Hiatal Hernia

What is a hiatal hernia?

A hiatal hernia is an upward bulge of the stomach through the diaphragm muscle, the horizontal muscle that separates the chest from the stomach. Normally, the esophagus (the swallowing tube) passes through a hole (the hiatus) in the diaphragm to reach the stomach. In a hiatal hernia, the stomach bulges up into the chest through that opening. A hiatal hernia is an extremely common condition that usually does not cause symptoms or problems.

What causes a hiatal hernia?

Most of the time, the cause is not known. Some studies suggest that increased pressure in the stomach from coughing, straining during bowel movements, pregnancy and delivery, or substantial weight gain may contribute to the development of a hiatal hernia. Others are born with a weakness or an especially large hiatus.

What are the symptoms of a hiatal hernia?

• Most people with a hiatal hernia have no symptoms at all.
• Some people with a hiatal hernia also have heartburn or GERD (Gastroesophageal Reflux disease). GERD is the upward spurting of stomach acid into the esophagus. Although there appears to be a link, one condition does not seem to cause the other, because many people have a hiatal hernia without having GERD, and others have GERD without having a hiatal hernia.
• When symptoms do occur, they may be heartburn, regurgitation of food, belching, nausea, sensation of something stuck in your throat or chest, chest pain after eating.

How are hiatal hernias treated?

Most people do not have any symptoms with their hiatal hernia, so no treatment is necessary. If there is constant heartburn, difficulty in swallowing or other symptoms general guidelines to reduce the secretion of acid and reflux are:

• Avoid foods that increase acid like greasy, spicy and fatty foods, citrus, and peppermint
• Avoid alcoholic drinks and caffeine products.
• Avoid large meals, eat slowly, eat 4 to 5 small meals a day.
• Do not smoke.
• Do not eat anything for at least 2 hours before bedtime.
• Do not bend over or lie down immediately after eating.
• Avoid tight fitting pants, belts, and undergarments.
• Lose weight if overweight.
• Do not strain during bowel movements, urination, or lifting.
• Raise the head of your bed 4-6 inches with wooden blocks or bricks. Gravity then helps keep stomach acid out of the esophagus while sleeping.
• If lifestyle and diet changes do not control the symptoms then antacids and prescription medications may be necessary. Call your doctor for worsening symptoms.
• Infrequently surgery is required to treat a hiatal hernia.