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Chronic Cough: Is it a Sign of Hiatus Hernia?

The Hyfe Mind

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March 1, 2021
CoughPro is not a medical product. It is a wellness app intended only for users to obtain a better understanding of their cough. It is not intended to diagnose, monitor, or treat any illness.

We at Hyfe, Inc., are a company devoted to working on tools to better understand the importance of cough. It is Hyfe’s intention in the future to seek regulatory approval for medical products that analyze cough in order that they may be used to diagnose, monitor, and facilitate better treatment of respiratory illnesses.

Hiatus hernia cough is one of the possible causes of chronic cough

A chronic cough is a cough that lasts for eight weeks or longer among adults. But what is a hiatus hernia cough?

We can visualize cough as a reflex that removes an irritant from the respiratory tract. On most occasions, it is a momentary action. 

However, when the irritant is continuous, as in the case of a hiatal hernia, it leads to a persistent cough. There might seem no likely cause, as we tend to associate a cough with external stimuli such as allergens or possible respiratory infection. 

A chronic cough associated with a hiatal hernia is persistent, dry, and often the only indication of underlying hernia. We will explore narrowing down a likely source of chronic cough to the stomach.

What Is A Hiatus Hernia?

Our stomach is a small flexible pouch confined within our abdominal cavity. This stable placement is possible through muscular structures like the diaphragm keeping the stomach in place. A few openings through the diaphragm allow blood vessels and the esophagus to pass through. 

A hernia is when an organ or structure in our body pushes through an opening within muscle tissue. For example, a hiatal hernia usually happens when there is a weakness in the muscles of the diaphragm allowing for the stomach to push its way through the small opening, the hiatus. 
There are two types of hiatal hernia: the classic sliding hiatus hernia and the paraesophageal hiatus hernia. It is only through diagnostic investigation can one variant be differentiated from the other.

Hiatal hernia graph
Image Courtesy: Wikimedia Commons

The exact cause why a hiatus hernia develops is not entirely understood. 

Being overweight, trauma to the diaphragm, surgery, age, and smoking can increase your risk of developing a hiatal hernia. 

Anything that increases pressure on the muscles supporting the stomach, such as vomiting, coughing, straining from constipation, or lifting heavy objects, may increase the chances of a hiatal hernia. In addition, the course of pregnancy or even recurrent pregnancies can weaken the diaphragm resulting in a hiatal hernia with time.

How Would I Know I Have a Hiatus Hernia?

For most people, hiatal hernias are minor, meaning no signs or symptoms are apparent that would point to an underlying hernia. For example, you typically only notice symptoms of hiatus hernia when the bulge of the stomach into the chest is significant. 

The most common signs are those similar to stomach acid reflux observed with gastroesophageal reflux disorder (GERD):

  • Heartburn, or discomfort in the chest, particularly after meals
  • In some instances, persistent chest pain, located below the sternum
  • Bloating and a general sense of gassiness
  • Sense of nausea even if you haven’t eaten
  • Sour or metallic taste in the mouth

While these are possible signs of hiatus hernia, they may not always be present, especially with small hernias.

Besides the above signs, a cough is often the only nagging indication that makes you take notice and seek professional advice.

What is the Hiatus Hernia Cough Like?

A hiatus hernia can result in a cough that is dry and persistent. Many individuals document this cough mainly at night. This symptom occurs when you lay down after a meal at night, resulting in stomach acid reflux. The recurrent stomach acid reflux irritates the cough centers in the throat resulting in a cough. 

Since coughing can increase reflux, in hiatal hernia can also worsen the cough itself. This added reflux forms what is known as a positive feedback loop that further increases the cough. Indeed, over time the cause and effect of the cough associated with hiatal hernia might be blurred, making it difficult to identify the cause for the cough.

While the cough might be of a dry variant, some might note a thick mucus produced with the cough as well. This mucus is a protective mechanism that works against stomach acid. 
Frequently it is the overall picture of cough at night, chest discomfort, and signs of acid reflux that might point to a possible diagnosis of hiatal hernia. But on the rare occasion, a lingering chronic cough without an easy understanding of a possible cause should prompt investigation for a hiatus hernia.

How Can I Get a Diagnosis for Hiatal Hernia?

To diagnose an underlying hiatal hernia, you will first relay all the possible signs suggesting gastroesophageal reflux. Often a lingering chest pain, heartburn, and a persistent dry cough are presenting signs your physician asks for. 

There are a few tests your doctor might consider conducting to diagnose your hiatus hernia:

  • Barium swallow: With this test, you drink liquid barium and then get an X-ray to determine the exact location of the stomach.
  • Endoscopy: A thin tube, the endoscope, is passed through your esophagus into your stomach. A camera locates the exact position of the stomach and its curvatures.

Check the pH in your esophagus: This can be a 24-hour test to see if gastroesophageal reflux occurs.

How Can I Manage My Hiatal Hernia Symptoms?

A hiatal hernia arises from a weakness in the diaphragm. Hence, treatment must reduce the pressure on the diaphragm.

Many cases of hiatal hernia appear among older individuals. However, as discussed above, several other factors can cause a hernia early on in life.

So for starters, when you observe having symptoms of reflux, consider checking in with a doctor. Your physician will conduct tests before prescribing medications to assess the degree of your hiatus hernia. Following a confirmatory diagnosis, your physicians might first advise you to make a few lifestyle modifications to lessen reflux symptoms. 

These could include:

  • Losing any excess weight
  • Opting for smaller meals
  • Avoiding acidic foods
  • Staying away from fried and fatty foods
  • Avoid laying down right after meals
  • Avoid wearing tight clothing, which can increase abdominal pressure

Other lifestyle habits like reducing alcohol, caffeine and staying away from cigarette smoking can immensely reduce hiatal hernia symptoms. In addition, healthcare professionals might prescribe a proton pump inhibitor to supplement lifestyle changes. 

Proton pump inhibitors are the first-line medication. These drugs reduce stomach acid production, the primary source of hiatal hernia symptoms. They are often available over-the-counter.

Treating Hiatal Hearnias

Since most of the hiatal hernias are small once diagnosed, rarely is surgical intervention required. Generally, doctors only opt for surgery in cases where the stomach might suffer dire consequences due to persistent constriction.  Surgery might also be considered when lifestyle and medications are not improving symptoms (refractory).

Unmanaged hiatal hernia can, in the long-term, cause damage to the esophagus and even the structures higher up in the throat, such as the pharynx and larynx (home of the vocal cords). In addition, when left untreated for a long time, other possible complications include strictures, inflammation, and even cancer.

Hiatal hernia is just one of the many possible causes for a mysterious nagging cough. Therefore, tracking the onset of symptoms and their aggravators is critical for reaching a diagnosis and working on actionable treatment. 

For the majority of those who have hiatal hernia, symptoms are unnoticeable. The occasional heartburn or chest discomfort could be the first signs indicating underlying hiatus hernia. However, if you notice persistent signs of significant chest pain and dry cough, you must get checked by a doctor. When detected early, simple measures such as lifestyle modifications and OTC medicines are sufficient to manage hiatal hernia symptoms.

Your Cough Matters

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  • Excellent, insightful
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    This app is easy to use, aesthetically pleasing and has provided me with useful information about my cough and disease patterns that have improved my overall health!

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    Impressed with how well it detected my coughs, even very slight ones.
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    by HBert Quach — Jan 22, 2023, - Google Play
    App is great at tracking cough when little ones are sick. I treat it as a early warning indicator before the cold gets back. Customer service is awesome, they actually respond to all my questions.
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    by Christi Hammock — Mar 7, 2023, - Google Play

    I had an issue logging into the new app but I contacted the support team and they were awesome in helping me figure out the issue. It turned out to be a technical issue which they resolved very quickly and I was kept in the loop on the status from start to finish. This app is really helpful when talking to my doctor too..
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  • Impressive app
    By KayakTina - Apr 7, 2023 - App Store
    "The app accurately is recording my coughs with excellent ways to review the results. I can add notes to help me identify patterns or have accurate information for my physicians. I’ve hoped for an app like this for years to help me accurately track the amount of coughing I’m doing"
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  • Accurate count of coughs
    by Beardonna — Mar 8, 2023 - App Store

    Just installed the app. Very accurate measuring coughs so far! Cannot wait to see how much coughing I do while sleeping. I'll have a better picture to discuss with my physician at my next visit.

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