Hiatal Hernia: Symptoms, Surgery, Treatment, and More (2023)

A hiatal hernia occurs when the upper part of your stomach pushes up through your diaphragm and into your chest region. Hiatal hernias don’t always cause symptoms. Hiatal hernia symptoms may include heartburn, acid reflux, and chest pain.

A hiatal hernia occurs when the upper part of your stomach pushes up through your diaphragm and into your chest region.

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, but 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.

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There are generally two types of hiatal hernia: sliding hiatal hernias and fixed, or paraesophageal, hernias.

Sliding hiatal hernia

This is the more common type of hiatal 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 don’t cause any symptoms, and may not require treatment.

Fixed hiatal hernia

This type of hernia is not as common. It’s 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. But there’s a risk that blood flow to your stomach could become blocked. If that happens, it could cause serious damage and is considered a medical emergency.

It’s rare for even fixed hiatal hernias to cause symptoms. If you do experience any symptoms, they’re usually caused by stomach acid, bile, or air entering your esophagus. Common symptoms include:

  • heartburn that gets worse when you lean over or lie down
  • acid reflux or GERD
  • chest pain or epigastric pain
  • trouble swallowing
  • belching
(Video) Hiatal Hernia Repair FAQ

Surgical treatment is sometimes required to repair larger hiatal hernias and treat heartburn symptoms. Surgery for Hiatal hernias is used if reflux symptoms can not be successfully controlled with medication or if you have a type of hernia called a giant esophageal hernia, also known as intrathoracic stomach.

Types of surgery

While hiatal hernias can often be treated with lifestyle changes or medication, some people may need surgery to repair their hiatal hernias.

Surgery to repair a hiatal hernia may involve tightening your diaphragm and pulling the stomach down from the chest cavity back into the abdomen.

A surgeon will recommend surgery based on what stage your hiatal hernia is.

Common surgical options include:

  • Hiatus repair surgery. This surgery uses sutures and prosthetic mesh to tighten and decrease the size of the enlarged hiatus, which is the opening in the diaphragm that the esophagus travels through on its way to the stomach. It prevents your stomach from bulging upward through the hiatus and is used for early-stage Hiatal hernias.
  • Nissen Fundoplication. This procedure involves using stitches to wrap the upper part of the stomach, called the fundus, around the bottom portion of the esophagus in order to hold the stomach in place below the diaphragmatic hiatus. The stitches create pressure at the end of your esophagus which prevents stomach acid and food from flowing up from the stomach.
  • Collis-Nissen gastroplasty. This surgery is used to lengthen the esophagus in patients with more complex forms of Hiatal hernia due to esophageal shortening. In this procedure, a surgeon will use tissue from the upper part of your stomach to extend your esophagus.

What to expect

Surgery to repair a hiatal hernia typically takes between 2 and 3 hours and is done while you’re under general anesthesia, so you’ll fall asleep and not feel pain during the procedure.

Surgery to repair a hiatal hernia can be done using different techniques:

  • Open repair. In an open repair surgery, your surgeon will make a large surgical cut in your belly in order to perform surgery.
  • Laparoscopic repair. In laparoscopic surgery, your surgeon will make several small cuts in your belly and insert a thin tube with a small camera through one of the cuts. Surgical tools will be inserted through the other cuts. Your surgeon will use a monitor hooked up to the camera in order to view the inside of your stomach and perform the surgery.

Recovery

You can expect to stay in the hospital for 1 to 2 days after your surgery. Some surgeries may require you to follow a soft or liquid diet and avoid carbonated beverages for a couple of weeks after surgery.

You may find that your appetite has decreased following surgery, and some patients may experience diarrhea during the first few days after their hernia repair.

(Video) Hiatus hernia: signs, symptoms and treatment

There are generally no significant restrictions after hiatal hernia repair surgery, which means it’s ok to walk, climb stairs, have sexual intercourse, or exercise as long as it doesn’t hurt.

Your surgeon or doctor will provide more specific guidelines and instructions for your recovery, depending on what type of surgery you have.

Most cases of hiatal hernia don’t require treatment. The presence of symptoms usually determines treatment. If you have acid reflux and heartburn, you may be treated with medications or, if those don’t work, surgery.

Medications

Medications your doctor may prescribe include:

  • over-the-counter (OTC) antacids to neutralize stomach acid
  • OTC or prescription H2-receptor blockers that lower acid production
  • OTC or prescription proton pump inhibitors to prevent acid production, giving your esophagus time to heal

Diet

Hiatal hernia causes acid reflux symptoms. 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:

  • spicy foods
  • chocolate
  • foods made with tomatoes
  • caffeine
  • onions
  • citrus fruits
  • alcohol

Other ways to reduce your symptoms include:

  • stopping smoking
  • raising the head of your bed by at least 6 inches
  • avoiding bending over or lying down after eating

The exact cause of many hiatal hernias is not known. In some people, injury or other damage may weaken muscle tissue. This makes it possible for your stomach to push through your diaphragm.

Another cause is putting too much pressure (repeatedly) on the muscles around your stomach. This can happen when:

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  • coughing
  • vomiting
  • straining during bowel movements
  • lifting heavy objects

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:

  • obesity
  • aging
  • smoking

You may not avoid a hiatal hernia entirely, but you can avoid making a hernia worse by:

  • losing excess weight
  • not straining during bowel movements
  • getting help when lifting heavy objects
  • avoiding tight belts and certain abdominal exercises

Several tests can diagnose a hiatal hernia.

Barium swallow

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’s protruding through your diaphragm, you have a hiatal hernia.

Endoscopy

Your doctor may perform an endoscopy. They’ll slide a thin tube in your throat and pass it down to your esophagus and stomach. Your doctor will then be able to see if your stomach is pushing through your diaphragm. Any strangulation or obstruction will also be visible.

Doctors don’t know exactly what causes hiatal hernias or how to prevent them from happening.

But certain factors like living with obesity and smoking may increase your risk of a hiatial hernia, so maintaining a moderate weight and quitting smoking may help decrease your risk of developing one.

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:

  • you feel nauseated
  • you’ve been vomiting
  • you can’t pass gas or empty your bowels

Don’t assume that a hiatal hernia is causing your chest pain or discomfort. It could also be a sign of heart problems or peptic ulcers. It’s important to see your doctor. Only testing can find out what’s causing your symptoms.

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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. It’s common for people with a hiatal hernia to have GERD. However, that doesn’t mean either condition always causes the other. You can have a hiatal hernia without GERD or GERD without a hernia.

Many people with hiatal hernias have no symptoms and do not need medical care. But for people with more severe hernias, treatment with medication, lifestyle changes, and, in some cases, surgery may be needed to repair the hernia and provide relief from uncomfortable symptoms like heartburn and chest pain.

It’s possible for a hiatal hernia to recur after surgery. In a 2020 study, the recurrence rate for patients who underwent a minimally invasive fundoplication surgery was 18 percent.

Lifestyle changes like losing weight and maintaining a healthy weight, quitting smoking, eating smaller portions of food, limiting certain fatty and acidic foods, and eating meals a least 3 to 4 hours before lying down can help you manage the symptoms of hiatal hernia.

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