What Is a Hiatal Hernia?
A hiatal hernia is when your stomach bulges up into your chest through an opening in your diaphragm, the muscle that separates the two areas. The opening is called the hiatus, so this condition is called a hiatus hernia.
Hiatal Hernia Symptoms
Many people with hiatal hernia don’t notice any symptoms. Others may have:
- Heartburn from gastroesophageal reflux disease (GERD)
- Chest pain
- Trouble swallowing
- Bad taste in the mouth
- An upset stomach and vomiting
- Backflow of food or liquid from the stomach into the mouth
Shortness of breath is something you may experience with a hiatal hernia if your hernia is compressing your lungs.
Get medical care right away if you have a hiatal hernia and:
- Severe pain in your chest or belly
- A persistent upset stomach
- Can’t poop or pass gas
These could be signs of a strangulated hernia or an obstruction, which are medical emergencies.
Hiatal Hernia Causes
Doctors don’t know why most hiatal hernias happen. Causes might include:
- Being born with a larger hiatal opening than usual
- Injury to the area
- Changes in your diaphragm as you age
- A rise in pressure in your belly, resulting from pregnancy, obesity, coughing, lifting something heavy, or straining on the toilet
Hiatal Hernia Risk Factors
Hiatal hernias happen more often in women, people who are overweight, and people older than 50.
Hiatal Hernia Diagnosis
To diagnose a hiatal hernia, your doctor may do tests including:
- Barium swallow. You drink a liquid that shows up on an X-ray so your doctor can get a better look at your esophagus and stomach.
- Endoscopy. Your doctor puts a long, thin tube called an endoscope down your throat. A camera on the end shows the inside of your esophagus and stomach.
- Esophageal manometry (pressure study). A different kind of tube goes down your throat to check the pressure in your esophagus when you swallow.
- pH test. This measures the acid levels in your esophagus.
If anemia is a concern, your doctor may take a blood sample to check your red blood cell count.
Hiatal Hernia Treatment
Most people don’t notice symptoms of a hiatal hernia and don’t need treatment.
Your doctor will decide the best long-term treatment for you, depending on things such as the nature of your hernia, your reflux, and your symptoms. Treatment options are:
Wait and watch. You might not need any treatment for your hernia. But your doctor may want to keep an eye on it. Your hernia might get bigger over time.
Medications. These can't stop your acid reflux, but they can reduce the acid content in your stomach. This makes your reflux less harmful and uncomfortable. Your doctor may suggest:
- Antacids to weaken your stomach acid
- Proton pump inhibitors or H-2 receptor blockers to keep your stomach from making as much acid
- Prokinetics to make your esophageal sphincter, the muscle that keeps stomach acid from backing up into your esophagus, stronger. They also help muscles in your esophagus work and help empty your stomach.
Surgery. You might need a minor surgical procedure to repair your hiatal hernia.
Hiatal Hernia Surgery
Hiatal hernia surgery has a 90% success rate. You'll likely be able to stop medications and have no more acid reflux after hiatal hernia surgery. But studies show that up to 50% of hiatal hernias eventually return after surgery, usually after many years.
If you have a paraesophageal hernia (when part of your stomach squeezes through the hiatus), your doctor might do surgery so your stomach doesn’t become strangled. You may also need surgery if sliding hernias bleed or become large, strangulated, or inflamed.
In surgery, your doctor reinforces your hiatus and moves your stomach. Many hiatal hernia surgeries use a method called laparoscopy. Your doctor will make a few small (5 to 10 millimeter) cuts in your belly. They insert a tool called a laparoscope through these incisions, and it sends pictures to a monitor so your doctor can see inside your body. These “minimally invasive” procedures have smaller cuts, lower risk of infection, lesser pain and scarring, and faster recovery than traditional surgeries.
Recovery from Hiatal Hernia Surgery
You may need to stay in the hospital for 1-2 days, depending on your situation and the kind of surgery you had. Your recovery is usually quicker when you have laparoscopic surgery or robotic surgery for hernia repair. That’s because you have small, keyhole incisions instead of the larger incision needed for an “open” surgery. But sometimes, you may need a more involved “open” surgery.
After the hospital, your home recovery will last 2-6 weeks. During this time, your doctor will prescribe a diet of clear liquids at first, and then soft foods, before you can eventually eat solid food again.
Foods to avoid while you recover from hernia surgery include those that are hard to digest, such as red meat. You'll also want to avoid spicy foods and others that can cause acid reflux, such as chocolate and anything with caffeine. It's also best to not have orange juice or fried food.
Weight loss is common after hernia surgery, with an average loss of 10 to 15 pounds.
Hiatal Hernia Lifestyle Changes and Home Remedies
Some changes to your daily life can help with acid reflux symptoms. They include:
- Don’t exercise or lie down for 3 or 4 hours after you eat.
- Avoid acidic foods such as orange juice, tomato sauce, and soda.
- Limit fried and fatty foods, alcohol, vinegar, chocolate, and caffeine.
- Eat smaller meals (four or five small meals each day) and eat slowly.
- Lift the head of your bed about 6 inches and sleep on your left side to help prevent reflux. A body pillow may also help.
- Don’t wear tight belts or clothes that put pressure on your belly.
- Lose extra pounds.
- Don’t smoke. Smoking can cause intense heartburn.
- Have an early dinner. Avoid lying down for a few hours after eating to keep gravity on your side.
Hiatal Hernia Types
There are two main types of hiatal hernias:
Sliding hiatal hernias (Type 1). Your esophagus (food pipe) usually goes through the hiatus and attaches to your stomach. But in a sliding hiatal hernia, your stomach and the lower part of your esophagus slide up into your chest through the diaphragm. About 95% of all hiatal hernias are this type.
Paraesophageal hiatal hernias. These are more dangerous than sliding hiatal hernias. Your esophagus and stomach stay where they should be, but part of your stomach squeezes through the hiatus to sit next to your esophagus. Your stomach can become squeezed and lose its blood supply. Your doctor might call this a strangulated hernia.
The three types of paraesophageal hernias are:
- Type 2: This is also called a rolling hiatal hernia. The upper part of your stomach pushes up through the hiatus alongside your esophagus, forming a bulge next to it.
- Type 3: This is a blend of type 1 and type 2. In this hiatal hernia, the part of your esophagus connecting to your stomach slides up through the hiatus. Another part of your stomach also sometimes bulges through.
- Type 4: This is rare and more complex. The hiatus is wide enough for two different organs to herniate through it. The hernia involves your stomach and another abdominal organ, such as your intestines, pancreas, or spleen.
- A hiatal hernia is when your stomach bulges up into your chest through an opening in your diaphragm.
- Hiatal hernias happen more often in women, people who are overweight, and people older than 50.
- Most people don’t notice symptoms of a hiatal hernia and don’t need treatment.
- Doctors don’t know why most hiatal hernias happen, but some factors can increase your risk.
- Most hiatal hernias aren't serious but some are.
- Treatment for your hiatal hernia depends on your overall condition and the type of hiatal hernia you have.
- Hiatal hernia surgery has a 90% success rate.
Hiatal Hernia FAQs
What are three signs of hiatal hernia?
Three signs you might have a hiatal hernia are heartburn, regurgitation of food or liquids into your mouth, and backflow of stomach acid into your esophagus (acid reflux).
Is hiatal hernia a serious condition?
Not usually. But a large hernia can become serious.
How does a hiatal hernia feel?
It varies, and you might have no pain at all. But if you do, you might feel pain in your chest or abdomen. You might feel it when you bend over, cough, or lift something heavy. You may feel hernia pain related to acid reflux. That can be high or low in your chest and feel like burning or even a heart attack.