Hiatal Hernia – Upper Stomach Bulging Through the Diaphragm

A hiatal hernia occurs when the upper part of the stomach pushes up through the diaphragm into the chest cavity, often through an opening called the hiatus (where the esophagus passes into the stomach). This can affect the diaphragm’s ability to support breathing and digestion, and may contribute to symptoms like heartburn, reflux, bloating, chest pressure, and shortness of breath.


Common Triggers

  • Weakness or thinning of the diaphragm muscle
  • Chronic coughing, vomiting, or heavy lifting increasing abdominal pressure
  • Obesity or pregnancy increasing upward pressure on the stomach
  • Frequent overeating or lying down soon after meals
  • Straining during bowel movements due to constipation
  • Age-related changes in tissue elasticity

How to Solve It

  • Reduce intra-abdominal pressure through posture, breath control, and gentle movement
  • Strengthen and mobilise the diaphragm to restore normal movement
  • Use positioning strategies to help the stomach slide back below the diaphragm
  • Address reflux symptoms with lifestyle and meal-timing adjustments

Quick Guide

  • Breath rhythm: gentle 4–5 s inhale / 6–8 s exhale through the nose.
  • Pressure/pain scale: never exceed 3–4/10 discomfort; no forceful abdominal compression.
  • Stop signs: severe chest pain, black/tarry stools, vomiting blood — seek urgent medical care.
  • Success indicators: reduced chest/upper abdominal pressure, calmer breathing, fewer reflux episodes.

Expanded Step-by-Step Relief Program

Step 1 — Morning Gravity Reset (2–3 minutes)
Goal: use upright positioning to encourage the stomach to drop below the diaphragm

  1. Upon waking, stand tall with feet hip-width apart.
  2. Place hands on lower ribs, inhale gently through the nose, expanding ribs outward and downward.
  3. Exhale slowly, relaxing the belly completely.
  4. Repeat for 6–8 breaths, visualising the stomach sliding down into its natural position.

Success: lighter sensation under ribs, easier upright posture.

Step 2 — Seated Diaphragmatic Breathing (3–5 minutes)
Goal: restore diaphragm mobility and reduce pressure on the hiatus

  1. Sit tall on a chair, feet flat, hands resting on belly.
  2. Inhale through your nose into the lower ribs and upper belly, keeping shoulders relaxed.
  3. Exhale slowly through pursed lips, letting your belly soften and drop.
  4. With each breath, imagine your diaphragm lowering on inhale and lifting on exhale, massaging your stomach.

Success: reduced tightness in upper abdomen, fuller breaths without strain.

Step 3 — Heel Drop Technique (30–60 seconds)
Goal: gentle mechanical encouragement for stomach repositioning

  1. Stand tall on your toes, inhale gently through your nose.
  2. Drop your heels lightly onto the floor, feeling a mild downward pull in the abdomen.
  3. Repeat 5–6 times, avoiding jarring or excessive force.

Avoid: if you have spinal compression injuries or severe joint pain. Success: subtle release under ribs.

Step 4 — Child’s Pose (Balasana, 2–3 minutes)
Goal: lengthen the spine, widen the lower ribs, and reduce upper abdominal tension

  1. Kneel on the floor, big toes touching, knees apart for comfort.
  2. Fold forward, resting torso between thighs, arms extended or alongside the body.
  3. Inhale into the sides of your rib cage; exhale, releasing any gripping in the belly and pelvic floor.
  4. Visualise your spine lengthening and your nervous system becoming calmer.

Success: feeling of decompression in upper abdomen and ribs.

Step 5 — Gentle Walking After Meals (10 minutes)
Goal: aid digestion and reduce reflux risk

  1. Start walking 15–20 minutes after finishing a meal.
  2. Maintain upright posture, shoulders back, and nasal breathing.
  3. Avoid bending forward or lying down for at least 2 hours after eating.

Success: reduced reflux episodes, lighter feeling in chest and belly.


Practical Tips

  • Eat smaller, more frequent meals to reduce stomach distension.
  • Avoid tight clothing around the waist and abdomen.
  • Elevate head of bed by 15–20 cm if reflux is worse at night.
  • Maintain healthy body weight to reduce upward pressure on the stomach.

When to Seek Medical Help

  • Severe chest pain or difficulty swallowing
  • Vomiting blood or passing black/tarry stools
  • Persistent or worsening reflux despite lifestyle changes
  • Unexplained weight loss or anemia

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