Ask Dr. Etingin: Hiatal Hernia; Pilates for Pain

I have a small hiatal hernia. Will it get bigger? Will I need surgery?

Hiatal hernias are common. Approximately 55 percent to 60 percent of adults over 50 have this condition, which occurs when part of the stomach pushes through the diaphragm— the muscle separating the chest from the abdomen. As women age, diaphragm muscles can weaken, increasing the risk of a hiatal hernia. Additionally, postmenopausal women often experience changes in abdominal pressure related to weight gain and this is a risk factor, as well.

A small hiatal hernia can become larger over time due to aging, increased abdominal pressure, or repetitive strain. To prevent a small hiatal hernia from worsening, maintain a healthy weight, lose weight if you have overweight or obesity, and avoid heavy lifting to minimize abdominal muscle strain. A small hiatal hernia is often symptom-free, whereas a larger one can cause stomach acid to back up into the esophagus, causing heartburn and chest pain. To prevent hiatal hernia symptoms, eat smaller, more frequent meals; avoid eating close to bedtime; and steer clear of alcohol, spicy foods, citrus fruits, coffee, chocolate, and tomatoes. To treat hiatal hernia symptoms, several medications can be used:

Antacids: These help neutralize stomach acid and provide quick relief. Examples include: Rolaids, Tums, and Mylanta.

H-2 Receptor Blockers: These reduce acid production. Examples include Pepcid, Tagamet, and Zantac.

Proton Pump Inhibitors (PPIs): These also reduce acid production, but are more potent than H-2 blockers. Examples include Nexium, Prilosec, and Aciphex.

If medications fail, surgery may be recommended. Discuss your concerns with a health-care provider, so you can get personalized advice.

I am considering trying a Pilates class. I’m 65 and have arthritis and lower back pain. Can Pilates help alleviate my pain?

Pilates, developed by Joseph Pilates in the early 1900s, focuses on strengthening core abdominal and back muscles, which support the rest of the body. It can improve flexibility and balance, making it beneficial for individuals with arthritis and lower back pain. Exercises are performed on a mat or a machine called a “reformer” that uses resistance for a low-impact workout. Due to its low-impact nature, Pilates is often easier on the joints and less strenuous compared with other exercises.

When researchers performed an analysis of several studies in an effort to find out if Pilates was helpful for older adults with chronic musculoskeletal conditions, they gave it a thumbs up. Their review of seven studies that included close to 400 adults over age 50 (about 75 percent were female) showed that Pilates was quite effective for reducing back pain, as well as other osteoarthritis and osteoporosis pain.

Many senior centers, health clubs, and YMCAs offer Pilates classes tailored to older adults. Attend classes led by a qualified instructor to ensure proper technique, and be sure to inform the instructor about your arthritis and back pain in case position or equipment modifications are warranted. It sounds like Pilates will be an excellent choice for you, but just as with any new fitness program, it’s a good idea to check with your doctor to make sure that this form of exercise is appropriate for you.

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