Chewing and Hernia Symptoms: Impact and Management
Thorough chewing is essential for patients with hernias to prevent complications such as obstruction, strangulation, and exacerbation of symptoms. Proper mastication plays a critical role in hernia management, particularly for patients with diaphragmatic hernias and those who have undergone bariatric surgery.
Impact of Chewing on Hernia Symptoms
Diaphragmatic Hernias
- Inadequate chewing can lead to larger food boluses that may:
- Increase intra-abdominal pressure
- Exacerbate symptoms of diaphragmatic hernias including dysphagia, abdominal pain, and respiratory symptoms 1
- Potentially cause obstruction in herniated portions of the GI tract
- Trigger reflux symptoms in hiatal hernias
Post-Bariatric Surgery Hernias
- For patients with internal hernias following bariatric surgery, proper chewing is particularly crucial:
- Insufficient chewing increases risk of food bolus obstruction
- May lead to acute abdominal pain, nausea, and vomiting 1
- Can precipitate emergency presentations requiring surgical intervention
Recommended Chewing Practices for Hernia Patients
General Recommendations
- Chew food thoroughly (≥15 times per bite) 1
- Eat slowly with meal duration of ≥15 minutes
- Take small bites to reduce pressure on hernia sites
- Separate liquids from solids (drink 15 minutes before or 30 minutes after meals)
Specific Recommendations by Hernia Type
Diaphragmatic/Hiatal Hernias
- Thorough chewing helps prevent:
- Dysphagia (difficulty swallowing)
- Regurgitation
- Respiratory symptoms from aspiration
- Avoid eating large meals that increase intra-abdominal pressure
Internal Hernias (Post-Bariatric)
- Careful chewing helps prevent:
- Food bolus obstruction
- Strangulation of herniated bowel
- Emergency surgical interventions
Foods Requiring Special Attention
High-Risk Foods
- Avoid or thoroughly chew:
- Fibrous foods (celery, stringy vegetables)
- Foods with skins (fruits, vegetables)
- Nuts (smooth nut butters are acceptable) 1
- Sweetcorn and other small, hard foods
Safer Food Choices
- Soft, well-cooked foods
- Ground meats instead of whole cuts
- Pureed fruits and vegetables if dysphagia is present
- Small, frequent meals rather than large meals
Warning Signs Requiring Medical Attention
- Persistent pain despite proper chewing techniques
- Progressive dysphagia despite careful eating
- Vomiting after meals
- Signs of obstruction (abdominal distention, severe pain)
- Respiratory symptoms during or after eating
Clinical Implications
Inadequate chewing can transform a manageable hernia into a surgical emergency. The risk of strangulation in hernias increases with poor eating habits, potentially leading to bowel ischemia, perforation, peritonitis, and sepsis 1. This is particularly concerning for patients with diaphragmatic hernias, where diagnosis is often delayed until clinical condition worsens in 14.6% of cases 1.
For bariatric surgery patients with internal hernias, proper chewing is a critical preventive measure against acute complications that might require emergency surgical exploration 1.
Proper patient education about thorough chewing should be considered an essential component of hernia management, particularly for those with high-risk hernias or previous surgical history.