Hiatal Hernia

Written by Amanda Delgado | Published on August 15, 2012
Medically Reviewed by George Krucik, MD

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.

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. However, 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, according to the Esophageal Cancer Awareness Association (ECAA).

What Causes a Hiatal Hernia?

The exact cause of many hiatal hernias isn’t known. In some people, muscle tissue may be weakened by injury or other damage. This makes it possible for your stomach to push through your diaphragm.

Another cause is putting too much pressure on the muscles around your stomach. This may happen when:

  • coughing
  • vomiting
  • straining during bowel movements
  • lifting heavy objects

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 include:

  • obesity
  • aging
  • smoking

Types of Hiatal Hernia

There are generally two types of hiatal hernia: sliding hiatal hernias and fixed or paraesophageal hernias.

Sliding Hiatal Hernia

This is the more common type of 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.

Fixed Hiatal Hernia

This type of hernia isn’t as common. It is also known as a paraesophageal hernia.

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 be 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 are usually caused by stomach acid, bile, or air entering your esophagus. Common symptoms include:

  • heartburn that gets worse when you lean over or lie down
  • chest pain
  • trouble swallowing
  • belching

Medical Emergencies

An obstruction or a strangulated hernia may block blood flow to your stomach. This is considered a medical emergency. Call your doctor right away if:

  • you feel nauseated
  • you’ve been vomiting
  • you can’t pass gas or empty your bowels

Don’t assume that chest pain or discomfort is due to a hiatal hernia. 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 symptoms.

What is the Connection Between GERD and Hiatal Hernias?

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 be done to diagnose a hiatal hernia.

Barium X-Ray

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 is protruding through your diaphragm, you have a hiatal hernia.

Endoscopy

Your doctor may slide a thin tube in your throat and pass it down to your esophagus and stomach. Your doctor will 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. Treatment is usually determined by the presence of symptoms. If you have acid reflux and heartburn, you may be treated with:

Medications

  • over-the-counter antacids to neutralize stomach acid
  • over-the-counter or prescription H2-receptor blockers that lower acid production
  • over-the-counter or prescription proton pump inhibitors to prevent acid production, which give your esophagus time to heal

Surgery

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:

  • rebuilding weak esophageal muscles
  • putting your stomach back in place and making your hiatus smaller

Surgery can be performed through a standard incision in the chest or abdomen. However, laparoscopic surgery can also be used to shorten recovery time.

Hernias can come back after surgery. You can reduce this risk by:

  • staying at a healthy weight
  • getting help lifting heavy objects
  • avoiding strain on your abdominal muscles

Lifestyle Changes To Address Your Symptoms

Most hiatal hernia symptoms are caused by acid reflux. Therefore, 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:

  • spicy foods
  • chocolate
  • foods made with tomatoes
  • caffeine
  • onions
  • citrus fruits
  • alcohol

Other ways to reduce your symptoms include:

  • stopping smoking
  • raising the head of your bed by at least 6 inches
  • avoiding bending over or lying down after eating

Reducing Your Risk of Hiatal Hernias

You may not avoid a hiatal hernia entirely. However, you may avoid making a hernia worse by:

  • losing excess weight
  • not straining during bowel movements
  • getting help when lifting heavy objects
  • avoiding tight belts and certain abdominal exercises
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