Understanding hiatal hernias1
A hiatal hernia occurs when the upper part of your stomach bulges through the muscles separating your abdomen and chest (diaphragm).1 There are four different kinds of hiatal hernias, with the most common being a type I sliding hernia in which the esophagus meets the stomach. Although most common in people 50 years of age and older, hiatal hernias occur across all ages and genders.
What are the common symptoms of a hiatal hernia?
The most common symptoms of hiatal hernias include acid reflux, heartburn, bloating, and indigestion.1 However, some hiatal hernias may not be painful or noticeable at all. Smaller hiatal hernias are often associated with little-to-no symptoms, whereas larger hiatal hernias have more frequent GERD-like symptoms, like heartburn, when food is digested.2
Some additional symptoms you may experience if you have a hiatal hernia include:1
- Non-cardiac chest or abdominal pain
- Shortness of breath
- A feeling of being full shortly after eating
- Gastroesophageal Reflux Disease (GERD)-like symptoms:
- Heartburn
- Regurgitation of food or liquids into the mouth
- Bitter or sour taste in the back of the throat
- Bloating or belching
Symptoms and complications that require immediate healthcare attention include:3
- Nausea or vomiting alongside a fever over 100.4 degrees
- A rapid heart rate (100 beats per minute or more)
- Severe chest pains
- Bloody or black stools
- Increased pain, swelling, redness, tenderness
How can I manage the symptoms of a hiatal hernia?
For some people with a hiatal hernia, nutritional choices can help make a difference in reducing common symptoms like heartburn or acid reflux. Eating foods that are non-acidic and minimally processed may help reduce symptoms associated with hiatal hernias.3
Learn more about Eating Smarter for Hiatal Hernia →
What are the causes of hiatal hernias?4
The exact cause of a hiatal hernia is not always easy to identify. Hiatal hernias may occur for a number of reasons—the most common being an increase in pressure in the abdominal cavity (such as obesity or pregnancy).1 Additional potential causes include:
- Age
- Being born with an unusually large hiatus (large opening) in the diaphragm
- Injury/trauma to the area
- Obesity
- Chronic coughing
- Lifting heavy objects/physical strain
- Straining during bowel movement
- Repetitive vomiting
How is hiatal hernia diagnosed?1
To identify whether you have a hiatal hernia, your healthcare provider may start with an esophageal pH test to confirm there is acid in your esophagus and may also order imaging tests to confirm the cause.
Imaging tests that can be used to diagnose a hiatal hernia include a(n):
- Chest X-ray: An X-ray or radiograph to take still images of the inside of your chest cavity where your esophagus is.
- Esophagram: A specialized X-ray of your esophagus that takes real-time video of your esophagus as you swallow.
- Esophageal manometry: Using a catheter inside your esophagus, this test will take pressure measurements of your muscles.
- Upper endoscopy: A long, thin tube with a small camera called and an endoscope will go inside your esophagus and stomach. The live images will be projected on a screen.
How is a hiatal hernia repaired?1
Specific treatment for a hiatal hernia will be determined by your doctor and depends on many factors, including the severity of your symptoms, general health, and location of the hernia. Surgery may be required for people with a hiatal hernia who have severe, long-lasting esophageal reflux and whose symptoms are not relieved by medical treatments or lifestyle changes.
How is repair surgery performed for a hiatal hernia?
There are two primary surgical options for hiatal hernia repair: open and minimally-invasive laparoscopic surgery. The appropriate type of surgery for you may depend on the size, severity, and location of your hernia. Ask your doctor about which option is right for you.
- Open Surgery: As the traditional surgical method, an open surgical procedure involves making a large incision over the area of the hernia. The hernia bulge is returned to its correct position, and a mesh is often placed to help strengthen and support the weakened area before closing up the incision.
- Laparoscopic Surgery: A surgeon will use several small, ‘key-hole’ sized incisions during laparoscopic surgery. Instruments, such as a camera, are then inserted through the incisions to perform the operation.
Emergency surgery may be needed if the hernia is causing blood supply to be cut off or if you have severe GERD-like symptoms that do not respond to medical treatments. Learn more about surgical techniques.
How can I prevent a hiatal hernia?5
Although there is no way to prevent a hiatal hernia, here are some things that may lower the chances of getting one:
- Maintaining a healthy weight
- Avoiding an excess of acid foods (citrus, juice, tomatoes, etc.)
- Limiting fatty, fried, and caffeinated items (carbonated drinks, alcohol, condiments, etc.)
- Quitting smoking
- Reducing the amount of pressure you put on the abdomen by not:
- Lifting heavy objects
- Wearing restrictive clothing that is too tight in the abdomen
Additionally, if you frequently need to strain when you move your bowels, speak to your doctor. Your doctor may prescribe stool-softening medication or suggest that you modify your diet to include more high-fiber foods, reducing the strain on your abdomen.5
Seeking care for your hiatal hernia
If you have symptoms of a hiatal hernia, it’s important to meet with a healthcare provider as soon as possible to have it diagnosed and to rule out other possible causes. Be sure to talk to your doctor and ask questions about hernia diagnosis and treatment options. You can use our Doctor Discussion Guide to help start the conversation.
The guidance provided in this article follows general rules that should be discussed with your doctor. This article is for informational and educational purposes only. It does not substitute for medical advice. If in doubt, always consult your doctor.
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References
- https://my.clevelandclinic.org/health/diseases/8098-hiatal-hernia
- https://www.mayoclinic.org/diseases-conditions/hiatal-hernia/symptoms-causes/syc-20373379
- https://www.verywellhealth.com/symptoms-of-a-hiatal-hernia-1742611
- https://www.hopkinsmedicine.org/health/conditions-and-diseases/hernias/hiatal-hernia
- https://www.health.harvard.edu/diseases-and-conditions/hiatal-hernia-a-to-z
This site is not intended as a substitute for professional medical care. Only your physician can diagnose and appropriately treat your symptoms. BD does not recommend the use of any particular physician or team of physicians. Please consult your healthcare provider for advice regarding who should be part of your hernia repair team.
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