Understanding Hiatal Hernia
A hiatal hernia occurs when part of the stomach pushes up through an opening in the diaphragm called the hiatus. The diaphragm is the sheet of muscle that separates the chest cavity from the abdomen. The esophagus passes through an opening in the diaphragm known as the esophageal hiatus to connect the mouth to the stomach.
What Is a Hiatal Hernia?
In a hiatal hernia, the upper part of the stomach moves up into the chest through that esophageal opening. There are two main types of hiatal hernia:
- Sliding hiatal hernia - where the stomach and esophagus slide back and forth through the hiatus into the chest cavity
- Paraesophageal hernia - where the stomach squeezes next to the esophagus into the chest
Symptoms of Hiatal Hernia
Many people with a small hiatal hernia may not have symptoms. Larger hiatal hernias can cause several signs and symptoms including:
- Heartburn or gastroesophageal reflux (GERD)
- Difficulty swallowing (dysphagia)
- Belching or bloating
- Chest or abdominal pain
- Shortness of breath or wheezing
- Vomiting of blood or passing black stools (a sign of bleeding)
What Causes a Hiatal Hernia?
Increased pressure within the abdomen is the main cause of hiatal hernias. Factors that can increase intra-abdominal pressure include:
- Obesity
- Pregnancy
- Straining during bowel movements or heavy lifting
- Coughing
- Vomiting
Weakness or loosening of the diaphragm muscle with age or injury can also allow part of the stomach to slide up through the hiatus into the chest.
Risk Factors for Hiatal Hernia
Certain factors that may increase your risk of developing a hiatal hernia include:
- Obesity
- Pregnancy
- Age older than 50 years
- Family history of hiatal hernia
- Previous surgery in the area
- Injury or trauma to the area
Complications of Hiatal Hernia
Serious complications from hiatal hernias are uncommon. But they can occur, including:
- Strangulation - portions of the stomach become trapped in the chest, cutting off blood flow
- Volvulus - portions of the stomach twist abnormally in the chest
- Bleeding - the herniated part of the stomach rubs against the diaphragm muscle causing bleeding
- Acute gastric obstruction - the hernia blocks food from leaving the stomach
Diagnosing Hiatal Hernia
Hiatal hernias often don't cause signs or symptoms severe enough for people to seek medical care. Many are discovered incidentally when medical care is sought for symptoms of GERD or during tests for other conditions.
To diagnose a hiatal hernia, your doctor may:
- Take a medical history and perform a physical exam
- Order tests such as a barium swallow, endoscopy, manometry, pH monitoring, or CT scan
Treating a Hiatal Hernia
Small hiatal hernias typically don't require treatment. Lifestyle changes and medication are recommended for relieving symptoms. But larger hernias or hernias with severe symptoms often require surgery.
Non-surgical treatment approaches may include:
- Diet changes like avoiding foods that make symptoms worse
- Eating smaller meals more frequently
- Avoiding lying down immediately after meals
- Medications like antacids, H2 blockers, proton pump inhibitors
In cases of severe, chronic symptoms from a large hiatal hernia, surgery may be needed. This could involve pulling the stomach back into the abdomen and reconstructing the tightened esophageal hiatus.
Preventing a Hiatal Hernia
You can lower your risk of developing a painful hiatal hernia by maintaining a healthy weight and avoiding factors that increase abdominal pressure like:
- Eating small meals slowly rather than overeating
- Not straining with bowel movements
- Avoiding heavy lifting
- Quitting smoking to reduce coughing
Seeing your doctor regularly is important to monitor symptoms of GERD or difficulty swallowing that could suggest you have a hiatal hernia.
Understanding Treatment Options
Getting an accurate hiatal hernia diagnosis is key to proper treatment. While small hernias may not require intervention, several lifestyle changes, medication options, and surgical procedures are available for managing larger hiatal hernias.
Working with your doctor can help determine the best course of treatment to relieve your symptoms and address the underlying hernia.
FAQs
What are the most common symptoms of a hiatal hernia?
The most common symptoms of a hiatal hernia are heartburn, acid reflux, bloating, burping, difficulty swallowing, and chest or abdominal pain. Many small hiatal hernias cause no signs or symptoms at all.
How do doctors diagnose a hiatal hernia?
Hiatal hernias are often diagnosed through medical history, physical exam, barium swallow x-ray, endoscopy, manometry test, pH monitoring, and CT scans. Many hiatal hernias are found incidentally when tests are done for other abdominal conditions.
What are the treatment options for hiatal hernia?
Small hiatal hernias typically only need lifestyle changes like avoiding foods that worsen symptoms. Larger hernias often require medication like H2 blockers or proton pump inhibitors. Surgery may be an option for severe, chronic symptoms from very large hiatal hernias.
What can I do to prevent getting a painful hiatal hernia?
You can reduce your risk of developing a symptomatic hiatal hernia by maintaining healthy weight, avoiding overeating, not straining during bowel movements, avoiding heavy lifting after eating, and not smoking.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.
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