A hiatal hernia occurs when a part of the stomach slides above the diaphragm (the thin muscle separating the stomach from the chest). This is a common problem and most people are not bothered by it. Your hernia may allow stomach acid to flow back into your esophagus, the tube that connects the mouth to the stomach. With time, the stomach acid may irritate your esophagus and cause problems. If this happens, you may need surgery to repair the hernia.
Learn More
- Symptoms of a Hiatal Hernia
- Causes of a Hiatal Hernia
- Diagnosing a Hiatal Hernia
- Treating a Hiatal Hernia
Symptoms of a Hiatal Hernia
A hiatal hernia cannot be seen on the outside of the body, and may cause no symptoms at all. Patients who do experience symptoms usually feel a burning sensation in the chest and throat a short time after eating. This is called gastroesophageal reflux disease (GERD) and is caused by stomach acids being pushed up into the esophagus. Other symptoms include heartburn, an uncomfortably full feeling after eating, and the frequent need to belch.
A serious complication of a hiatal hernia can occur if the part of the stomach that is herniated becomes twisted or pinched by the diaphragm. This is called a strangulated hiatal hernia. If this happens, that portion of the stomach can lose its blood supply. Symptoms include severe chest pain, bloating, and difficulty swallowing. Very large hiatal hernias can develop lesions that bleed and cause anemia from the blood loss.
Causes of a Hiatal Hernia
A hiatal hernia is caused by a weakness in the muscle tissue at the opening in the diaphragm where the esophagus passes through to the stomach. In some people, this weakness is present at birth. In others, it develops over time. Because the muscle is weak, the hernia occurs during various forms of abdominal strain:
- Excessive weight gain
- Physical activity that places pressure on the abdomen
- Pregnancy
- Heavy lifting
- Straining during bowel movements due to constipation
- Severe vomiting
- Chronic and intense coughing
Diagnosing a Hiatal Hernia
To diagnose a hiatal hernia, your doctor will rely upon your medical history, your description of symptomsm and a series of diagnostic tests. These may include endoscopy or a barium swallow. With endoscopy, a flexible viewing tube is inserted through the mouth and down to the stomach so the doctor can check for the hiatal hernia between the esophagus and the stomach. You will be given a mild sedative during the procedure so you will feel no discomfort. With a barium swallow, x-rays are taken after you drink a special barium solution. The barium helps reveal the bulge of a hiatal hernia on the x-ray. These tests are usually done on an outpatient basis.
Treating a Hiatal Hernia
The treatment for many hiatal hernias is focused on diet and lifestyle changes; surgery is usually reserved for severe cases.
Diet and Lifestyle Changes
Doctors recommend:
- Restricting your intake of spicy and acidic foods and beverages, caffeinated beverages, and chocolate
- Elevating your head when lying down to prevent gastroesophageal reflux
- Remaining in an upright position after eating
- Eating frequent small meals throughout the day rather than two or three large ones
Surgery
Surgery is necessary for a strangulated hiatal hernia and very large hiatal hernias that cause severe gastroesophageal reflux. This procedure may be performed using laparoscopic surgery, in which the surgeon inserts a special viewing instrument called a laparoscope through a small incision in the chest or abdomen. The laparoscope is like a tiny video camera that gives the surgeon a clear view of the abdominal area. Other small incisions are made to insert the surgical instruments used to pull the stomach back down into the abdomen and repair the weak muscle or make a smaller opening between the diaphragm and the esophagus.