What is a hiatal hernia?
A hiatal hernia occurs when the upper part of your stomach
pushes up through your diaphragm and into your chest region.
The diaphragm is a large muscle that lies between your
abdomen and chest. You use this muscle to help you breathe. Normally, your
stomach is below the diaphragm, but in people with a hiatal hernia, a portion
of the stomach pushes up through the muscle. The opening it moves through is
called a hiatus.
This condition mostly occurs in people who are over 50 years
old. It affects up to 60 percent of people by the time they’re 60 years old,
according to the Esophageal Cancer Awareness Association.
What causes a hiatal hernia?
The exact cause of many hiatal hernias isn’t known. In some
people, injury or other damage may weaken muscle tissue. This makes it possible
for your stomach to push through your diaphragm.
Another cause is putting too much pressure (repeatedly) on
the muscles around your stomach. This can happen when:
during bowel movements
Some people are also born with an abnormally large hiatus.
This makes it easier for the stomach to move through it.
Factors that can increase your risk of a hiatal hernia
Types of hiatal hernia
There are generally two types of hiatal hernia: sliding hiatal hernias and
fixed, or paraesophageal, hernias.
This is the more common type of hiatal hernia. It occurs
when your stomach and esophagus slide into and out of your chest through the
hiatus. Sliding hernias tend to be small. They usually don’t cause any
symptoms. They may not require treatment.
This type of hernia isn’t as common. It’s also known as a
In a fixed hernia, part of your stomach pushes through your
diaphragm and stays there. Most cases are not serious. However, there is a risk
that blood flow to your stomach could become blocked. If that happens, it could
cause serious damage and is considered a medical emergency.
Symptoms of a hiatal hernia
It’s rare for even fixed hiatal hernias to cause symptoms.
If you do experience any symptoms, they’re usually caused by stomach acid,
bile, or air entering your esophagus. Common symptoms include:
that gets worse when you lean over or lie down
pain or epigastric pain
An obstruction or a strangulated hernia may block blood flow
to your stomach. This is considered a medical emergency. Call your doctor right
can’t pass gas or empty your bowels
Don’t assume that a hiatal hernia is causing your chest pain
or discomfort. It could also be a sign of heart problems or peptic ulcers. It’s
important to see your doctor. Only testing can find out what is causing your
What is the connection between GERD and
Gastroesophageal reflux disease (GERD) occurs when the food,
liquids, and acid in your stomach end up in your esophagus. This can lead to
heartburn or nausea after meals. It’s common for people with a hiatal hernia to
have GERD. However, that doesn’t mean either condition always causes the other.
You can have a hiatal hernia without GERD or GERD without a hernia.
Testing for and diagnosing hiatal hernias
Several tests can diagnose a hiatal hernia.
Your doctor may have you drink a liquid with barium in it
before taking an X-ray. This X-ray provides a clear silhouette of your upper
digestive tract. The image allows your doctor to see the location of your
stomach. If it’s protruding through your diaphragm, you have a hiatal hernia.
Your doctor may slide a thin tube in your throat and pass it
down to your esophagus and stomach. Your doctor will then be able to see if
your stomach is pushing through your diaphragm. Any strangulation or
obstruction will also be visible.
Treatment options for hiatal hernias
Most cases of hiatal hernias don’t require treatment. The
presence of symptoms usually determines treatment. If you have acid reflux and
heartburn, you may be treated with medications or, if those don’t work,
Medications your doctor may prescribe include:
antacids to neutralize stomach acid
or prescription H2-receptor blockers that lower acid production
or prescription proton pump inhibitors to prevent acid production, giving
your esophagus time to heal
If medications don’t work, you might need surgery on your
hiatal hernia. However, surgery is not commonly recommended.
Some types of surgery for this condition include:
weak esophageal muscles
your stomach back in place and making your hiatus smaller
To perform surgery, doctors either make a standard incision
in the chest or abdomen, or use laparoscopic surgery, which shortens recovery
Hernias can come back after surgery. You can reduce this
at a healthy weight
help lifting heavy objects
strain on your abdominal muscles
Acid reflux causes most hiatal hernia symptoms. Changing
your diet can reduce your symptoms. It may help to eat smaller meals several
times a day instead of three large meals. You should also avoid eating meals or
snacks within a few hours of going to bed.
There are also certain foods that may increase your risk of
heartburn. Consider avoiding:
made with tomatoes
Other ways to reduce your symptoms include:
the head of your bed by at least 6 inches
bending over or lying down after eating
Reducing your risk of hiatal hernias
You may not avoid a hiatal hernia entirely, but you can
avoid making a hernia worse by:
straining during bowel movements
help when lifting heavy objects
tight belts and certain abdominal exercises