Breathing exercises to strengthen lower esophageal sphincter

If you're experiencing acid reflux, it may have to do with a weakened lower esophageal sphincter muscle.

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If you want to ease the discomfort and pain of heartburn and other symptoms of acid reflux, but aren't keen on taking medication, you might be able to find some relief by strengthening your lower esophageal sphincter (LES) muscle, which is designed to keep stomach acids from escaping.

About Your LES Muscle

About 20 percent of Americans experience acid reflux due to a weakened LES muscle, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The LES is a muscular ring that connects the esophagus with the stomach. Its job is to keep food and stomach acids from leaving the stomach and rising back up into your esophagus.

"The goal of the lower esophageal sphincter is to open up when you swallow, let the food go down through the esophagus and into the stomach and then close to serve as a blocker against reflux," explains Michael S. Smith, MD, chief of gastroenterology and hepatology at Mount Sinai West and Mount Sinai St. Luke's Hospitals in New York. "Other than when you're going through a swallow, the sphincter is supposed to stay shut."

However, the pressure in the lower esophageal sphincter can be become overly relaxed by a number of factors, according to Harvard Health. These include:

• Trigger foods such as herbs, caffeinated beverages, whole milk, tomatoes and peppermint
• Smoking
• Alcoholic beverages
• Pregnancy
• Some medications and supplements* Abdominal pressure from obesity or multiple pregnancies
• Hiatal hernia (when the stomach protrudes into the diaphragm)

When the LES weakens and stomach contents or acids start to back up — a process called gastroesophageal reflux (GER) — you can get the burning pain and discomfort of heartburn, says NIDDK. If it happens on a regular basis, you're likely to be diagnosed with gastroesophageal reflux disease (GERD).

To alleviate symptoms, many people rely on over-the-counter or prescription-strength acid buffers, such as H2 blockers or proton pump inhibitors (PPI). But a drug-free approach — specialized breathing — is getting positive attention.

Breathing Exercises to Strengthen Your LES

Breathing exercises involving the diaphragm, intended to strengthen the pressure of the lower esophageal sphincter, could be helpful to people with chronic acid reflux, according to a review of research on the subject published in the European Review for Medical and Pharmacological Sciences in 2016.

In particular, the report cited a randomized, controlled study published in March 2012 the American Journal of Gastroenterology. The small study involved 20 participants, half of whom practiced breathing exercises involving the diaphragm that are commonly used by singers.

Of the five exercises, two involved abdominal breathing while lying down. Participants moved their abdominal wall against some resistance while relaxing the muscles in the chest and between the ribs. The other three included breathing exercises while seated and standing, focusing on slow exhales with raised arm movements and vocalizing.

After one month, participants in the exercise group showed a significant decrease in exposure to stomach acids and an increase in their quality of life, compared with those only taking PPIs. After eight months, the exercisers continued to report improved quality of life and less need for PPIs.

Why It Works

How can such exercises work? According to Nefarati Ellis-Marin, DPT, a physical therapist with Mount Sinai West, posture and body mechanics over time can affect the diaphragm, and it's possible to re-educate the body so that the diaphragm and, in turn, the LES, work better.

A physical therapist can look at the position of your diaphragm and your ribs to see how everything is aligned and then suggest exercises such as deep breathing (also called belly breathing), done either lying down or standing, and show you how to engage the stomach muscles, she explained.

"In general, you need to be very diligent," Ellis-Marin says. "It does help, but because there isn't a lot of research, it can be trial and error with each patient." But, she says, working with a trained PT will help you learn the correct techniques.