instruction: hello doctor I am a 31 year old male who until recently weighed about 100 keg for the last six months to a year I was obsessively performing a valsalva maneuver because I had health anxiety and ocd and I was worried about an operation when I was younger I could have impacted my continence I have been having some gi issues lately and read that you can cause a hiatal hernia from chronic straining is it possible that I could have caused a hiatal hernia at my age are six months to a year chronic enough if I have caused a hiatal hernia will it stay forever or can I reduce it and the hernia size through exercise to tone and strengthen the diaphragm and weight loss I am extremely worried I have caused a hernia and will have to live with it forever I have had a standard ray of the chest which came back normal could a hernia have been missed
output: hello I can very well understand your concern and at the start I want to tell you that chronic straining does not lead to the development of hiatus hernia however your weight can hiatus hernia is an anatomical change that can present since birth and after certain surgical procedures over abdomen or diaphragm overweight to obese can develop hiatus hernia because of the excessive pressure over the stomach from belly fat causing upward lifting of the lower part of food pipe and formation of hernia and lastly due to the old age when the diaphragmatic muscle gets weakened allowing part of the lower esophagus to get pulled in the lower part of the chest in a young healthy people diaphragmatic muscle is strong enough to prevent this from happening valsalva maneuver if performed vigorously can cause tears in the lower part of the esophagus which is an acute complication of this but it will not alter the anatomy or produce a hiatus hernia valsalva can harm somebody if it is done without a reason there are certain indications for medical conditions but it can only cause damage to the lower part of the esophagus acutely but would not alter the anatomy of it I hiatus hernia yes an ray plain without contrast can easily miss a hiatus hernia a special ray with contrast named barium is swallowed and serial ray images from the chest are taken that can diagnose the hiatus hernia instantly however a plain chest ray cannot detect the presence of hiatus hernia so now coming to your second concern that you have to live with it well it is not yet proven that you have a hiatus hernia secondly it is not uncommon to have hiatus hernia in people without any symptoms and it can remain undiagnosed until their whole life the point is it can present harmlessly in human for years and years and does not necessitate any investigations the time to develop a hiatus hernia is variable but it does take many years of overweight to cause hiatus hernia very less likely within to 12 months time it is not a rule that every hiatus hernia would cause symptoms or disease or any complications I would not suggest you even to worry about it and get tested for it because it would not change anything for you simple exercises keeping a healthy lifestyle reduce weight are all that is required the weight loss is very compulsory this will not only help you preventing hiatus hernia but also other things like gastroesophageal reflux herd bloating gas distention constipation I hope this helps overweight barium swallow if worried about it or have symptoms suggestive of gastroesophageal reflux weight reduction follow up to discuss if any concern