A hernia is when an internal body part, like intestines, pushes into places where it should not be. The hiatus is the opening in the diaphragm. The esophagus usually passes through the hiatus and adheres to the stomach.
When you have a hiatal hernia, the stomach pushes up into the chest in the hiatus opening. This can happen to a patient for multiple reasons and result in different interventions.
Types of Hiatal Hernia
- Sliding – This is when the stomach slides up into the chest through the hiatus. This is a very common condition that usually does not require surgery.
- Paraesophageal – This kind of hernia is less common, but much more dangerous. When the stomach squeezes through the hiatus, it ends up laying next to the esophagus. This can cause a twisting of the stomach and lead to a loss of blood supply. It can also result in the stomach getting stuck, which causes an obstruction. Either of these situations would require surgery to fix.
Problems Caused by a Hiatal Hernia
- Heartburn – This can happen often or just occasionally.
- Chest pain – This can happen when the patient eats. It can happen continuously or sporadically. A patient should make sure that they are not having a problem with their heart before chalking the pain up to a hernia.
- Shortness of breath – If the stomach pushes on the diaphragm or compresses the lungs, the patient may need surgery to alleviate this problem.
- Vomiting or regurgitation of food into the mouth – Food can be pushed back out of the stomach because of a hernia.
- Backflow of stomach acid – This can be caused by the stomach acid pushing out of the stomach and into the esophagus.
- Difficulty swallowing – This may create a situation where a hernia needs to be repaired.
Causes of Hiatal Hernia
- Injury – If you are in an accident, you may injure the area around the hiatus.
- Congenital – You may be born with a large hiatus, which would allow the stomach to bulge into the opening.
- Intense pressure on muscles around esophagus – This can be caused by excessive coughing, vomiting, exercising, lifting weights, or straining during a bowel movement. If you have persistent pressure on the muscles, it can cause the stomach to bulge through.
- Age – As you get older, muscles get weaker and various changes can happen in your body. You can experience changes in your diaphragm and it can cause a larger opening in your hiatus, which leaves room for the stomach to bulge through.
- Medications – Many patients can get relief from some of the symptoms of a hiatal hernia, especially if it is small. Sometimes, you can manage with a temporary medication but other times, you might have to take medications for a long period of time.
- Surgery – This is more common with a paraesophageal hernia. Sometimes the hernias can be large, and they require surgery to fix them. Large hernias enable most of the stomach to sit in the chest cavity above the diaphragm. Usually the surgery is done laparoscopically through a few small incisions in the abdomen.
It is possible to have GERD without having a hernia. One does not cause the other. GERD should be treated as its own disorder, many times with medication that reduces the acid production in the stomach.
A hernia can be confirmed by getting an upper endoscopy, or an EGD. This involves the patient being sedated and a doctor putting a scope down the throat. The scope will be able to view the esophagus, stomach, and the entry to the small intestine. By doing this test, the doctor can confirm a hernia or potentially find other issues, like an ulcer. This test will help dictate what kind of treatment you receive. Your options are medication or surgery and can be accompanied by lifestyle changes, such as avoiding certain foods.
If you are diagnosed with a hiatal hernia, you should make sure you take the steps to get your condition under control. This might mean medication, it might mean surgery, or it might mean that nothing needs to be done. Sometimes hernias have no symptoms and are found by accident. For instance, if you are going to have weight loss surgery, you may have to have an EGD performed. During this test, your doctor might find a hiatal hernia, but you may have no symptoms.
Understanding that a hiatal hernia means your stomach is pushing itself into places where it does not belong is important when you are discussing the situation with your doctor. Make sure to ask your doctor as many questions as you want. You may even want them to draw you a diagram or show you the imaging they got during your testing. Additionally, you should research your symptoms and diagnosis. Being educated helps you make a decision that you understand and discuss with your doctor.