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.
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:
- 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:
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 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.
Fixed hiatal hernia
This type of hernia isn’t as common. It’s 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 become blocked. If that happens, it could cause serious damage and is considered a medical emergency.
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:
- heartburn that gets worse when you lean over or lie down
- chest pain or epigastric pain
- trouble swallowing
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 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 symptoms.
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.
Tests and diagnosis
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.
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, surgery.
Medications your doctor may prescribe include:
- 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, 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:
- rebuilding weak esophageal muscles
- putting 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 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
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:
- spicy foods
- foods made with tomatoes
- citrus fruits
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
You may not avoid a hiatal hernia entirely, but you can 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