Hernia, hiatal

Also known as: Sliding hiatal hernia, Paraesophageal hiatial hernia, Mixed hiatial hernia, Hiatial hernia

A hernia is a bulge of intestine, another organ, or fat through the muscles of the belly. A hernia can occur when there is weakness in the muscle wall that allows part of an internal organ to push through. Hernias typically do not heal on their own. Surgery is the only way to treat a hernia and is usually performed by a general surgeon.

There are a number of different types of hernias:

  • Inguinal hernia
  • Femoral hernia
  • Umbilical hernia
  • Incisional hernia
  • Epigastric hernia
  • Hiatal hernia

This article is about hiatal hernia (say "hi-AY-tul HER-nee-uh").

What is a hiatal hernia?
A hiatal hernia sometimes happens along with gastroesophageal reflux disease (GERD). Symptoms of a hiatal hernia are usually caused by GERD. For more information about the symptoms of GERD and how to treat it, see the topic Gastroesophageal Reflux Disease (GERD).

A hiatal hernia happens when part of your stomach bulges up through the diaphragm and into your chest. The diaphragm is a sheet of muscle that separates your belly (abdomen) from your chest.

The hernia bulges through the diaphragm at a place called the hiatus. This is the opening in the diaphragm that the esophagus passes through. The esophagus is the tube that connects the throat to the stomach.

There are three main types of hiatal hernia:

  • Sliding: Most people who have a hiatal hernia have a sliding hiatal hernia. In a sliding hiatal hernia, a small part of the stomach pushes through the diaphragm and into the chest during moments of increased pressure in the abdomen. The stomach will fall back down to its normal position when the pressure is relieved.
  • Paraesophageal:  A paraesophageal hernia (also known as a fixed hiatal hernia) is not common, but it may occur when the opening in the diaphragm next to the esophagus is abnormally large. The stomach and other abdominal organs (such as the intestine, spleen, or colon) may also bulge into the chest cavity with a paraesophageal hernia.
  • Mixed.

What causes a hiatal hernia?
A hiatal hernia often is caused by weak muscles and tissue within and around the hiatus. Risk factors in adults may include:

  • Obesity
  • Poor seated posture (such as slouching)
  • Frequent coughing
  • Straining with constipation
  • Frequent bending over or heavy lifting
  • Heredity
  • Smoking

Children with hiatal hernias are usually born with the condition.

What are the symptoms?
For most people, a hiatal hernia by itself causes no symptoms. Symptoms of pain and discomfort may be present if the patient also suffers from a condition called gastroesophageal reflux disease (GERD).A hiatal hernia can lead to GERD, and people often have both conditions at the same time.

If you have pain behind your breastbone, it is important to see your doctor to make sure it is not caused by a problem with your heart. GERD usually causes a burning sensation after you eat. Pain from the heart usually feels like pressure, heaviness, weight, tightness, squeezing, discomfort, or a dull ache. It occurs most often after you are active.

In rare cases, a fixed, or paraesophageal, hiatal hernia may result in strangulation of the stomach. This is where a portion of the stomach becomes trapped and the blood supply is cut off. Symptoms include severe stomach pain, sudden severe chest pain, radiating chest pain that isn't relieved by taking an antacid, difficulty in swallowing, nausea and vomiting. A strangulated hiatal hernia is a medical emergency requiring immediate surgery.

How is a hiatal hernia diagnosed?
A hiatal hernia is often diagnosed when you see your doctor or have tests for another health problem.

If you have symptoms, your doctor will ask you questions about them. If your symptoms happen often and are severe, you may have gastroesophageal reflux disease (GERD). If this is the case, your doctor may do more tests or give you medicine for GERD.

How is it treated?
If you have no symptoms, you don't need treatment. An exception is paraesophageal hernias, which tend to get worse over time. Surgery is usually necessary to treat the problem.

Surgery to correct a hernia is usually performed by a general surgeon. Some hernia’s can be repaired utilizing minimally invasive and robotic-assisted techniques, although not all patients are candidates for this type of surgery.

If you have mild symptoms, your doctor may suggest lifestyle changes and perhaps nonprescription medicines. Some things you can try include:

  • Change your eating habits. It’s best to eat several small meals instead of two or three large meals.
  • After you eat, wait 2 to 3 hours before you lie down.
  • Avoid late-night snacks.
  • Do not eat chocolate or mint or drink alcohol, all of which can make GERD worse by relaxing the valve between the esophagus and the stomach.
  • Spicy foods, foods that have a lot of acid (like tomatoes and oranges), and coffee can make GERD symptoms worse in some people. If your symptoms are worse after you eat a certain food, you may want to stop eating that food for a while to see if your symptoms get better.
  • Do not smoke or chew tobacco.
  • If you get heartburn at night, raise the head of your bed 6 in. (15 cm) to 8 in. (20 cm) by putting the frame on blocks or placing a foam wedge under the head of your mattress. (Adding extra pillows does not work.)
  • Do not wear tight clothing around your middle.
  • Lose weight if you need to. Losing just 5 to 10 pounds can help.

If you often have symptoms or have severe symptoms, you may have GERD. Lifestyle changes may help, and your doctor may prescribe medicine. In severe cases, surgery can be used to pull the hernia back into the belly.

For more information:
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