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. This opening is called the hiatus, so this condition is called a hiatus hernia, or hiatal hernia.
“The hiatus is normally a fairly small opening, just big enough to allow the esophagus to come through. If it’s enlarged larger than it needs to be, that’s considered a hernia,” says Mir Ali, MD, medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA.
What Are the Symptoms of Hiatal Hernia?
Many people with hiatal hernia don’t notice any symptoms. Others may have:
- Heartburn from gastroesophageal reflux disease (GERD)
- Acid reflux (when stomach acid rises into your throat)
- Chest pain
- Belly pain
- Bloating
- Burping
- Trouble swallowing
- Bad taste in your mouth or bad breath
- Sore throat or hoarseness
- An upset stomach and vomiting
Shortness of breath can also be a symptom if your hernia presses on your lungs.
Get help from a doctor right away if you know that you have a hiatal hernia and you have any of the following:
- Fever
- Vomiting
- Chills
- Blood in your stool
- Can’t poop or pass gas
These could be signs of a strangulated hernia. That’s when part of your intestine gets stuck in the opening of your abdominal wall. Blood can’t flow to it, which can cause the tissue to die very quickly. A strangulated hernia is a medical emergency.
Asymptomatic hiatal hernias
It’s common to have a hiatal hernia and not notice any symptoms. For instance, 55%-60% of people over 50 years of age have a hiatal hernia, but only 9% have symptoms.
What Causes Hiatal Hernia?
Doctors don’t know why most hiatal hernias happen. Reasons for it might include:
- Being born with a larger hiatal opening than usual
- Injury to the area
- Excess weight gain
- Natural changes in your diaphragm as you age
- Increased pressure in your belly (for instance, from long-term coughing, heavy lifting, or straining on the toilet)
What Are the Risk Factors of Hiatal Hernias?
You’re more likely to get this type of hernia if you:
- Have obesity
- Are more than 50 years old
- Are pregnant
- Smoke or chew tobacco
How to Diagnose a Hiatal Hernia?
Your doctor may find a hiatal hernia when they’re looking into other symptoms that you have, such as heartburn or acid reflux.
What tests are used to detect a hiatal hernia?
Your doctor will do tests to figure out what’s going on inside your body. That could include one or more of the following:
Barium swallow. This is a type of imaging test. First, you drink a liquid or swallow a pill that contains barium, a chemical element. Then, X-rays are taken. The barium helps your doctor get a better look at your esophagus and upper gastrointestinal (GI) tract.
Endoscopy. During this procedure, your doctor puts a long, thin tube called an endoscope down your throat. A camera on the end lets them see the inside of your esophagus and stomach.
Esophageal manometry (pressure study). A different kind of tube can go down your throat to check the pressure in your esophagus when you swallow. It gets this information with the help of many tiny sensors.
pH test. A tiny capsule is placed in your esophagus. It measures the acid levels in your esophagus over 48 hours. The capsule doesn’t need to be removed. Instead, it comes loose on its own and passes through your system.
How Do You Treat a Hiatal Hernia?
Whether or not you need treatment often depends on whether or not you have symptoms and how serious they are. Your doctor will explain your options.
Wait and watch
If you don’t have symptoms, your doctor may suggest leaving your hernia alone and doing nothing for now. This is sometimes called “watchful waiting.” Your doctor will want to see you regularly. It’s common for hernias to get bigger over time.
Medications
Medications can’t shrink your hernia, but they can neutralize the acid in your stomach. “Your esophagus doesn’t have the same kind of lining as your stomach, so when acid comes up, it can cause an irritation and burning sensation,” Ali says. “Medications neutralize that acid so you don’t feel that discomfort.”
Your doctor may suggest:
- Antacids to weaken your stomach acid
- Proton pump inhibitors or H2 receptor blockers, which keep your stomach from making as much acid
- Prokinetics to strengthen your esophageal sphincter, the muscle that keeps acid from backing up into your esophagus; they also help empty your stomach.
Surgery
In some cases, you might need a surgery to repair your hiatal hernia. This is usually needed if:
- Medication and lifestyle changes don’t help with your symptoms
- Side effects from medication bother you
- Your hernia is large enough to cause other problems over time
- You have other health issues, such as a narrowed esophagus
“The majority of time, this is an elective surgery,” Ali says. “It’s not typically an emergency.”
What Surgeries Are Done to Correct a Hiatal Hernia?
Hiatal hernia surgery has a 90% success rate. After you have it, you probably won’t have acid reflux any more and will be able to stop medications. But studies show that up to 50% of hiatal hernias return after surgery, usually after many years.
In surgery, your doctor will close the hole in your diaphragm and move your stomach back to its proper place. Many hiatal hernia surgeries use a method called laparoscopy. Your doctor will make a few tiny cuts in your belly. Then, they insert a thin tool called a laparoscope. It contains a camera that sends pictures to a monitor so your doctor can see inside your body.
A laparoscopy is a “minimally invasive” procedure. That means you’ll have a smaller scar, lower risk of infection, and less pain than a traditional “open” surgery, which makes one big incision (cut).
For either type of surgery, you’ll get anesthesia. That will help you sleep through the procedure. You won’t be aware of what’s going on or feel pain during it.
How to Recover From a Hiatal Hernia Surgery?
You may need to stay in the hospital for one or two days. It depends on your overall health and the kind of surgery you have. Recovery is usually faster when you have laparoscopic surgery or robotic surgery for hernia repair. But sometimes, open surgery is the best option.
After the hospital, you’ll recover at home for two to six weeks. During this time, your doctor will prescribe a diet of clear liquids at first. You’ll then move on to soft foods, such as soup and mashed potatoes, before you can eat solid food again.
Foods to avoid while you recover from hernia surgery
Your doctor will give you a long list of foods to avoid right after your surgery. That includes foods that are hard to digest, such as red meat, or foods that cause gas, such as broccoli and cabbage. Eating them can strain the area that’s healing.
You’ll also want to skip foods that can cause acid reflux, including:
- Spicy foods
- Chocolate
- Caffeine
- Citrus products (such as orange juice)
- Fried food
Activities to avoid after hernia repair
Low-impact activities, such as walking, can help keep your digestive system moving. But you’ll want to skip high-impact cardio, heavy lifting, and anything that works your stomach muscles.
Ask your doctor which types of activity are safe to do and when. Make sure to follow their guidelines.
Hiatal Hernia Lifestyle Changes and Home Remedies
“It’s difficult to know the exact cause of a hernia, but weight is definitely a factor,” Ali says.
Getting to a healthier weight can help keep your hernia from coming back. Weight loss is common after hernia surgery, with an average loss of 10-15 pounds. But whether or not you have surgery, you can aim to reach a weight that’s right for you.
Some tips that can help:
Eat smaller portions. Tracking your food in an app or journal can help you be more mindful of what you eat.
Don’t eat while you’re doing something else. When you’re in front of a screen or driving, it’s easy to lose track of how much you eat.
Eat less rich, high-fat foods. For instance, try to cut back on desserts, creamy sauces and dressings, and packaged snacks such as chips.
Other lifestyle changes to keep in mind:
Sleep with your head propped up. This can keep acid from coming up into your throat.
Eat dinner three to four hours before bed. You want to give food time to digest before you lay down.
Be mindful of how foods affect you. If you have symptoms after eating a certain food or drink, you may need to avoid it.
Stop smoking. Quitting is easier with support. Your doctor can give you some tips.
Don’t overuse over-the-counter antacids. While they can offer quick, short-term relief, using them often can hurt your kidneys and cause other side effects, such as diarrhea. Let your doctor know if you have trouble managing your symptoms.
What Are the Different Types of Hiatal Hernias?
Not all hernias are the same. Your doctor will tell you which kind you have.
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 your diaphragm. It’s very common. As many as 1 in 4 people has a sliding hernia by the age of 40.
Paraesophageal hiatal hernias
These hernias concern doctors more than sliding hiatal hernias, even though they still may not cause symptoms. Your esophagus and stomach stay where they should be, but part of your stomach finds its way through the hiatus to sit next to your esophagus.
Paraesophageal hernias include type 2 through type 4 hiatal hernias. The three types of paraesophageal hernias are:
Type 2. You might hear this called a rolling hiatal hernia. The upper part of your stomach pushes up through the hiatus next to your esophagus, forming a bulge next to it.
Type 3. This is a blend of type 1 and type 2. Part of your esophagus that connects your stomach slides up through the hiatus. Another part of your stomach also sometimes bulges through.
Type 4. This type of hernia is rare and more complex. The hiatus is wide enough for two different organs to squeeze through it. A type 4 hernia involves your stomach and another abdominal organ, such as your intestines or spleen.
What Are the Complications of an Untreated Hiatal Hernia?
A hiatal hernia can lead to:
Gastroesophageal reflux disease (GORD). Stomach acid leaking into your esophagus can cause damage and discomfort.
Esophageal ulcers. These sores, which may bleed, can be painful.
Esophageal strictures. Scar tissue can build up in your esophagus, making it smaller. This can make swallowing harder.
Barrett’s esophagus. Over time, inflammation can cause the cells in your esophagus to mutate (change). This can raise your risk for esophageal cancer.
Strangulated hernia. Although it’s rare, part of your stomach can get stuck in your hiatus, and blood flow to it can get cut off.
Takeaways
A hiatal hernia is when your stomach bulges up into your chest through an opening in your diaphragm. Most people don’t have symptoms and don’t need treatment, but it depends on your health and the type of hiatal hernia you have. Medication, lifestyle changes, and surgery can all be good treatment options.
Hiatal Hernia FAQs
What are three signs of hiatal hernia?
Three signs you might have a hiatal hernia are heartburn, regurgitation (or coming back) 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.
Can hiatal hernias be fatal?
If part of your intestine gets stuck inside your diaphragm wall, it can be life-threatening. Call 911 or get to a hospital if you have a sudden pain in your hernia or the skin around it changes color. These are signs of a strangulated hernia that needs to be treated right away.
When should I see a doctor for a hiatal hernia?
A hiatal hernia won’t go away on its own. If you have symptoms, see a doctor. They can do tests to rule out other conditions. They can also start treatment and suggest simple changes to your lifestyle so you feel more comfortable.
How to stop a hiatal hernia attack right away?
If your hernia causes sudden, severe pain, get to a hospital right away. Parts of your intestine or another organ could be stuck and will need to be released through surgery. The trapped tissue can begin to die in as little as four hours.
Where is hiatal hernia pain located in women?
No matter what sex you were assigned at birth, you’ll feel hiatal hernia pain in your chest or belly. You might notice it more when you’re doing certain activities and that area gets squeezed.
