What Causes a Hiatal Hernia to Flare-up? 8 Causes.

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Summary of the causes of hiatal hernia flare-up:

  1. Cough.
  2. Straining as weight lifting and vigorous exercise.
  3. Vomiting.
  4. Hiccough.
  5. Some foods include citrus fruits, fatty, fried foods, caffeine, chocolate, and others.
  6. Eating large meals and eating before bedtime.
  7. Not elevating your head during sleeping.
  8. Others, such as obesity, pregnancy, smoking, and some medications.

1. Cough.

The diaphragm (a sheet-like muscle between your abdominal cavity and the chest. A hiatal hernia is due to the passage of part of your stomach through an opening in the diaphragm.

During a cough, forceful diaphragm contraction increases pressure inside your abdomen.

A cough can cause a hiatal hernia to flare up due to:

  • The increased pressure inside the abdomen pushes your stomach into the chest.
  • Contraction of the diaphragm may increase the defect through which the stomach passes.

However, we don’t know the exact mechanism or relationship between coughs and hiatal hernia flare-ups.

As a cough may cause a flare-up of a hiatal hernia, a hiatal hernia also may trigger a cough through the sensitivity to acid in the esophagus (reference).

2. Straining (especially weight lifting).

Straining can also cause hiatal hernia flare-ups by a mechanism similar to cough. In addition, straining can increase the pressure inside your abdomen.

The high intra-abdominal pressure promotes the herniation of the stomach through the opening in your diaphragm.

Your stomach contents are kept from reaching the esophagus through the lower esophageal sphincter. The sphincter is a muscle ring that contracts and relaxes periodically.

Researchers found that straining during the relaxation phase of the LES leads to a flare-up of hiatal hernia (reference).

Straining can be in the form of:

  • Heavy weight lifting.
  • During bowel movements (constipation).
  • Physical Exercise (Going to the gem can cause a hiatal hernia to flare up).

Heavy weight lifting is one of the significant causes of hiatal hernia flare-ups. In addition, patients who lift heavy weights have a 3.6 times higher risk of recurrent hiatal hernia (reference).

3. Vomiting.

Vomiting is frequent with GERD and Hiatus hernia. You may think vomiting is a symptom of a hiatal hernia, but this is only a part of the truth.

The scientific evidence shows that vomiting can cause hiatal hernia flare-ups. In addition, people with recurrent vomiting have a five times higher risk of hiatal hernia recurrence after surgery (reference).

So, the relation between vomiting and hiatal hernia can be in both directions. Vomiting can cause hiatal hernia recurrence and flare-ups. Also, a hiatal hernia can trigger vomiting.

4. Hiccough.

Hiccough is also a potential trigger of a hiatal hernia. During a hiccough, your diaphragm contracts forcefully, and the pressure increases inside your abdomen.

Both diaphragmatic contraction and increased intra-abdominal pressure can cause hiatal hernia flare-ups.

The previous study about vomiting and hiatal hernia investigated the effect of hiccoughs on hernia recurrence. There was an association between hiccoughs and hernia, but it was not as strong as vomiting (reference).

In addition, note that hiatal hernia and GERD are causes of hiccoughs (bi-directional relationship).

5. Food that may cause hiatal hernia to flare up.

Foods are an essential factor that can contribute to hiatal hernia flare-ups. Foods can trigger GERD and hiatal hernia symptoms by either:

  • Increased acidity by eating acidic foods increases the exposure of your esophagus to acid.
  • Relaxation of the LES (lower esophageal sphincter) as with fatty foods and caffeine.

Food is extensively studied with GERD (acid reflux). The below foods are known to trigger acid reflux. However, we don’t know if they cause a direct effect on hiatal hernia or not.

Possible foods triggering GERD symptoms and hiatal hernia flare-up (reference).

  • Fatty foods.
  • Fried food.
  • Spicy food.
  • Tomatoes and their derivatives (salsa, tomato sauce).
  • Soft drinks.
  • Coffee and caffeinated drinks.
  • Peppermint and peppermint oil.
  • Citrus fruits such as oranges and lemons.
  • Alcohol.
  • Onions and garlic.
  • Chocolate.
  • Whole milk.

MORE: Can You Eat Eggs with Hiatal Hernia & acid reflux?

6. Large meals & eating before bedtime.

Not only the type of food that matters with GERD and hiatal hernia, but other factors can trigger hernia flare-ups such as:

  • Large meals: overeating in a single meal is an essential factor in hiatal hernia flares. Try eating smaller, more frequent meals instead of two or three large meals daily.
  • Eating before bedtime: This is a significant factor. Going to bed directly after eating will trigger reflux symptoms when you have a hiatal hernia. Early meals (4-6 hours before bedtime) improve GERD symptoms. (reference).
  • Laying down directly after eating: Lying on your couch to scroll social media or watch TV can trigger reflux symptoms.

7. Not elevating your head during sleep.

Head elevation during sleep consistently improved the reflux symptoms in patients with GERD (with or without hiatal hernia) (reference).

Sleeping without head elevation may cause a hiatal hernia to flare up. Use multiple pillows or a specialized wedge pillow to decrease the number of hiatal hernia flare-ups.

wedge pillows for GERD

8. Other triggers of hiatal hernia symptoms.

Other factors linked to GERD and hiatal hernia flare-ups include:

  • Psychological stress and anxiety.
  • Pregnancy.
  • Obesity: weight loss and bariatric surgery dramatically improve symptoms of GERD and hiatal hernia (reference).
  • Smoking.
  • Medications such as NSAIDs, antibiotics, and others.`