Heartburn is a painful burning sensation experienced in the upper stomach or chest due to the reflux of acid in the oesophagus.

The reflux is caused due to the relaxation of the lower oesophageal sphincter (LES) which in turn is triggered usually by poor diet and lifestyle, though other factors might also be involved.

Heartburn is a relatively common disorder and can easily be treated with simple home remedies and medications. Negligence of this disorder can lead to a more chronic from called gastro-oesophageal reflux disease (GERD).

Stress and Heartburn

It has been reported by many people across the world that stress induces or exacerbates heartburn.

Certain stressful situations such as an interview, workload, mood swings, and examinations among many others increase the symptoms of acid reflux and the associated pain.

Research also suggests that psychological stressors related to daily life are directly related to inflammatory and hypersensitivity disorders of the gastrointestinal tract.

Potential manifestations of such stressors are seen in the form of increased acid exposure to the oesophageal lining, inhibition of gastric emptying process, inflammation in the gut and other hypersensitivities [1].

There are several ways by which stress can affect the gut and aggravate heartburn, some of which are described below.

Stress Increases Mucosal Permeability

One important prospect of heartburn is the thickness of the mucosal lining in the gut and its permeability to acids and other stomach contents.

When it becomes more porous or thinner, it becomes easier for the acid to reach the sensory nerve endings present in the gut tissue (oesophagus and stomach), which causes the sensation of pain.

In a study done on rats, it was found that stress increases the mucosal permeability and directly affects the thickness of the mucosal lining in the gut, intensifying the effects of acid reflux [2].

Stress and Perception of Pain

Several types of such as auditory stress, visual stress, and psychological stress affect the perception of pain.

In a study on auditory stress and GERD, it was found that it increases the perception and realization of pain and thus enhances the symptoms [3].

Similarly, psychological stress also affects the severity of heartburn, making it worse because of the increased sensitivity and awareness towards pain [4].

Stress decreases Gastric Motility and Gastric Emptying

Although the reasons are not yet clear it has been found that stress increases the retention time of food in the stomach, causing indigestion and vital exhaustion [5].

This is directly related to heartburn because dyspepsia and enhanced retention time of food in the stomach increase the chances of acid being refluxed up and causing the symptoms of this disorder.

Not just that, stress also decreases the motility of the gut which also plays an important role in digestion and heartburn [6].

Massage _ Relaxation Benefits in Heartburn

How Massage Decreases Heartburn

Massage and relaxation are directly related to the reduction in stress levels of the body.

Several types of massages such as aromatherapy, massage with relaxing music, meditation and massage, etc. are all successful on different levels for the reduction of stress and stress-related disorders [7].

The immediate effect of massage is a feeling of deep relaxation and calmness which is attributed to the release of endorphins in the brain, which mediates the feeling of wellbeing.

It also reduces the levels of stress hormones such as adrenaline, cortisol, and norepinephrine.

Massage and Immunity

Studies indicate that stress impairs the immune system and causes immunological hypersensitivities in certain parts of the body including gastrointestinal tract, which also might be considered a reason behind the inflammatory reactions caused in heartburn.

It has been found that massages increase circulation in the body and makes the immune system efficient [8].

This proves that massage not only reduces stress but also directly soothes the affected body parts by alleviation of the symptoms of the disorder.

Massage and Reduction in Constipation/Indigestion

A study on the effect of massage and constipation revealed that abdominal massage of people suffering from gastrointestinal disorders such as constipation, irregular bowel movements, indigestion, heartburn, etc. experienced amelioration of the symptoms after a few weeks of regular abdominal massages.

The gastrointestinal function was measured and the bowel movements and blood circulation in the gut were found to be highly improved [9].

Listed below are several other roles that massage plays in the promotion of an overall reduction of stress by affecting certain body functions.

  •  Reduced muscle tension
  • Reduction of stress hormones
  • Increase of neurotransmitters responsible for “happy” feelings
  • Improved skin tone
  • Improved circulation
  • Increase in the speed of healing of injuries
  • Reduced anxiety and depression
  • Reduced blood pressure

Various Massage and Relaxation Techniques

There are a number of massages and relaxation techniques available which can be opted for a reduction in stress and stress-induced heartburn.

1. Aromatherapy

It includes massage with fragrant essential oils extracted from flowers and ornamental plant species with particular therapeutic properties.

It can help reduce nervous tension and other disorders depending on the healing properties of the oil used.

2. Baby massage

It can help treat colic, constipation and other gut problems.

3. Reflexology

Massage of the feet leading to relaxation of the other body parts.

4. Therapeutic Massage

Also known as Swedish massage or western massage, it promotes relaxation and blood circulation.

5. Remedial

It enhances the healing of injured tissues.

6. Shiatsu

It is similar to acupuncture and involves massage of specific points in the body. It increases energy flow.

7. Sports Massage

It is mainly designed for those who are engaged in sports activities and help in easy recovery of such people from certain disorders.

8. Pregnancy Massage

It is specially designed for expecting mothers for relief from symptoms such as morning sickness and heartburn

9. Relaxation

By meditation, sleep or engaging in any relaxing task such as pursuing a hobby, watching videos, yoga, cooking, etc. it reduces the overall stress levels [10]

Relaxation and Heartburn

Several relaxation activities such as meditation, yoga, listening to music, pursuing hobbies, peaceful sleeping, praying, massage, etc. have been shown to decrease or buffer the gastric disorders including heartburn by affecting the patient’s psychology.

Such relaxation activities not only promote well being by stimulating the production of happy chemicals such as endorphins but also by increasing positivity and motivation.

People who take time to relax are shown to have a better ability to tolerate pain, improved vital functioning and better clinical outcome [11].

Relaxation techniques include a number of practices such as autogenic training, progressive relaxation, guided imagery, biofeedback, self-hypnosis, and deep breathing exercises.

All these techniques aim at a common goal-lower the blood pressure, increase circulation, reduce stress and enhance overall well being.

Meditation, yoga, and tai chi have also shown to promote relaxation by increasing the gray matter of the brain and reducing the percentage of the part of the brain that deals with stress and stress responses.

1. Autogenic Training

It helps concentrate on warmth, heaviness, and relaxation of different parts of the body.

2. Biofeedback

This technique uses electrical devices that analyze the body functions and gives feedback regarding each body part which is accordingly focussed for relaxation by controlling them.

This method helps reduce muscle tension

3. Deep Breathing Exercises

These involve slow deep breathing motions to relax the brain and improve oxygen flow.

4. Guided Imagery

In this technique, people are taught to focus on pleasant images to replace negative feelings/thoughts.

5. Progressive Relaxation

It involves tightening and relaxing of various muscles of the body.

6. Self-hypnosis

In this, people are taught to produce a relaxation response when prompted by a specific hypnosis-inducing phrase or a nonverbal cue [12].

7. Yoga

A traditional Indian technique, it involves body movements coordinated with breathing exercises [13].

Safety Concerns and Precautions for Practice of Massage and Relaxation Techniques

There have been highly rare cases of any side effects or adverse effects of massage and relaxation in people of any age group or any medical condition if it is carried on properly.

However, people occasionally report symptoms of unpleasant thoughts, anxiety and fear of losing control.

It is important in case of messages that it should only be performed by registered practitioners as it involves a risk of affecting wrong points in the body leading to side effects.

People with heart disease, bone abnormalities, skin rashes and expecting mothers, should consult a doctor before undergoing any kind of massage or relaxation program [14],[15].

Summary

Stress is one of the strongest factors in the increase in the cases of heartburn and exacerbations in the symptoms of patients with acid reflux and other gastrointestinal problems.

Massage and relaxation are the two techniques which not only help reduce stress and its related patho-physiologies but also enhance the immune system, circulation and promote overall well being.

With rarely any side effects reported if practiced under the guidance of authorized practitioners, massage and relaxation help ameliorate and even fully cure heartburn and other disorders.

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