Hiatus hernia is a condition that occurs when part of the stomach pushes up through the diaphragm into the chest cavity. While it may initially present without noticeable symptoms, many individuals with a hiatus hernia experience a persistent cough that can be both frustrating and disruptive to daily life.
This “hiatus hernia cough” often results from acid reflux and irritation caused by stomach contents moving back up into the esophagus.
Understanding the link between hiatus hernia and chronic coughing can help those affected find effective ways to manage their symptoms and improve their quality of life.
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What is a Hiatus Hernia?
A hiatus hernia is a medical condition where a portion of the stomach bulges or pushes up through the diaphragm and into the chest cavity. Normally, the diaphragm—a muscle that separates the chest from the abdomen—has a small opening called the hiatus, through which the esophagus passes before connecting to the stomach.
In a hiatus hernia, the stomach pushes up through this opening, often due to a weakness in the diaphragm muscles or increased abdominal pressure.
There are two main types of hiatus hernias:
- Sliding Hiatus Hernia: This is the more common type, where the stomach and the lower part of the esophagus slide up into the chest through the diaphragm. This movement can make it easier for stomach acid to reflux into the esophagus, leading to symptoms like heartburn and acid reflux.
- Paraesophageal Hiatus Hernia: In this less common type, part of the stomach squeezes through the hiatus and sits next to the esophagus. While the stomach stays in place, it can cause more serious complications, such as a risk of stomach strangulation, which requires medical attention.
Note: Hiatus hernias can range from mild to severe, and while some people experience no symptoms, others may struggle with chronic acid reflux, heartburn, chest pain, and even persistent coughing due to acid irritation.
Does a Hiatus Hernia Cause Coughing?
Yes, a hiatus hernia can cause coughing, especially if it leads to acid reflux. When the stomach pushes through the diaphragm, it can weaken the lower esophageal sphincter, the muscle that normally prevents stomach acid from moving up into the esophagus.
This condition, often called gastroesophageal reflux disease (GERD), causes acid and stomach contents to flow back, irritating the esophagus and throat. The irritation can trigger a reflexive, persistent cough as the body tries to clear the acid.
Additionally, acid reflux may cause symptoms like heartburn, throat clearing, and a sensation of a lump in the throat, which can further contribute to coughing. Managing acid reflux with dietary changes, medication, and other treatments may help alleviate this chronic cough.
Why Does a Hiatus Hernia Cause a Cough?
A hiatus hernia can cause a cough primarily because of the way it promotes acid reflux, which irritates the esophagus and upper airway.
When part of the stomach pushes through the diaphragm, it can weaken the lower esophageal sphincter, the muscle that usually keeps stomach acid from traveling back into the esophagus. This weakened barrier allows acid to flow upward, a condition known as gastroesophageal reflux disease (GERD).
When acid and stomach contents move back up into the esophagus and throat, they irritate the lining, causing a sensation that triggers a cough reflex as the body attempts to clear the irritation.
Note: This reflexive cough can become chronic and may worsen if the reflux continues, especially when lying down or after eating.
What Does a Hiatal Hernia Cough Sound Like?
A hiatal hernia cough often sounds like a dry, persistent, and sometimes hacking cough. It may resemble a throat-clearing type of cough rather than a deep chest cough associated with respiratory infections.
This type of cough can be triggered by irritation from acid reflux, so it may also occur after meals, when lying down, or when bending over, as these actions can increase reflux.
Unlike a typical cough from a cold or allergies, a hiatal hernia cough often does not produce mucus and may be accompanied by symptoms of heartburn, a sour taste in the mouth, or a burning sensation in the throat.
Note: The cough is usually chronic and can last for weeks or even months if the underlying acid reflux remains untreated.
Symptoms of Hiatal Hernia
The symptoms of a hiatal hernia vary, but many people experience little to no symptoms, especially with small hernias. When symptoms do occur, they often result from acid reflux and can include:
- Heartburn or a burning sensation in the chest
- Acid reflux or regurgitation
- Chest pain, especially after eating or lying down
- Difficulty swallowing (dysphagia)
- Chronic cough or throat irritation
- Hoarseness or a sore throat
- A sensation of a lump in the throat
- Belching and bloating, particularly after meals
Diagnosis of Hiatal Hernia
To diagnose a hiatal hernia, doctors typically use the following tests:
- Upper Endoscopy: A thin, flexible tube with a camera (endoscope) is passed down the throat to examine the esophagus and stomach, allowing doctors to view any herniation or signs of inflammation.
- Barium X-ray: After drinking a barium solution that coats the esophagus and stomach, X-rays are taken to help visualize the position and movement of the stomach.
- Esophageal Manometry: This test measures pressure in the esophagus to assess the function of the esophageal muscles, especially if there is difficulty swallowing.
Note: These tests help confirm the presence of a hiatal hernia and guide appropriate treatment based on the severity and type.
How to Stop Hiatus Hernia Coughing
To stop coughing caused by a hiatus hernia, managing acid reflux and reducing irritation to the esophagus is key.
Here are some effective methods:
- Dietary Changes: Avoid foods that trigger acid reflux, such as spicy, fatty, or acidic foods, as well as caffeine and alcohol. Eating smaller, more frequent meals can also help prevent reflux.
- Avoid Lying Down After Meals: Wait at least two to three hours before lying down after eating to reduce the chance of reflux.
- Elevate the Head of Your Bed: Raising the head of your bed by 6–8 inches helps keep stomach acid from rising during the night.
- Medication: Over-the-counter antacids, H2 blockers, or proton pump inhibitors (PPIs) can reduce stomach acid and alleviate symptoms. Always consult a doctor before starting medications.
- Weight Management: Losing excess weight can decrease abdominal pressure, reducing hernia symptoms and the likelihood of acid reflux.
- Avoid Tight Clothing: Wearing loose-fitting clothing prevents additional pressure on the abdomen, which can trigger reflux and coughing.
- Stress Management: Stress can exacerbate reflux symptoms, so practicing relaxation techniques like meditation or deep breathing can help manage cough-triggering stress.
Note: With consistent lifestyle adjustments and possibly medical guidance, individuals can reduce the frequency and severity of hiatus hernia-related coughing.
Treatment Options
The treatment for a hiatus hernia cough primarily focuses on managing the underlying GERD. Over-the-counter antacids, H2 blockers, and proton pump inhibitors (PPIs) can help reduce the production of stomach acid and relieve symptoms.
It’s crucial to discuss this with your doctor before starting these medications, as they may have side effects.
Lifestyle modifications can also play a significant role in managing a hiatus hernia cough. This includes maintaining a healthy weight, quitting smoking, avoiding food and drinks that trigger heartburn, eating smaller meals, and not lying down or going to bed immediately after a meal. Raising the head of your bed might also help prevent nighttime symptoms.
For severe cases of hiatus hernia causing significant symptoms, surgical intervention might be necessary. Procedures such as Nissen fundoplication or laparoscopic hiatus hernia repair may be performed to repair the hernia and strengthen the lower esophageal sphincter.
FAQs About a Hiatus Hernia Cough
How is a Hiatus Hernia Diagnosed?
A hiatus hernia is diagnosed through a combination of physical examination, a review of medical history, and specific diagnostic tests.
These tests might include an endoscopy, where a thin, flexible tube with a camera is used to examine the esophagus and stomach, or a barium swallow X-ray, which visualizes the digestive tract.
Additionally, a pH monitoring test may be conducted to measure acid levels in the esophagus, which can confirm if acid reflux is present.
Who is at Risk for a Hiatus Hernia?
Risk factors for a hiatus hernia increase with age, particularly for individuals over 50. Other risk factors include obesity, which increases abdominal pressure and can contribute to the formation of a hiatus hernia, and smoking, which can weaken the diaphragm.
Note: A congenital hiatal weakness or an injury to the diaphragm area may also increase the risk.
What are the Possible Complications of a Hiatus Hernia?
While many people with a hiatus hernia experience mild or no symptoms, potential complications can arise. The most common complication is gastroesophageal reflux disease (GERD), characterized by heartburn, chest pain, and regurgitation.
If GERD is left untreated, it can lead to esophagitis, esophageal ulcers, and in severe cases, a condition called Barrett’s esophagus, which increases the risk of esophageal cancer.
In rare cases, a paraesophageal hernia can lead to a serious condition called strangulation, where the blood supply to the herniated portion of the stomach is cut off.
Can a Hiatus Hernia Cause a Tickly Cough?
Yes, a hiatus hernia can cause a tickly, or irritating, cough. This symptom occurs when the hernia results in gastroesophageal reflux disease (GERD).
The refluxed stomach acid can irritate the larynx and airways, leading to a persistent, often dry and tickly cough.
How Do You Perform a Hernia Cough Test?
A hernia cough test is a physical examination method often used to diagnose or confirm the presence of certain types of hernias, like inguinal hernias, but it’s not typically used for hiatus hernias.
During this test, the patient is asked to stand up and cough while the doctor feels for a bulge or movement in the area of concern. If a hernia is present, the increased abdominal pressure caused by coughing can make it more noticeable.
What is the Best Treatment for Hiatus Hernia?
The best treatment for a hiatus hernia depends on the severity of the symptoms. For mild symptoms, lifestyle modifications such as maintaining a healthy weight, quitting smoking, avoiding trigger foods, and adjusting eating and sleeping habits may be recommended.
Over-the-counter or prescription medications like antacids, H2 blockers, and proton pump inhibitors can help manage acid reflux symptoms. In severe cases or when complications arise, surgical intervention may be necessary.
Is a Hiatal Hernia Deadly?
While a hiatal hernia itself is typically not life-threatening, certain complications can be serious. For instance, a rare complication called strangulation, where the blood supply to the herniated stomach is cut off, is a medical emergency.
Additionally, untreated GERD can lead to conditions like esophagitis, esophageal ulcers, and Barrett’s esophagus, the latter of which increases the risk of esophageal cancer.
Therefore, any persistent symptoms associated with a hiatal hernia should be evaluated by a healthcare professional to prevent potential complications.
Final Thoughts
A hiatus hernia cough can be a distressing symptom, but understanding its link with GERD and seeking appropriate treatment can greatly improve the quality of life for those affected.
While over-the-counter medications may provide temporary relief, it’s important to consult a healthcare provider for a comprehensive management plan, which often involves lifestyle modifications and sometimes surgery.
Remember that each patient’s condition is unique, and what works for one may not work for another. Therefore, individualized medical advice is crucial.
Written by:
John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.
References
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- Sfara A, Dumitrascu DL. The management of hiatal hernia: an update on diagnosis and treatment. Med Pharm Rep. 2019.
- Seeras K, Bittar K, Siccardi MA. Nissen Fundoplication. [Updated 2023 Feb 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.