- Hiatal Hernia
- What is a hiatal hernia?
- What causes a hiatal hernia?
- What are the symptoms of a hiatal hernia?
- How are hiatal hernias treated?
- Types of Hernias
- Common Hernia Causes
- Tips to Decrease the Risk of a Hernia
- Umbilical hernias are common and often don’t need surgery
- Abdominal Wall Hernias
- Types of Abdominal Wall Hernias
- Make an Appointment
- Is This A Hernia?
- Small Weight Gain Linked To Acid Reflux (GERD)
- What are the other Names for this Condition? (Also known as/Synonyms)
- What is Hiatal Hernia? (Definition/Background Information)
- Who gets Hiatal Hernia? (Age and Sex Distribution)
- What are the Risk Factors for Hiatal Hernia? (Predisposing Factors)
- What are the Causes of Hiatal Hernia? (Etiology)
- What are the Signs and Symptoms of Hiatal Hernia?
- How is Hiatal Hernia Diagnosed?
- What are the possible Complications of Hiatal Hernia?
- How is Hiatal Hernia Treated?
- How can Hiatal Hernia be Prevented?
- What is the Prognosis of Hiatal Hernia? (Outcomes/Resolutions)
- Additional and Relevant Useful Information for Hiatal Hernia:
What is a hiatal hernia?
A hiatal hernia is an upward bulge of the stomach through the diaphragm muscle, the horizontal muscle that separates the chest from the stomach. Normally, the esophagus (the swallowing tube) passes through a hole (the hiatus) in the diaphragm to reach the stomach. In a hiatal hernia, the stomach bulges up into the chest through that opening. A hiatal hernia is an extremely common condition that usually does not cause symptoms or problems.
What causes a hiatal hernia?
Most of the time, the cause is not known. Some studies suggest that increased pressure in the stomach from coughing, straining during bowel movements, pregnancy and delivery, or substantial weight gain may contribute to the development of a hiatal hernia. Others are born with a weakness or an especially large hiatus.
What are the symptoms of a hiatal hernia?
- Most people with a hiatal hernia have no symptoms at all.
- Some people with a hiatal hernia also have heartburn or GERD (Gastroesophageal Reflux disease). GERD is the upward spurting of stomach acid into the esophagus. Although there appears to be a link, one condition does not seem to cause the other, because many people have a hiatal hernia without having GERD, and others have GERD without having a hiatal hernia.
- When symptoms do occur, they may be heartburn, regurgitation of food, belching, nausea, sensation of something stuck in your throat or chest, chest pain after eating.
How are hiatal hernias treated?
Most people do not have any symptoms with their hiatal hernia, so no treatment is necessary. If there is constant heartburn, difficulty in swallowing or other symptoms general guidelines to reduce the secretion of acid and reflux are:
- Avoid foods that increase acid like greasy, spicy and fatty foods, citrus, and peppermint
- Avoid alcoholic drinks and caffeine products.
- Avoid large meals, eat slowly, eat 4 to 5 small meals a day.
- Do not smoke.
- Do not eat anything for at least 2 hours before bedtime.
- Do not bend over or lie down immediately after eating.
- Avoid tight fitting pants, belts, and undergarments.
- Lose weight if overweight.
- Do not strain during bowel movements, urination, or lifting.
- Raise the head of your bed 4-6 inches with wooden blocks or bricks. Gravity then helps keep stomach acid out of the esophagus while sleeping.
- If lifestyle and diet changes do not control the symptoms then antacids and prescription medications may be necessary. Call your doctor for worsening symptoms.
- Infrequently surgery is required to treat a hiatal hernia.
Feb 22, 2018 12:00 AM
Author: Office of Public Affairs
With plans for spring cleaning, remodeling, and other ambitious projects on the horizon, the possibility of heavy lifting being a part of those plans is certain. Along with the risk of back injury, many people may suffer from a hernia. Hernia? Isn’t that limited to athletes and old people? Hernias occur more often than you may think. Having a better understanding of this condition and the repercussions of a hernia will shed light on this sometimes painful and surprisingly prevalent condition.
Types of Hernias
The most common type of hernia is abdominal, and the variations depend on its location: according to the American Hernia Society, umbilical hernias appear around the navel; inguinal hernias occur near the creases where the abdomen and the upper thighs meet; and incisional hernias occur after surgery at the site of the incision.
In other words, everyone is at risk of getting a hernia.
Experts estimate that over one million surgeries are performed each year to repair an abdominal wall hernia, which is described as a tear or a hole in the body’s tissue which allows another body part to protrude, causing a bulge. “Patients may have pain or discomfort from this condition, or it may not become painful until the patient coughs, sneezes, or lifts something,” says Daniel J. Vargo, MD, with University of Utah Health’s General Surgery Services.
Although men are more likely to use a hernia as an excuse for spending all day on the couch, research shows that abdominal hernias occur equally, if not more often, in women.
Common Hernia Causes
- Obesity—Those extra pounds increase the strain and weaken your abdominal muscles, making them more prone to developing a hernia.
- Family History—Although family history may not guarantee a hernia, research shows it is a reliable predictor of one occurring.
- Pregnancy—The risk is small, but studies show that pregnancy is associated with an increase in the risk of hernia recurrence.
- Constipation—The constant strain may cause a portion of your intestine to get trapped in the abdominal wall. This can lead to some painful problems with the bowel. If bowel movements are a struggle, see a doctor.
- Chronic Cough—Often associated with the effects of smoking, constant coughing weakens the abdominal wall.
- Injury—Most sports-related hernias occur in the groin and don’t appear as a bulge. But if left untreated, it can evolve into an inguinal hernia.
Surgery is a common treatment, but Vargo says that he has seen many cases where surgery wasn’t required. “Not everyone with a hernia needs to have it fixed because it isn’t affecting daily activity,” says Vargo. “But if you have pain, surgery is recommended.”
Tips to Decrease the Risk of a Hernia
- Maintain a healthy weight. Rapid weight loss and weight gain place pressure on the abdominal wall.
- Don’t smoke.
- Change lifting stance. Lift with the legs, not the back.
- Change your diet to improve bowel movements.
It’s tempting to make light of the things that happen “down there.” But the truth is that hernias are serious and often painful conditions. If you are suffering from discomfort or abdominal pain, talk with your doctor about the possibility of a hernia. The treatment is easy, and the result is a satisfying, pain-free life.
Hernias are “a hole in something that allows things to poke through that typically should not,” Dr. Rosen says. Hiatal hernias are located in the diaphragm where the esophagus joins the stomach. They typically cause heartburn and reflux. If the hernia just makes you uncomfortable, doctors will treat it with medications, Dr. Rosen says.
But more serious hiatal hernias, also known as paraesophageal hernias, become larger over time and the stomach starts to rise farther into the chest. This sometimes causes significant chest pain after eating. It can even cause weight loss and bleeding, Dr. Rosen says. In those cases, surgery is usually needed, he says. It’s best to ask your doctor about treatment as soon as a hernia begins to cause discomfort.
Why that first ‘pitch’ is so important
So why is that first surgery so important?
An unsuccessful surgery is frustrating for the surgeon, but even more so for the patient because of the resulting poor quality of life. The symptoms bothering you in the first place return.
Risks associated with remedial surgery include recurrent heartburn, difficulty with swallowing, increased bowel symptoms and nerve damage. Working with an experienced surgeon is best for any hernia patient. But surgeries for recurrent hernias – especially in older patients – are even more complex and challenging.
If you reach the point where you need hernia surgery, it’s important to go to a comprehensive hernia center to get the best treatment. With expertise in both minimally invasive surgery and large comprehensive surgery, a dedicated hernia center helps ensure the operation is done right the first time, Dr. Rosen says.
Advances in minimally invasive surgery mean that, for many patients, hernia surgery is no longer a major operation that puts you in the hospital for a week to 10 days. Patients now typically go home within a couple of days, Dr. Rosen says.
No way to prevent hernias, but good general health can help
In most patients, the cause of a hernia is not known. An injury, straining or weakness in the area may contribute.
Two other types of hernias can impact the elderly but are no more likely to occur later in life than at a younger age.
Inguinal hernias, which occur in the groin, are more common in men. They are typically associated with heavy lifting, constipation, and prostate issues that cause urination difficulty or increases in abdominal pressure.”They can cause a lot of pain and discomfort,” Dr. Rosen says. “There is no way to prevent any hernia – not heavy lifting wouldn’t prevent them.”
But once you notice a bulge in your groin that causes discomfort, he suggests patients see a physician. “Once you have a hole there, it will never go away on its own,” Dr. Rosen says. “Most of these hernias can now be fixed using minimally invasive techniques, with decreased post-op pain, and help folks return to regular activity levels a lot quicker.”
Ventral hernias, which occur in the abdomen, also exhibit a bulge and pain. “Those will not go away, either,” he says. “There’s no way to prevent them.” Having said that, Dr. Rosen adds, ventral hernias are more common in people who are obese, or who have diabetes or chronic smoking habits. “Being in general good health reduces the chances of those kinds of complications,” he says.
Sometimes doctors perform these surgeries laparoscopically and sometimes they reconstruct the entire abdominal wall. The latter provides two advantages, Dr. Rosen says. “It improves your functional outcome because you get your core muscles back, plus it improves the cosmetics because you end up with a flatter abdomen.”
Umbilical hernias are common and often don’t need surgery
Dear Doctor: I am a 64-year-old male in good health, although I have a bit of a gut in the middle. My issue is that I have developed an umbilical hernia that looks like a large “outie.” It is not very attractive, but it is not causing any pain or discomfort. What course of action should I take?
Dear Reader: Umbilical hernias, or so-called “bellybutton hernias,” are quite common. They occur because of tissue weakness at the umbilical ring. The weakness allows the contents within the abdomen to bulge into the opening, thus making an “innie” appear like an “outie.” In children with umbilical hernias, the hernia develops because of incomplete closure of the belly button (umbilicus) at birth. In adults, umbilical hernias develop because of increased pressure within the abdomen that stretches and weakens the tissue (fascia) at the umbilicus. Increased pressure in the abdomen can be caused by obesity, pregnancy or fluid in the belly from diseases such cirrhosis or ovarian cancer.
Umbilical hernias are three times more common in women than in men. The material that typically bulges within a hernia is fat from the abdomen and the lining of the abdominal cavity. In the majority of people, the herniation doesn’t hurt. However, when the lining of the abdominal cavity (the omentum) becomes stuck within a hernia, the area can become painful. Even worse is when the small intestine becomes stuck. Called an incarcerated hernia, this compression leads to a loss of blood flow to the intestine, which can cause severe pain, altered bowel movements and possible death of the bowel tissue. The omentum and the intestine are more likely to become entrapped in men. Women more commonly have umbilical hernias that are reducible, meaning the material that pushes into the hernia can easily be moved back into the abdomen.
A small umbilical hernia without symptoms doesn’t require treatment. That changes if a hernia causes pain or is not reducible. For a small, symptomatic hernia, a surgeon cuts into the skin and locates the hernia sac. He or she then removes the sac or pushes it back into the abdomen; sutures the surrounding fascial layers together; and thus closes the area of weakness. With a larger hernia, a surgeon will have difficulty bringing together the surrounding fascial layers. This is when he or she will place a mesh over the defect and attach the mesh to the surrounding fascial layers. Unless the hernia is very large (more than 9 centimeters in size), a surgically repaired hernia is unlikely to recur or cause pain.
Abdominal Wall Hernias
A hernia occurs when an organ protrudes through the wall of muscle that encircles it. There are several different types of hernias that can occur in the abdominal and surrounding areas. These include umbilical hernias, epigastric hernias, incisional hernias, and others. For more information on these specific types of hernias, including symptoms and treatment methods, see below.
Types of Abdominal Wall Hernias
An epigastric hernia occurs when a weakened area in the abdominal wall allows a bit of fat to push through. Epigastric hernias are typically small. They occur in the middle of the belly, in the area between the belly button and the breastbone.
Some patients develop more than one epigastric hernia at a time. These hernias typically don’t cause symptoms, but you may experience pain in your upper belly.
Treatment of epigastric hernias typically involves surgery, but your doctor will discuss all your options with you in detail.
A hernia that occurs in the area of a previous surgery is known as an incisional hernia. These hernias may occur when the abdominal wall has been weakened by surgery, or when a surgical incision becomes infected, further weakening the area.
Incisional hernias are relatively common because surgical incisions weaken the abdominal area. That weakness makes it easier for a part of the intestine or other tissue to protrude.
Incisional hernias can develop soon after surgery, or they can develop slowly, over months or even years. They typically occur alongside vertical incisions. Incisional hernias tend to be large and rather painful.
Incisional hernias will not heal on their own. Talk to your doctor for more details about your treatment options.
Spigelian hernias occur throughout the spigelian fascia. Unlike other types of hernias, which develop immediately below layers of fat, spigelian hernias occur in the midst of abdominal muscles. This means that spigelian hernias may not be immediately visible as a bulge or lump. They can go undetected for longer periods of time.
Because spigelian hernias tend to be small, the risk of developing a strangulated hernia is higher.
Spigelian hernias tend to occur more rarely than other types of hernias.
An umbilical hernia occurs when a weak spot in the belly allows a bit of fat, fluid, or intestine to push through, creating a lump or bulge near the belly button.
Umbilical hernias frequently occur in infants. In most cases, these hernias will heal on their own. Occasionally, however, surgery may be required.
Umbilical hernias also occur in adults, particularly those with health issues that cause increased pressure in the belly. Those issues may include obesity, pregnancy, chronic coughing or constipation, and difficulty urinating.
Because they tend to grow bigger over time, umbilical hernias require treatment. Treatment typically involves surgery, but your doctor will discuss all your options with you in detail. Without treatment, you are at risk of developing a strangulated hernia, which means that blood supply to the tissue has been cut off. Strangulation is life threatening and requires emergency surgery.
Abdominal wall hernias are generally visible: they will look like a lump or bulge beneath the skin. These hernias don’t usually cause any other symptoms except for mild pain or discomfort, usually when you are straining (for instance, lifting something heavy).
If the hernia becomes strangulated, however, you may experience more serious symptoms, such as severe pain, nausea, vomiting, and/or redness in the area of the hernia. Contact your doctor immediately if you begin to experience these symptoms. A strangulated hernia is life-threatening.
Abdominal wall hernias can occur in people of any age, including infants. However, the risk of developing a hernia tends to increase as you age. Most abdominal wall hernias are caused by an area of weakness in the abdominal walls. A number of different factors can contribute to the development of that weakness. These factors include:
- Chronic coughing
- Collagen vascular disease
- Frequent heavy lifting
- Genetic defects
- History of previous hernias
- Infection (especially following surgery)
- Injuries to the abdominal area
- Straining during bowel movements or urination
- Surgical openings
In most cases, your doctor will be able to determine whether you are in fact suffering from a hernia simply by looking and by gently palpating the affected area.
If for some reason a diagnosis isn’t immediately apparent, your doctor may decide to order an imaging test, such as an abdominal ultrasound, CT scan, or MRI. These imaging tests can help to show the hole in the muscle wall, along with the tissue protruding from it.
Abdominal wall hernias that have no associated symptoms may not require any treatment at all. Your doctor will discuss your options with you which may include surgery or watchful waiting.
Larger hernias, however, or hernias that are causing pain, may require surgical repair to relieve pain as well as to prevent complications.
There are two types of surgical hernia repair: open and minimally invasive surgery. The type of surgery chosen will depend on the severity and type of hernia you’ve developed, the anticipated recovery time, your past medical and surgical history, and your surgeon’s expertise.
Open Surgery: During this procedure, your surgeon will make a small incision into your groin, and then push the protruding tissue back into your abdomen. Your surgeon will then sew up the weakened area. In some cases, your surgeon will use a mesh to reinforce that weakened area.
Open surgery can be performed either with general anesthesia or with sedation or local anesthesia.
After your surgery, it might be several weeks before you’re able to fully resume your normal activities. However, it’s still important that you begin moving about again as soon as possible for a healthier recovery.
Minimally Invasive Surgery: Minimally invasive surgery is typically performed under general anesthesia.
During this procedure, your surgeon will make a few small incisions in your abdomen. Your surgeon will then inflate your abdomen, using a special gas, in order to make your internal organs easier to see.
Your surgeon will then insert a small, narrow tube into one of the incisions in your abdomen. This tube has a tiny camera, or laparoscope, at the end of it. That camera serves as a kind of guide for your surgeon, who is then able to insert surgical instruments through the other incisions in your abdomen. Your surgeon will repair the hernia using and may use mesh.
Patients who are candidates for minimally invasive surgery may experience less scarring and discomfort following surgery than those who undergo open surgery. Patients may also be able to return more quickly to their normal activities.
Your doctors will speak with you in detail about all of your treatment options and will recommend a course of action best suited to your individual needs.
Make an Appointment
To discuss a potential hernia surgery, contact the Surgery Call Center at (734) 936-5738.
Is This A Hernia?
Hernias can occur in different areas of the body, though most commonly, hernias form in the stomach area. Men can develop hernias in their scrotums. Even babies can get hernias.
What Is a Hernia?
A hernia happens when an internal organ comes through its protective layer of tissue and muscle. The hernia will look like a lump or bulge under the skin. Hernias in different parts of the body have different names:
- Inguinal hernia (groin area)
- Femoral hernia (top of the inner thigh)
- Hiatal hernia (abdomen)
- Epigastric hernia (between the navel and breastbone)
- Umbilical hernia (at the belly button)
- Incisional hernia (at the site of a surgical incision)
What Are the Symptoms of a Hernia?
The most common symptom of a hernia is a lump or bulge.
- Inguinal Hernia: With an inguinal hernia, you may feel or see a lump on either side of your pubic bone where the groin and thigh meet. A type of inguinal hernia in men can occur in the testicles.
- Femoral Hernia: With a femoral hernia, sometimes women feel a burning sensation that travels to the labia, or experience discomfort, burning, or pain in the upper inner thigh area.
- Hiatal Hernia: With a hiatal hernia, besides the bulge, you may experience a burning or aching sensation, acid reflux, chest pain and can have difficulty swallowing.
- Epigastric Hernia: An epigastric hernia causes a lump in the breastbone area that’s above your belly button. This type of hernia is a fat mass. You may only see the bulge when you cough, laugh, or sneeze. An epigastric hernia can also cause pain and tenderness, but it’s common for an epigastric hernia not to show any symptoms.
- Umbilical Hernia: Umbilical hernias are most commonly found in babies, but adults can get them too. Umbilical hernias in babies may not be noticed unless a baby is crying, laughing, or straining to empty their bowels.
- Incisional Hernia: Incisional hernia symptoms can include a bulge or lump, pain, putrid-smelling drainage, swelling, fever and redness that indicate an infection. It’s important to get medical help right away for this type of hernia.
What Causes a Hernia?
Hernias are often caused in people who have weakened abdominal muscles or who do a lot of heavy lifting or straining. Depending on the cause, a hernia can develop quickly, or slowly over time. Common muscle weakness can come from a birth defect (where the abdominal wall doesn’t close properly while in the womb), age, chronic coughing, or damage from injury or surgery.Common strain causes that can lead to a hernia, especially when muscle weakness is present, include pregnancy (abdominal strain), constipation (straining during bowel movements), lifting heavy things, fluid in the abdomen, sudden weight gain, surgery, a chronic cough, or frequent sneezing.
How Are Hernias Treated?
Many hernias don’t require treatment and your doctor will keep an eye on it, but some do. If a hernia is causing pain or is severe, a surgeon can perform a simple and safe laparoscopic surgery to repair the hernia.
What’s the Long-Term Outcome If You’re Found to Have a Hernia?
A hernia doesn’t go away on its own, but with prompt medical care and lifestyle changes (weight loss and/or dietary changes), you can minimize the effects of a hernia and avoid life-threatening complications, such as strangulation. Many people don’t experience symptoms of a hernia, but if you are, it’s important to get checked by a doctor. The physicians at Gotham Gastroenterology are highly trained in diagnosing and treating hernias. If you’re concerned about the possibility of a hernia, or about your digestive health, make an appointment with us at one of our convenient NYC locations today.
Small Weight Gain Linked To Acid Reflux (GERD)
GERD (gastroesophageal reflux disease) has been directly linked to even small gains in body weight, without the person having to be overweight, say researchers in a report published in the New England Journal of Medicine, June 1 issue.
One of the symptoms of GERD is heartburn.
Dr. B Jacobson, study author, from Boston University School of Medicine, USA, said that his study shows that any excess weight may have a negative effect on health, even small amounts which would not class the person as overweight. In other words, a person of normal weight who gains a bit of weight – and is still considered to be of normal weight – can become more prone to GERD.
GERD is the failure of the valve between the stomach and the esophagus to close properly. Stomach acids work their way up into the esophagus, which erodes. GERD can lead to cancer of the esophagus.
We have known for a while that obese/overweight people are prone to GERD. The association between GERD and BMI (body-mass index) was unclear. This study clearly showed a link.
10,545 women completed a questionnaire which asked them how often, how severely, and how long they suffered from GERD symptoms. They were categorized according to BMI, which was then referenced over to GERD data.
22% had GERD symptoms once a week or more. Of the women who had had GERD symptoms at some time, 55% described them as moderate.
Those with a BMI under 20 were 33% less likely to suffer from GERD than those with a BMI between 20-22.4.
Women with a BMI of 22.5-24.9 had a 38% higher chance of having GERD symptoms in comparison with the 20-22.4 BMI group.
Women with a BMI higher than 25 are classed as overweight.
The researchers found the increase in GERD risk correlated pretty much in parallel to the increase in the womens’ BMI – the trend was linear.
The scientists stressed that they would not advise a person whose weight is ideal to lose weight if he/she is suffering from GERD symptoms.
However, if a person of ideal weight puts on a few pounds and notices his/her GERD symptoms become more severe, losing a few pounds may help alleviate the symptoms. They added that aiming for your ideal weight brings with it a host of other health benefits, including a lower risk of heart disease, cancer and diabetes, as well as reducing GERD symptoms.
GERD is more likely to get people to do something about it than worrying about the risk of diabetes or cancer is. This is because heartburn is an annoying problem that will make you think carefully about your weight. It hits you there and then – put an a few pounds and the annoyance immediately grows, lose a few and the bother immediately goes away.
Written by: Christian Nordqvist
Editor: Medical News Today.
What are the other Names for this Condition? (Also known as/Synonyms)
- Hiatus Hernia
- Paraesophageal Hiatal Hernia
What is Hiatal Hernia? (Definition/Background Information)
- When a part or whole of an internal organ (or tissues) protrudes through weak areas of the adjoining muscles or connective tissues, the condition is termed as a hernia. Hernia occurs through the weakened area, whenever there is increased pressure or strain on it. They most commonly occur in the abdomen region
- Medically, there are various types of hernia and the most common ones are:
- Inguinal hernia
- Incisional hernia
- Femoral hernia
- Umbilical hernia
- Hiatal hernia
- A Hiatal Hernia occurs when the upper portion of the stomach (or any abdominal structure other than the esophagus) enters into the chest cavity (thorax). It enters through the diaphragm, which is a muscular tissue separating the abdomen and chest. The word ‘hiatus’ means a gap in an anatomical region; in hiatal hernia, it is the diaphragm
- Though the exact cause and mechanism is unknown, it may be caused by elevated pressure in the abdomen due to frequent coughing, stressful bowel movements (such as during constipation), and many other factors. Hiatal Hernia is a very common disorder in the elderly
- The signs and symptoms of Hiatal Hernia could include abdominal pain, burping, hiccups, swallowing difficulties, coughing, aspiration of food particles into the lungs, and gastroesophageal reflux disease (GERD)
- Asymptomatic Hiatal Hernias may not require any treatment and the prognosis is good in such cases. But, if the symptoms continue to aggravate, or if other complications develop, then a surgery may be proposed
There are 4 types of Hiatal Hernias. The classification is important, because the indications for treatment differ with the different types.
- Type I Hiatal Hernia: A sliding Hiatal Hernia occurs when the gastroesophageal junction (the part where the esophagus meets the stomach) slides above the diaphragm, along with the small top portion (cardia) of the stomach. This type accounts for about 95% of all the cases
- Type II Hiatal Hernia: A fixed Hiatal Hernia occurs when part of the stomach (fundus) protrudes through the esophageal hiatus (the hole in the diaphragm through which the esophagus and vagus nerve pass through). The stomach and esophagus remain in the normal anatomical position below the diaphragm. This type accounts for about 5% of the cases
- Type III Hiatal Hernia: This is a rare kind of Hiatal Hernia and is a combination of types I and II
- Type IV Hiatal Hernia: This is another rare type that is associated with a large defect in the diaphragm, allowing other organs, such as the colon, spleen, pancreas, and small intestine, to enter into the chest cavity
- Types II, III, and IV are called Paraesophageal Hiatal Hernias
- The overall prognosis of commonly occurring hiatal hernias is generally good
Who gets Hiatal Hernia? (Age and Sex Distribution)
- Hiatal Hernias become very common with increasing age. It is estimated that up to 70% of the adults over 70 years, may have Hiatal Hernia
- Sometimes, it is a congenital (present at birth) condition and may be seen in children
- Sliding Hiatus Hernia (type I) occurs at an earlier age than Paraesophageal Hiatal Hernias (types II, III, and IV)
- Paraesophageal Hiatal Hernias are more common in women than men (ratio of 4:1)
- It is noticed that Hiatal Hernias are generally more common in the developed nations because of chronic constipation, typically due to low-fiber diets
What are the Risk Factors for Hiatal Hernia? (Predisposing Factors)
Any factor that increases the abdominal pressure and/or any factor that causes weakness in the diaphragm and surrounding regions (ligaments) increase one’s risk of Hiatal Hernia. These factors may include:
- Hiatal Hernia is more common with an advancing age
- Chronic abdominal stress due to chronic constipation, chronic coughing, etc.
- Long-term use of drugs (such as cocaine)
- Those with weak diaphragm or surrounding regions; or a large hiatus. The weakness may be genetically acquired
- Pregnant women
- Significant weight gain
It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.
Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.
What are the Causes of Hiatal Hernia? (Etiology)
Even though there is generally no definitive cause for the occurrence of Hiatal Hernia, the following conditions may potentially result in it:
- Increased abdominal pressure
- Chronic or intense coughing
- Extreme tension exerted during bowel movements
- Pregnancy, labor, and delivery
- Significant weight gain
- Intense lifting (heavy weights)
- Slouching or bending too much over long periods of time
- Congenital weakness in the diaphragm or surrounding regions; or a large hiatus
What are the Signs and Symptoms of Hiatal Hernia?
Most individuals with Hiatal Hernia do not present any symptoms. It is diagnosed by chance, during upper gastrointestinal diagnostic tests undertaken for other health reasons. The signs and symptoms of Hiatal Hernia may include the following:
- Hiccups, burping, or belching
- Bloating, fullness following a meal
- Mild to major heartburn
- Aching or painful chest region
- Trouble swallowing
- Chronic coughing
- Abdominal pain in the upper portion
- Gastroesophageal reflux disease (GERD) symptoms such as bitter taste in the mouth, water brash (regurgitation of stomach contents), or even aspirating food contents into the lungs. In GERD, stomach acids and digestive enzymes flow up into the esophagus, due to a weak sphincter
One should seek immediate medical attention, if any of the following symptoms occur:
- Heart palpitations, racing
- Shortness of breath or difficulty breathing
- Blood in one’s vomit or stool
- Black, dark, or tarry stools
- Trouble with swallowing, both foods and/or liquids
- Chest pain or intense pressure
In the case of a sliding Hiatal Hernia, if blood supply to the stomach is blocked (strangulation), it would cause extreme abdominal pain and potentially severe illness (shock). In such cases, an emergency surgery is necessary.
How is Hiatal Hernia Diagnosed?
There are many different tests that can be used to diagnose a Hiatal Hernia. These may include:
- Complete medical history and a thorough physical exam
- Esophago-gastro-duodenoscopy (EGD, a type of endoscopy): A thin flexible tube is pushed through the esophagus, to see the insides of the pharynx (throat), esophagus, stomach, and part of the duodenum
- Barium swallow x-ray: It is a special type of x-ray in which the individual drinks a liquid (contrast barium) and series of x-rays are taken to visualize the contour of esophagus and stomach
- High resolution manometry (HRM): A gastrointestinal (GI) motility diagnostic system that is used to measure the pressure activity within the upper gastrointestinal tract
- Capsule pH test: During an endoscopy, a small capsule is attached to the bottom of the esophagus to record the amount of time it takes for the stomach acid to reflux back up into the esophagus, and also whether or not a heartburn actually occurs, during the reflux
- CT scan of abdomen and chest may performed in emergency situations, if acute complications are suspected
Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.
What are the possible Complications of Hiatal Hernia?
The complications of Hiatal Hernia could include:
- GERD and its complications including erosive esophagitis (inflammation), stricture (narrowing), ulceration, and/or Barrett’s esophagus. Barrett’s esophagus is a condition where the inner lining of the esophagus changes to that of the stomach lining, due to acid irritation
- If Barrett’s esophagus is present for a long time, cancer of the esophagus can occur
- Volvulus of stomach: This is a medical emergency. In this condition, the stomach rotates on its axis and in the process blood supply to the stomach gets cut-off, causing death of the stomach tissues
- Obstruction of the portion of the organ that herniates into the chest
- Perforation of esophagus
- Anemia is common in paraesophageal hernias
- Complications occurring outside the esophagus may include asthma, hoarseness, cough, chest pain, and/or aspiration
Complications due to surgery: Nissen fundoplication is the kind of surgery (minimally-invasive) commonly used to treat GERD symptoms of Hiatal Hernia. Some of the complications associated with the surgery include:
- Intensive scarring
- Swallowing trouble (dysphagia)
- Excessive bloating due to gas buildup
- Rapid gastric emptying – when ingested foods skip past the stomach too fast and enter the small intestine mostly undigested
- The hernia may recur even after a surgery is performed
How is Hiatal Hernia Treated?
Treatment is often unnecessary, since many Hiatal Hernias (especially the most common sliding type) cause no symptoms.
- Medications and lifestyle changes may be tried initially for mild symptoms, such as bloating or heartburn, of Hiatal Hernia
- Weight loss programs if overweight or obese
- Eating small frequent meals rather than few large meals
- Eating 4 hours before sleeping or lying down
- Elevation of the head end of the bed to keep the acid in the stomach (by gravity)
Medications for acid reflux include over-the-counter medications, such as antacids and ranitidine, or prescription medications such as omeprazole
- If the stomach becomes strangulated (when blood supply to the stomach gets cut-off), or the symptoms from the hernia continue to worsen despite conservative approach, surgery may be necessary.
- Most Paraesophageal Hiatal Hernias may need to be treated surgically
- Most surgeries are minimally-invasive, performed through small incisions and done laparoscopically. The advantages of this type of surgery are faster healing process – with less risk of the wounds becoming infected, less post-operative pain, quicker recovery, and lesser scarring
- Most often, these surgeries have a full recovery period of only 2-3 weeks. However, one should avoid lifting heavy objects for up to 3 months following surgery
How can Hiatal Hernia be Prevented?
Hiatal Hernia cannot be prevented from occurring as the exact cause and mechanism is not known. However, once diagnosed, the symptoms and progression of the condition can be prevented by observing the following measures:
- Weight loss, if one is obese, is very important
- Include more physical activities and exercise regularly
- By undertaking less straining, leaning, or slumping, while performing everyday activities
- Smoking cessation
- Sleep at an angle on the bed, with the head raised around 4-6 inches
- Maintain a healthy diet (by including high fiber) to avoid constipation
What is the Prognosis of Hiatal Hernia? (Outcomes/Resolutions)
- The overall prognosis of Hiatal Hernia is generally good. Also, most Hiatal Hernias do not cause any symptoms
- Lifestyle changes, medications, and surgical options can treat most symptoms of Hiatal Hernia
- However, they may recur in up to 10% of the individuals despite surgical treatment
- Untreated paraesophageal hernias have the potential for severe and acute complications; it may even result in death in a few individuals. Nevertheless, paraesophageal hernias are uncommon than sliding hernias
Additional and Relevant Useful Information for Hiatal Hernia:
- Hiatal hernia repair is a procedure indicated for the treatment of objectively documented, relatively severe, gastroesophageal reflux disease (GERD)
The following article link will help you understand hiatal hernia repair surgical procedure: