageal hiatus.

After you swallow food, it travels between your mouth and stomach through a muscular tube called the esophagus. The esophagus passes through the hiatus to enter the abdominal cavity. At the bottom of the esophagus is a muscle called the lower esophageal sphincter, which acts as a valve. The hiatus itself acts like a second valve. Normally the hiatus and the lower esophageal sphincter line up with each other to keep stomach contents from backing up into the esophagus (a condition called reflux). But the hiatus can stretch because of muscle weakness or too much abdominal pressure. When this occurs, the stomach can slip through the hiatus, causing a hiatal hernia.

A hiatal hernia can be caused by:

obesity
pregnancy
tight clothing
sudden physical exertion, such as weight lifting
straining, coughing
abdominal injury.

Although most hiatal hernias cause no symptoms, some people experience heartburn. Heartburn is caused by gastric reflux, in which the acid from the stomach refluxes up into the esophagus, causing an irritating and burning sensation. People with reflux symptoms have gastroesophageal reflux disease (GERD) and may need drug therapy. In certain people, reflux damages the lining of the esophagus, resulting in erosions. In extreme cases, the normal lining is replaced by abnormal cells, a condition called Barrett's esophagus.

You should not worry about having a hiatal hernia. Many people over the age of 50 have such a hernia, and it does not need treatment unless heartburn or GERD is present and causes significant discomfort, or unless the hernia is in danger of becoming twisted and cutting off the stomach's blood supply. Treatment may also be considered if you have complications such as severe GERD or esophagitis, which is an inflammation of the esophagus. In such cases, the doctor may recommend surgery to repair the hiatal hernia.

If a hiatal hernia is causing symptoms, the following tips may help:

Eat smaller, more frequent meals.
Avoid foods and drinks that may cause symptoms.
Avoid lying down for 3 hours after eating.
Raise the head of your bed 4 to 8 inches.
Avoid wearing tight clothing around your waist.
Take acid-reducing medications.
Lose weight

ANSWERS:

From Genevieve Ryder, RN, AYTT 2000

Certainly, as you suspected, inversions need to be avoided, possibly twists. The medical recommendations for hiatus hernia include sleeping with one's bed on a slope, placing 6 inch blocks under the supports at the head of the bed. I recently taught my mother some intercostal breathing to improve her poor breathing capacity and it may have triggered symptoms of her previously undiagnosed hiatal hernia. Woe is me!

From Linda Martin, YTT Summer 2001:

My mother had a hiatial hernia and judging from her symptoms I would agree with you that inversions should be avoided. I hope you get some positive suggestions as this problem is pretty common. Good luck to you.

From Bob Fulkerson

I had my hernia operated on a year ago July, and the one asana that still hurts "down there" is the dreaded ustrasana (camel). I still (with care and very begrudgingly) teach it, but it hurts for a few days after. No other asana comes close to generating the pain of a hernia like the camel, in my experience.

Good luck,
Bob

From Pam Blasco, Yerington, NV, Las Vegas, NV, McCall, ID, YTT 1999 Ananda

Hi Butchie,

There have been a few people with the hernia situation in class and it seems any time there is pressure moving up into the abdomen, ie. sasamgasana; the hernia flares up. The people have had good results doing the variation using their hands place under the shoulders and lifting with the hands as support raising the buttocks. Sometimes even Balasana can be uncomfortable for people with H.H. Lifting the forehead with support from a blanket can take the pressure off the abdomen pushing into the diaphragm. You can do an inversion with their legs on the wall and blankets under their back and buttocks. I hope this gives a little help.

Joy to you,
Pam