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