Connections between Hiatal Hernias and the Autonomic Nervous System

I should start out by saying I am not a doctor. I do not treat, diagnose, cure or even prevent any diseases outside of my scope of practice (I’m a licensed massage therapist).

With that said, I have been working with the Polyvagal System – treating nervous system dysfunction and lack of regulation since 2012. And I’m currently taking Somatic Experiencing training – getting more specific knowledge and skills about how to work with the CNS and ANS.

Recently I have treated a few clients who have the symptoms of hiatal hernias – discomfort, acid reflux, pressure up into diaphragm, etc. Their doctors have diagnosed them as having these hernias.

And I should note (immediately and with some insistence) that having a hiatal hernia is complicated. It most likely took some years or even decades (of stress and challenge) to develop. Therefore there is no easy fix. Especially if there is a tear in the tissue around the hiatus – the opening in the diaphragm which is allowing some abdominal tissue to sneak up into the upper thoracic cavity. Ouch.

People with these hernias are often prescribed medicine for the acid reflux and then are given exercises to pull the tissue down from around their stomachs. And their doctors will watch them to make sure they don’t develop serious GERD (potentially damaging acid reflux) or other complications.

I wonder what else can be done for these life-altering types of diseases?

It looks like there is a significant Vagus (ventral vagus) nerve component to the esophagus. The ventral vagus branch innervates the upper third of it, and when working properly, it allows for some appropriate slack in the tissue when taking deep breaths so the diaphragm can descend. When the esophagus is stuck in a tight, shocked, frightened, or feeling less-than-safe pattern, there can be problems with the proper tension in the esophageal tissue. If we are taking deep breaths with a really tight esophagus, then eventually some lower abdominal tissue might start to slip through the hiatus – the opening in the diaphragm which the esophagus passes through. This is where the hiatal hernia begins to develop.

Ideally we want the dorsal vagus and the ventral vagus branch to be on the same page and sending the same messages to the brain. Often times though, in times of stress, the ventral vagus branch gets disrupted. This has many side effects, but one of which is to disrupt communication between the ventral and dorsal branches of the vagus system and to possibly have the sympathetic chain stay “stuck” on – being activated, tense, or anxious for days on end.

It also turns out that if hiatal hernias get bad enough, they will start to affect the breathing capacity – as the diaphragm can’t descend properly. There seems to be evidence that some COPD cases may involve hiatal hernias as well. 

I appreciate all the learning and study and wisdom of Western medical practitioners. They know how to treat the biological body and most of the bio-chemical systems in it, to patch it up, to tweak neurotransmitters, to balance pH, to replace organs, to set broken bones, etc. And yet I wonder if the healing actually happens in the biological body – or does it happen in the psycho-spiritual body? And if it is the latter, why don’t they teach more about this in contemporary medical schools?

So speaking of psycho-spiritual concepts.. working with the autonomic nervous system – building resiliency, tracking where the client is in their nervous system (sympathetic, parasympathetic charge, fight or flight, freeze or collapse, etc), assessing the client’s capacity – how refined is their window of tolerance? – are all necessary competencies to know and understand before putting hands on and saying, “I can resource the nervous system skillfully.”

There is a very easy technique to resource and settle the ventral branch of the vagus nerve. It is called the Basic Exercise. This plus Visceral Manipulation techniques (balancing the sphincters, working with the visceral organs) and other forms of nervous system resiliency building can be really good for potentially managing hiatal hernias (and I suspect in preventing them). What I’m trying to say is: “Go see your doctor if you have unexplained symptoms or pain (especially around the upper left quadrant of your abdomen and which might include acid reflux).” You may also want to work with a complimentary medicine practitioner as well. Continue working with a doctor you trust for sure – you do not want this condition to get worse.

Ideally, you want to calm and soothe your nervous system before the stresses on the tissues, openings and sphincters becomes so great that a little tear develops. If you have pain, try to figure out what is going on, same for acid reflux. The old adage – “if it ain’t broke, don’t fix it” – can get people in trouble.

So go see your doctor or nurse practitioner first. And then do something healthy and positive (and hopefully efficacious) to reduce your stress. Somatic Experiencing, counseling, meditation (find a good teacher), yoga, qigong are all techniques and modalities which can do this. Having a competent teacher is important however – if they aren’t walking their talk, walk away 🙂

I offer bodywork treatments – Working with the Polyvagal System, Craniosacral Therapy, Somatic Experiencing, Integrated Massage and Asian Bodywork in the Charlottesville, Virginia area. Visit my website www.mkirbymoore.com to schedule an appointment.

Thanks for reading!

KM