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What Is a Hiatal Hernia?
Any time an internal body part pushes into an area where it doesn't belong, it's called a hernia.
The hiatus is an opening in the diaphragm -- the muscular wall separating the chest cavity from the abdomen. Normally, the esophagus (food pipe) goes through the hiatus and attaches to the stomach. In a hiatal hernia (also called hiatus hernia), the stomach bulges up into the chest through that opening.
There are two main types of hiatal hernias: sliding and paraesophageal (next to the esophagus).
In a sliding hiatal hernia, the stomach and the esophagus slide up into the chest through the hiatus. This is the more common type of hernia.
The paraesophageal hernia is less common, but is a greater cause for concern. The esophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus, landing it next to the esophagus. Although you can have this type of hernia without any symptoms, the danger is that the stomach can become "strangled," or have its blood supply shut off.
Often, people with hiatal hernia also have heartburn or GERD (gastroesophageal reflux disease). 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.
What Causes a Hiatal Hernia?
Most of the time, the cause of a hiatal hernia is not known. Some people develop a hiatal hernia after sustaining an injury to that area of the body; others are born with a weakness or an especially large hiatus. Some experts suspect that increased pressure in the abdomen from coughing, straining during bowel movements, pregnancy and delivery, or substantial weight gain may contribute to the development of a hiatal hernia.
Who Is at Risk for Hiatal Hernia?
Among those at greatest risk for a hiatal hernia are:
- Those over the age of 50
- Overweight people (especially women)
- Smokers
How Is a Hiatal Hernia Diagnosed?
A hiatal hernia can be diagnosed with a barium swallow study, a special X-ray that allows visualization of the esophagus, or with endoscopy.
How Are Hiatal Hernias Treated?
Most people do not experience any symptoms of their hiatal hernia, so no treatment is necessary. However, the paraesophaeal hernia (when part of the stomach squeezes through the hiatus) can cause the stomach to be strangled so surgery is usually recommended. Other symptoms that may occur along with the hernia, such as chest pain, should be properly evaluated. Symptoms of GERD should be treated
When Is Hernia Surgery Necessary?
If the hiatal hernia is in danger of becoming constricted or strangulated (so that the blood supply is cut off), surgery may be needed to reduce the hernia, meaning put it back where it belongs.
WebMD Medical Reference provided in collaboration with the Cleveland Clinic
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