A hiatal hernia occurs when the upper part of your stomach pushes up through your diaphragm and into your chest.
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. However, 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 theyre 60, according to the Esophageal Cancer Awareness Association (ECAA).
The exact cause of many hiatal hernias isnt known. In some people, muscle tissue may be weakened by injury or other damage. This makes it possible for your stomach to push through your diaphragm.
Another cause is putting too much pressure on the muscles around your stomach. This may happen when:
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:
There are generally two types of hiatal hernia: sliding hiatal hernias and fixed or paraesophageal hernias.
This is the more common type of 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 dont cause any symptoms. They may not require treatment.
This type of hernia isnt as common. It is 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 be blocked. If that happens, it could cause serious damage and is considered a medical emergency.
Its rare for even fixed hiatal hernias to cause symptoms. If you do experience any symptoms, they are usually caused by stomach acid, bile, or air entering your esophagus. Common symptoms include:
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:
Dont assume that chest pain or discomfort is due to a hiatal hernia. It could also be a sign of heart problems or peptic ulcers. Its important to see your doctor. Only testing can find out what is causing your symptoms.
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. Its common for people with a hiatal hernia to have GERD. However, that doesnt mean either condition always causes the other. You can have a hiatal hernia without GERD or GERD without a hernia.
Several tests can be done to 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 is 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 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 dont require treatment. Treatment is usually determined by the presence of symptoms. If you have acid reflux and heartburn, you may be treated with:
If medications dont work, you might need surgery on your hiatal hernia. However, surgery is not commonly recommended.
Some types of surgery for this condition include:
Surgery can be performed through a standard incision in the chest or abdomen. However, laparoscopic surgery can also be used to shorten recovery time.
Hernias can come back after surgery. You can reduce this risk by:
Most hiatal hernia symptoms are caused by acid reflux. Therefore, 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:
Other ways to reduce your symptoms include:
You may not avoid a hiatal hernia entirely. However, you may avoid making a hernia worse by: