What is Hiatal Hernia?
This is a medical condition in which a small portion of your stomach gets into your chest through an opening in your diaphragm, which is the flat thin dome shaped sheet of muscle that lies above your abdomen and below your chest, separating them. In your diaphragm there is a small opening referred to as a hiatus, which is where your esophagus passes through on its way to connect to your stomach. It is as that opening where your hiatal hernia can happen. It is also called a hiatus hernia. It can happen to any race, gender, or age but it is most common in people over the age of fifty.
There are two types of hiatal hernias which are:
- Paraesophageal hernia - this type of hiatal hernia is not very common but yet has more cause for concern. In this type your stomach and esophagus stay in the normal locations but a part of your stomach squeezes through your hiatus. The part that squeezes through lands next to your esophagus and the danger with this type are that your stomach can have its blood supply cut off, which is referred to as your stomach being “strangled.”
- Sliding hiatal hernia - in this type a section of your esophagus that joins your stomach and your stomach slide up into your chest. This is the most common type.
Most people who have a hiatal hernia will have no symptoms but there are others who may have heartburn. This symptom is related to GERD, which is gastroesophageal reflux disease. Some who experience the heartburn may also have chest pains. In addition, the size of the hiatal hernia will normally reflect on whether you have symptoms of not.
Small hiatal hernia - this type causes no symptoms
Large hiatal hernia - this type may cause symptoms such as:
- Having difficulty swallowing
- Feeling fatigued
A person gets a hiatal hernia when your weakened muscle tissue allows your stomach to push up through your diaphragm but the exact cause of having a hiatal hernia is not known but some physicians feel it could be caused by:
- Your esophagus has permanently got shortened and as a result it consequently pulls your stomach up through the hole in your diaphragm. Your esophagus could be shortened by scarring and inflammation from the regurgitation of your stomach acid. It could also be caused by an abnormally loose attachment of your esophagus to your diaphragm allowing your stomach and esophagus to slip upwards.
- If it happens in children they are usually born with it, making their hiatal hernia a congenital defect.
- In adults it is something that has usually developed over a period of time.
- Being obese
- Getting older
- Injury to the area where a hiatal hernia forms
- Intense and persistent pressure on the surround muscles which can happen when you strain during a bowel movement, violent chronic coughing, lifting heavy things, pregnancy, or even vomiting.
- Your esophageal hiatus is bigger than its normal size.
If your physician feels you have a hiatal hernia in order to confirm it your physician will do either
- A specialized x-ray after doing a barium swallow. This will allow your physician to see your esophagus. When you have this type of x-ray, you have to drink a chalky liquid that contains barium. This barium will coat the upper digestive tract so the physician will have a clear silhouette of the stomach, the upper part of your small intestine, and esophagus.
- Do an endoscopy, which is when the physician uses a thin scope with a camera and light at the tip to look inside your upper part of your digestive system. Your physician will guide this scope down your throat into your stomach and esophagus to look for inflammation.
Both of these tests are done as an outpatient procedure.
If you have a hiatal hernia and are not experiencing any symptoms you probably will not need any type of treatment but if you have recurrent acid reflux and heartburn these are usually treated with medications, and if it is severe you may need surgery.
- Antacids that will help to neutralize your stomach acid may help to provide some fast relief using over-the-counter medications like Maalox, Tums, or Rolaids.
- Medications that will help to reduce the production of acid, which are called H-2 receptor blockers. Some of these milder over-the-counter medications can include Tagamet HB, Axid AR, Zantac 75, or Pepcid AC. If you need a stronger form of these medications your physician will have to give you a prescription for them.
- Medications that help to heal your esophagus and block acid production which are called proton pump inhibitors. They not only block the production of acids but also help to allow time for your damaged esophageal tissue to heal. You can get milder over-the-counter medications such as Prilosec OTC, or Prevacid 24 HR. Again, if you need a stronger form of these medications you will need a prescription from your physician.
With a hiatal hernia in a small number of cases you may need surgery to correct the problem. Normally surgery is done on an emergency basis and also for those that none of the medications help to relieve the acid reflux and heartburn. Having hiatal hernia repair surgery is often combined with gastroesophageal reflux disease surgery.
When having hiatal hernia surgery the surgeon may:
- Pull your stomach down into the abdomen, making the opening in the diaphragm smaller.
- Reconstruct your weakened esophageal sphincter
- Removing your hernia sac.
When surgery is performed in some cases the surgeon will make a single incision in your abdomen, called a laparotomy or in your chest wall, called a thoracotomy. In other hiatal hernia surgeries the surgeon may insert special surgical tools and a tiny camera through several small incisions in the abdomen. When doing this type of hiatal hernia surgery your surgeon views the images from inside your body, which are displayed on a monitor as he performs the operation, which is called a laparoscopic surgery. When you have either of these surgeries it is done under general anesthesia.
Most people who have had hiatal hernia surgery can return to their normal activities within fourteen to twenty-eight days. During the first week the area will be tender and it is important during this first week that you protect the incision from any activity that will increase abdominal pressure. You can do this by applying gentle but firm pressure on your incision line.
You should protect your incision when you:
- Move from a lying position to a seated position or from sitting to standing
- Straining to have a bowel movement
Foods to Avoid
Some of the foods that you need to avoid after to help prevent your hiatal hernia from developing the symptoms of acid reflux disease and after having hiatal hernia surgery to help prevent it from reoccurring include:
- Raw onions
- Fried potatoes
- Orange, cranberry, and grapefruit juice
- Fat free sour cream
- Ice cream
- Macaroni and spaghetti
- Salad dressings that are creamed based or made with vinegar and oil
- Buffalo wings
- Chicken nuggets
- Ground beef
- Sirloin that is marbled
- White sugar
These should be implemented after hiatal surgery and before to help prevent acid reflux disease.
- Do not drink water with meals but drink it either thirty minutes before or after eating
- Eat six smaller meals instead of three big ones and the last meal you eat should be two hours before bedtime.
- After eating do not lie down but sit up for at least an hour.
- After meals try to avoid bending over but if you have to bend over bend to the right.
- Avoid smoking and drinking alcohol
- Keep your head and shoulders at an incline of at least six inches when sleeping
- Do not wear clothes that can constrict your stomach.
Robin Duncan on October 23, 2020:
Very informative I just had this surgery a week ago and this info is better than what they give you on discharge.
Kathleen Grant on March 14, 2019:
Very helpful before operation information
Only thing missing is: Breathing problems when walking after eating.
Should all go well after my operation, I will add recovery comments
Lisa from Central USA on July 01, 2014:
great article! My son actually has a parasophageal hiatal hernia and I found this information very helpful to me. Thank you so much!
Quotes Lover on January 09, 2014:
Andrew Channing from UK on January 09, 2014:
Very helpful and well written
Eiddwen from Wales on January 08, 2014:
Interesting and useful.
Thank you for sharing.