Sliding hiatal hernia irritated by bench press

[UTG2812]

Hi Rip,

I have a sliding hiatal hernia.

Lifting does not generally aggravate my HH, except for bench press. Right after benching, I feel my HH being irritated.

Is there any modification I could do?
Should I drop weight and perform the exercise without valsalva maneuver to decrease the intra-abdominal pressure?

Thanks.

[Mark Rippetoe]

Where is it?

[UTG2812]

Where is it?

Sorry, not fully sure what you mean. The hiatal hernia is at the hiatus of the diaphragm, but you know this already.
I have been diagnosed with an axial sliding hiatal hernia (4cm) by endoscopy.

[Mark Rippetoe]

Right. I have one too. It is estimated that 35% of the population has some degree of hiatal hernia. Do you train on a full stomach?

[UTG2812]

Right. I have one too. It is estimated that 35% of the population has some degree of hiatal hernia. Do you train on a full stomach?

I usually wait 60-90min after eating before I train, more if it was a bigger meal.

[Mark Rippetoe]

What adverse effects do you experience after benching?

[UTG2812]

What adverse effects do you experience after benching?

So my usual symptoms are:
- discomfort right beneath the left rib cage
- cant inhale as deeply
- feeling that I need to belch

when the HH gets severely irritated also
- reflux
- increased heart rate and nervousness (presumably due to irritation of the vagus nerve by the HH)

I have some breathing/manipulation techniques which can calm the irritation, but it always takes a couple of hours for my stomach to feel normal again.

Other triggers (besides bench pressing) for the same symptoms are
- acidic foods/drinks
- black coffee
- sitting hunched over for longer periods of time

[Mark Rippetoe]

Much worse than mine. There is a surgical procedure, but I have heard that it is largely unsatisfactory.

[UTG2812]

Much worse than mine. There is a surgical procedure, but I have heard that it is largely unsatisfactory.

Yeah, it can have nasty side effects and the recurrence rate is quite high.

Most days I have this well under control with diet and posture. I believe acidic foods are a trigger because acid can lead to esophageal shortening. This can pull the stomach further up and trigger more reflux thus more acid and shortening.

I think the problem with the bench press is the lying position. The intra-abdominal pressure will put pressure on my stomach and lead reflux, which wouldn't happen in an upright position.

So I think I should try exhaling during the push. Or do you have any other ideas?

[Mark Rippetoe]

What is your height and bodyweight?