Hiatal Hernia: Symptoms, Causes, Diagnosis, and Treatment

Sep 16, 2019

As we age, there are some conditions that we are more predisposed to than others. Those over the age of 50 commonly have a condition known as hiatal hernia. A hernia occurs when any type of organ moves or slides beyond where it should be, usually pushing through a weak spot in a wall or cavity that would usually hold the organ in place. Read on to learn more about hiatal hernias, the causes, symptoms, and treatment, and how you can possibly prevent hiatal hernia as you age.

What Is a Hiatal Hernia?

Between everyone’s stomach and chest is their diaphragm, and there is a small part of the diaphragm known as the hiatus. The hiatus is a small opening in the diaphragm. A hiatal hernia occurs when the top part of the stomach pushes through into the hiatus. Usually, the esophagus would pass through the hiatus into the stomach; however, with a hiatal hernia, the top part of the stomach protrudes out when it should not. There are actually two separate types of hiatal hernias, which are slightly different from each other.

A sliding hiatal hernia is the most common type of hiatal hernia and is clearly described above. The sliding type of hiatal hernia occurs when the top part of the stomach pushes through the hiatus.

Paraesophageal hernia is not as common as a sliding hiatal hernia but can be more serious in some cases, warranting more scrutinized medical attention. Instead of the top part of the stomach pushing into the hiatus, a paraesophageal hernia occurs when the top part of the stomach pushes into the chest instead of the hiatus, next to the esophagus. This type of hernia also may have more noticeable or painful symptoms, such as chest pain.

What Causes Hiatal Hernia?

Like many other medical complications, especially those related to age, scientists, researchers, and doctors don’t have a strong grip on the exact cause of hiatal hernia. However, straining of any type is definitely thought to be linked to the development of a hernia. This includes straining you may not even think about while doing it, such as pushing too hard to have a successful bowel movement. Other types of “strain” can include:

vomiting
coughing
pregnancy
overexertion

Obesity is also strongly correlated with the development of both types of hiatal hernia. Those with a higher body mass index (BMI) seem to be more predisposed to hernia, especially after the age of 50.

Congenital anomalies of the diaphragm and sudden trauma to the esophagus or diaphragm (such as a motor vehicle accident) can also cause hiatal hernia; however, these are more rare. Pregnancy is thought to be a root cause of many hiatal hernias, as the growing fetus weakens organ walls.

What Are the Symptoms of a Hiatal Hernia?

Often, patients don’t realize they have any type of hiatal hernia because there are no symptoms that accompany the condition. This can be especially true if a hiatal hernia occurs during pregnancy as a patient may not feel symptoms from the hernia until she is much older. Quite regularly, doctors notice the presence of hiatal hernia while performing other tests for other conditions, such as an X-ray. Symptoms between sliding hernias and paraesophageal hernias are slightly different. The more common sliding hiatal hernia may cause symptoms such as:

feeling nauseous
heartburn
trouble swallowing
reflux
regurgitation
vomiting

A hiatal hernia may feel like a bad case of heartburn or acid reflux. However, if symptoms persist longer than what seems normal, it’s best to confer with a doctor.

As paraesophageal hernias are more serious, they have more serious symptoms and complications. Some symptoms of paraesophageal hernia include:

chest pain
abdominal bleeding
feeling full
anemia
blood loss
trouble eating (swallowing) and digesting food

Anyone experiencing chest pain or similar symptoms should see their doctor or seek emergency treatment as soon as possible.

When it comes to the prevention of hiatal hernia, some doctors and researchers disagree. Some clearly state there are no preventative tactics for a hernia because causes aren’t clear; however, other doctors believe you can help prevent a hernia by taking a few simple health-related steps.

Avoiding obesity is recommended in the prevention of hernia. This is accomplished by eating a healthy diet, exercising regularly, and keeping the BMI within the normal range.

Avoiding or reducing heartburn is also another step. Those who suffer from persistent acid reflux or gastroesophageal reflux disease (GERD) suffer more regularly from heartburn than those without the condition; however, both acid reflux and GERD are managed with medication or by avoidance of certain foods. Generally speaking, to avoid heartburn, you should limit the intake of tomatoes or acidic foods, spicy foods, alcohol, chocolate, and caffeine. Patients are also advised not to lie down immediately after eating, as this can cause indigestion, heartburn, and acid reflux.

Hiatal Hernia Exams and Tests

As previously mentioned, often doctors “catch” hiatal hernias when they’re looking for other conditions or problems. However, doctors can certainly check for hiatal hernia by using a few different types of means. One of the simplest ways is to have a chest X-ray, as doctors can see the hiatal hernia easily through the film. Patients may also be tested using an upper endoscopy, which looks at the lining of the stomach and esophagus, an upper GI or barium swallow series, which looks at the organs of the digestive system, and esophageal manometry, which checks the strength of the esophageal muscles. Many less serious hiatal hernias don’t require treatment, so if a hernia is suspected, the easiest way to check for it is by having an X-ray. Other tests may be used if other problems are suspected along with hernia, such as severe GERD caused by hiatal hernia or other troubles with the GI tract.

When to Seek Medical Care for a Hiatal Hernia

You should seek medical care for a hiatal hernia whenever symptoms are noticeable or painful. Symptoms of hernia can also mimic other GI disturbances, so if you’re experiencing frequent heartburn, pain, or are having trouble swallowing or eating, it’s best to consult a medical professional to be tested for hiatal hernia or other issues.

Less severe hernias, such as the more common sliding type, don’t really require any treatment. Your doctor may tell you much of the advice listed above, such as avoiding spicy food and not lying down after eating. However, there are other viable treatments for hernia, especially if the doctor thinks it is more serious. Doctors may advise over-the-counter treatments, such as antacids, for heartburn, or may prescribe something stronger, such as a proton pump inhibitor, to reduce stomach acid.

Very severe hiatal hernias can require surgery. In this instance, a patient will undergo general anesthesia and have laparoscopic surgery performed to pull the stomach back into place. Surgery is certainly the last option and is only discussed when medications and lifestyle changes have done nothing to reduce symptoms, heartburn, or pain. It is estimated that 90 percent of patients do see an improvement after having the surgery, which is known as laparoscopic Nissen fundoplication (LNF).

If you need more information about hiatal hernia, are experiencing symptoms, or need to see a physician, please book an appointment with Carolina Digestive Health Associates today. We offer specialized, individual care as well as eight separate locations for your convenience.