Hiatal Hernia: Gentle Care in Kuala Lumpur

This Post Has 16 Comments

1. Chanda Kumar April 23, 2024 Reply

   Do you offer chiropractic care for symptoms of hiatal hernia?

   1. Yama Zafer, D.C. April 24, 2024 Reply

      Yes, that kind of care is offered, and it is worth being precise about what it consists of and what it can reasonably be expected to do, since this area attracts a good deal of overstatement.

      What a session involves: assessment and treatment of the diaphragm and the tissue below the ribs, work on the mid-back and rib mechanics, which influence how the diaphragm moves, and breathing retraining, since a shallow upper-chest breathing pattern changes the pressure relationship between the chest and abdomen. Some practitioners also use a technique applying gentle downward traction below the ribs, intended to encourage the stomach downward.

      What it can be expected to do: possibly ease symptoms in some people, particularly where posture and breathing pattern contribute. What it cannot do, and this should be said plainly, is correct the anatomy. A hiatal hernia exists because the opening in the diaphragm has stretched, and no manual technique narrows that opening. The evidence base here is limited, consisting largely of case reports and small uncontrolled series describing symptom change rather than imaging-confirmed correction. Any provider describing it as returning the hernia to its normal position is going beyond what the evidence supports.

      Given that, the sensible arrangement is a short defined trial rather than an open-ended course: an assessment, a handful of sessions, and an honest review. If your symptoms have not shifted noticeably by then, continuing is not justified. That is a fair thing to agree in advance, and it is worth asking any provider what would make them tell you to stop.

      Alongside it, the measures with the strongest support should already be in place, because they do most of the work and cost nothing: smaller meals, around three hours between the last meal and lying down, raising the head of the bed by roughly fifteen centimeters with blocks under the legs rather than extra pillows, avoiding tight waistbands, reducing abdominal weight where that applies, and identifying your own trigger foods. Where symptoms persist despite those, acid-reducing medication is effective and worth discussing with a doctor, and for significant symptoms that do not respond, surgical repair is what addresses the anatomy.

      See a doctor rather than pursuing manual care if you have difficulty swallowing or food sticking, unintentional weight loss, vomiting blood or black tarry stools, persistent vomiting, or anemia on a blood test. New chest pain, particularly with breathlessness or sweating, needs emergency assessment.

2. Tan January 22, 2024 Reply

   Hi, is this treatment (GERD / Hernia) available in Sri Petaling?

   1. Yama Zafer, D.C. April 22, 2024 Reply

      Call the Sri Petaling center directly to confirm, since what is offered can differ between centers and the reception team can tell you what is currently available there. The direct number is on that center’s contact page.

      More useful is a distinction that matters before you book anything, because the two things in your question are not the same.

      A hiatal hernia is anatomical: part of the stomach sits above the diaphragm. Reflux, or GERD, is a symptom pattern caused by stomach contents coming back up the esophagus. They overlap but they are separate. Many people have a hiatal hernia and no reflux symptoms at all, and many people have significant reflux with no hernia. So treatment aimed at the hernia is not the same as treatment aimed at the reflux, and it is worth knowing which of the two is actually troubling you.

      If your problem is reflux symptoms, the measures with the strongest support cost nothing and should be in place before or alongside anything else. Smaller meals rather than large ones. Around three hours between the last meal and lying down. Raising the head of the bed by roughly fifteen centimeters using blocks under the bed legs rather than stacking pillows, since pillows bend you at the waist and can make reflux worse. Avoiding tight waistbands. Reducing abdominal weight where that applies. And identifying your own trigger foods rather than following a general list, since these vary considerably between people. Where symptoms persist, acid-reducing medication is effective and worth discussing with a doctor.

      On manual approaches, an honest position: work on the diaphragm, upper abdomen, breathing pattern, and mid-back may ease symptoms in some people, particularly where posture and breathing contribute. The evidence is limited, and it does not correct the anatomy of a hernia. Any provider should describe it in those terms, and a short defined trial with a review point is more sensible than an open-ended course.

      Some symptoms need a doctor rather than any of this: difficulty swallowing or food sticking, unintentional weight loss, vomiting blood or black tarry stools, persistent vomiting, or anemia on a blood test. New chest pain, especially with breathlessness or sweating, needs emergency assessment, because reflux and cardiac pain cannot be told apart reliably by how they feel.

3. Win October 3, 2023 Reply

   Is the chiropractic treatment for hiatal hernia available at every branch or only at certain branches? If I’m confirmed to be diagnosed with H.H., do I still need to undergo the assessment? How long would the whole treatment take?

   1. Yama Zafer, D.C. May 1, 2024 Reply

      Three questions, three answers.

      On availability by center: call the center you have in mind and ask directly, since what is offered can differ between them. Direct numbers and current hours are on each center’s contact page.

      On whether you still need an assessment with a confirmed diagnosis: yes, and the reason is not procedural. A confirmed hiatal hernia tells you about anatomy. It does not tell you what is producing your symptoms, and the two are not the same. Many people have a hiatal hernia with no symptoms at all, and many people have significant reflux without one. So the assessment establishes what is actually driving your symptoms, what your breathing pattern and posture contribute, what your meal timing and habits contribute, and what your baseline is, so that any change afterward can be measured rather than guessed at. It also screens for the symptoms that need a doctor rather than manual care, which is worth doing before treatment rather than after.

      On how long: this should be a short defined trial rather than a course with a fixed length, and it is worth understanding why. A hiatal hernia is anatomical, and no manual technique narrows the opening in the diaphragm that has stretched. What treatment can do is ease symptoms in some people, particularly where posture and breathing pattern contribute. Given that, the sensible arrangement is an assessment followed by a handful of sessions and an honest review. If nothing has shifted by then, continuing is not justified. Ask whoever treats you, in advance, how many sessions before we review and what would make you tell me to stop. A clear answer to that is a good sign.

      Alongside it, the measures with the strongest support should be in place from the start, because they do most of the work: smaller meals, roughly three hours between the last meal and lying down, raising the head of the bed by about fifteen centimeters using blocks under the legs rather than stacking pillows, avoiding tight waistbands, reducing abdominal weight where that applies, and identifying your own trigger foods. Where symptoms persist despite those, acid-reducing medication is effective and worth discussing with a doctor, and surgical repair is what addresses the anatomy in significant cases.

      See a doctor rather than beginning treatment if you have difficulty swallowing or food sticking, unintentional weight loss, vomiting blood or black tarry stools, persistent vomiting, or anemia on a blood test. New chest pain, especially with breathlessness or sweating, needs emergency assessment.

4. Md. Abul Kashem August 21, 2023 Reply

   My son, Abrar Jamil, is 10 years old and 6 months old. First, he was diagnosed with Hiatus Hernia sliding in 2021. Since then, his condition has gone down gradually; no medication could have improved his condition.

   Presently, his main problem is severe weakness. He cannot go to school for the last 1 year. He feels pain in his leg if he walks for about 4/5 minutes. He cannot keep sitting either for a long time. He cannot breathe properly and suffers from short breath. Sometimes, he Suffers from vertigo, and at that time, his eyesight appears blurred, and it happens mainly at night when he goes to sleep.

   He also feels very discomfort when he goes to sleep. Suffer from stomach spasms and cramps and feel pain in the abdomen, especially before going to the toilet. He often feels nauseous and sometimes vomits. His body weight is seriously less than standard.

   He suffers from high-grade GERD. Whatever he eats, it produces gas. The food he is taking does not give his body any nutrition. It also seems that he is hearing a bit less. He is living a miserable life at present. In addition, if he eats anything, his stomach burns often. He feels pain in his bones. His stomach spasms increase at night, especially. He also suffers from vertigo, especially when he goes to sleep.

   Is there any cure for my son, please? I am from Bangladesh.

   1. Yama Zafer, D.C. May 1, 2024 Reply

      This needs a pediatrician, and promptly. A child who has become severely weak and has been unable to attend school is not a situation for chiropractic or physiotherapy, and I would rather say that clearly than offer something that delays him getting the right assessment.

      The central point is this: a sliding hiatal hernia does not cause severe weakness. It causes reflux and its consequences. So either something else is going on, or the hernia has produced a complication that is causing the weakness indirectly. That second possibility is worth raising specifically with his doctor, because it is common, it is easily missed, and it is treatable.

      Long-standing reflux can inflame the lining of the esophagus, and inflamed tissue can bleed slowly over months. Slow blood loss that is never visible produces iron deficiency anemia, and in a child that presents exactly as you describe: progressive weakness, tiredness, poor concentration, and being unable to keep up at school. Reduced eating because swallowing is uncomfortable adds poor nutrition and slowed growth on top of it. Both are correctable once identified, and neither will improve with treatment aimed at the hernia alone.

      So ask his doctor for these specifically. A full blood count and iron studies, meaning ferritin, to look for anemia and iron deficiency. A check of his weight and height plotted against growth charts over the past two years, since a falling growth curve is objective evidence of what has been happening. Vitamin and nutritional status. And a referral to a pediatric gastroenterologist, with the question of whether endoscopy is needed to see what state the esophagus is in, since two years without improvement on medication is itself a reason to look.

      Alongside that, the weakness needs to be examined in its own right rather than assumed to follow from the hernia. Ask for a proper pediatric assessment including a neurological examination, and mention whether the weakness is general tiredness or genuine muscle weakness, whether it affects his arms and legs equally, whether it is worse at particular times of day, and whether he has difficulty climbing stairs or rising from the floor. Those details matter and will guide what else is looked for.

      Please do not delay this while pursuing manual treatment. A child who has been declining for two years and is now out of school needs a full medical workup, and there are treatable explanations that fit his story.

      Take him to the hospital rather than waiting for an appointment if he becomes breathless, unusually pale, faints or nearly faints, vomits blood, passes black or tarry stools, or becomes unable to keep fluids down.

5. Ray Kw March 18, 2022 Reply

   Can you give me references of radiographic or gastro endoscopic evidence after successful chiropractic treatment of hiatus hernia?

   1. Yama Zafer, D.C. March 24, 2022 Reply

      No, and the honest reason is that such evidence does not exist as far as I am aware.

      There are no controlled trials demonstrating radiographic or endoscopic reduction of a hiatal hernia following manual or chiropractic treatment. What exists in the literature is case reports and small uncontrolled series describing symptom improvement. That is a much weaker class of evidence, and importantly it is evidence about symptoms rather than about anatomy. Reported symptom change without before-and-after imaging or endoscopy does not demonstrate that a hernia has been reduced, and it is a mistake to present it as though it does.

      It is worth being explicit about why symptom improvement alone cannot carry that claim. Reflux symptoms fluctuate naturally and people typically seek treatment when they are at their worst, so improvement afterward is expected regardless of what was done. Anyone starting treatment usually also changes meal size, timing, and diet at the same time, and those measures have real effects. And treatment expectation reliably produces symptom change in conditions like this. Any one of those explains an improvement without the hernia having moved.

      There is also a mechanical problem with the claim. A hiatal hernia exists because the opening in the diaphragm that the esophagus passes through has stretched. Manual pressure applied below the ribs does not narrow that opening. Even where the stomach’s position shifts temporarily, the enlarged hiatus and the pressures acting on it remain, which is why any repositioning would not be expected to hold.

      So the accurate position is this. Manual work on the diaphragm and upper abdomen, breathing retraining, and treatment of the mid-back may ease symptoms in some people, particularly where posture and breathing pattern contribute. It should be offered on that basis and described in those terms. It should not be described as returning the hernia to its original position, and any provider claiming imaging-confirmed correction should be asked to produce that imaging.

      What does have evidence behind it: meal size and timing, elevation of the head of the bed, avoiding tight waistbands, weight reduction where relevant, acid-suppressing medication, and surgical repair for the anatomy itself in appropriate cases.

      Asking for the evidence before accepting a claim is the right instinct, and it is a fair question to put to any provider.

6. Voon March 15, 2022 Reply

   Hi,

   Can a hiatus hernia be pushed back to its original position? Are the treatments you provide for symptom relief, or do they cause the hernia to return to normal?

   1. Yama Zafer, D.C. March 24, 2022 Reply

      Symptom relief. That is the honest answer to your second question, and it should be given plainly rather than hedged.

      On whether a hiatus hernia can be pushed back: the stomach can shift position, and manual techniques applied below the ribs are sometimes described as encouraging it downward. What does not change is the reason it moved in the first place. The hiatus is the opening in the diaphragm that the esophagus passes through, and in a hiatal hernia that opening has stretched. No manual technique narrows it. So even where the stomach’s position shifts temporarily, the enlarged opening remains and the pressure that pushed it up in the first place is still there. That is why any repositioning effect is not a permanent correction, and why it is misleading to describe treatment as returning the hernia to normal.

      Restoring the anatomy is a surgical matter. The operation narrows the opening in the diaphragm and reconstructs the valve mechanism at the top of the stomach, and it is considered for people with significant symptoms that persist despite medication, or for particular types of hernia. That is the only route that changes the structure, and it is a decision for a surgeon after assessment.

      What conservative measures do achieve is worthwhile in its own right, and for most people it is enough. Symptoms come largely from pressure and from reflux, and both are reducible. Smaller meals rather than large ones. Around three hours between the last meal and lying down. Raising the head of the bed by roughly fifteen centimeters using blocks under the legs rather than stacking pillows, since pillows bend you at the waist and can worsen reflux. Avoiding tight waistbands. Reducing abdominal weight where that applies, which directly lowers the pressure driving the hernia upward. And identifying your own trigger foods rather than following a general list. Where symptoms persist, acid-reducing medication is effective and is worth discussing with a doctor.

      Manual and breathing-based work on the diaphragm and mid-back may ease symptoms in some people, particularly where posture and breathing pattern contribute. The evidence for it is limited, and it belongs alongside the measures above rather than in place of them, and certainly not in place of a surgical opinion where one is warranted.

      Some symptoms need a doctor rather than any conservative approach: difficulty swallowing or food sticking, unintentional weight loss, vomiting blood or black tarry stools, persistent vomiting, or anemia on a blood test. New chest pain, especially with breathlessness or sweating, needs emergency assessment, since reflux and cardiac pain are not reliably distinguishable by how they feel.

7. Hamidah Omar September 28, 2019 Reply

   Do you have a clinic in Penang?

   1. Yama Zafer, D.C. October 4, 2019 Reply

      No, there is no center in Penang. All six are in Kuala Lumpur and Selangor.

      Since this page concerns hiatal hernia, the more useful part is what actually changes symptoms, because most of it does not require a clinic at all.

      The measures with the strongest support are unglamorous and effective. Smaller meals rather than large ones, because volume is what raises pressure in the stomach. Leaving three hours between the last meal and lying down. Raising the head of the bed by around fifteen centimeters using blocks under the bed legs rather than extra pillows, since pillows bend you at the waist and can make reflux worse rather than better. Avoiding tight waistbands and belts. Reducing abdominal weight where that applies, which lowers the pressure driving the hernia. And identifying your own trigger foods rather than following a general list, since these vary considerably between people. Where symptoms persist despite those, medication that reduces acid is effective and is worth discussing with a doctor.

      On manual and breathing-based approaches, an honest position. Techniques aimed at the diaphragm and the upper abdomen, together with breathing retraining and work on posture through the mid-back, may ease symptoms in some people, particularly where there is a strong postural or breathing-pattern component. The evidence supporting them is limited, and they should be described as worth trying alongside the measures above rather than as a treatment that corrects the hernia. A hernia is an anatomical situation, and no manual technique reliably restores the anatomy.

      Some symptoms need medical assessment rather than any of this, and these matter. Difficulty swallowing or food sticking. Unintentional weight loss. Vomiting blood, or stools that are black and tarry. Persistent vomiting. Anemia found on a blood test. Chest pain that is new or different, particularly with breathlessness or sweating, which needs emergency assessment because reflux and cardiac pain are not reliably distinguishable by how they feel. Any of those warrants seeing a doctor, and several would prompt an endoscopy.

      For anything ongoing, a gastroenterology assessment in Penang will serve you better than traveling.

      1. Farah Dayana February 24, 2022 Reply

         Hi, how long is the course of treatment, and what would be the estimated price?

         1. Yama Zafer, D.C. February 25, 2022 Reply

            An honest answer on both, because hiatal hernia does not work like a course of treatment for a joint or a disc.

            A hiatal hernia is an anatomical situation: part of the stomach sits above the diaphragm rather than below it. No manual technique reliably restores that anatomy, and anyone describing a course of treatment that corrects the hernia is overstating what is possible. What conservative care can aim at is the symptoms, and in some people, particularly where there is a strong postural or breathing-pattern component, work on the diaphragm, the upper abdomen, and the mid-back does ease them.

            Because of that, the sensible structure is not a long course but an assessment followed by a short defined trial, on the order of a handful of sessions, with an honest review at the end. If your symptoms have not shifted noticeably by that point, continuing is not justified and you should be told so rather than sold more sessions. That is the question worth asking any provider before you start: how many sessions before we review, and what will make you tell me to stop.

            On price, the assessment is priced separately from treatment and takes longer, and follow-up visits are priced separately again. The reception team gives current figures on request and fees are explained before care begins. With a short defined trial you can know the likely total in advance, which is not true of an open-ended course.

            Worth saying plainly: the measures that do most of the work here cost nothing. Smaller meals rather than large ones, leaving around three hours between the last meal and lying down, raising the head of the bed by about fifteen centimeters with blocks under the bed legs rather than adding pillows, avoiding tight waistbands, reducing abdominal weight where that applies, and identifying your own trigger foods rather than following a general list. Where symptoms persist despite those, acid-reducing medication is effective and worth discussing with a doctor. Those should be in place before or alongside any treatment, not after it has been tried.

            Some symptoms need a doctor rather than any of this: difficulty swallowing or food sticking, unintentional weight loss, vomiting blood or black tarry stools, persistent vomiting, or anemia on a blood test. New chest pain, particularly with breathlessness or sweating, needs emergency assessment, since reflux and cardiac pain cannot be reliably told apart by how they feel.