Hiatal hernias: Causes, symptoms & treatments

Any time an internal body part pushes into an area it doesn't belong, it's called a hernia. A hiatal hernia occurs when the upper part of the stomach pushes through a small opening (hiatus) in the diaphragm and into the chest cavity. The diaphragm is a thin muscle wall separating the chest cavity from the abdomen.

Before taking a deeper dive into the many treatment options available for hiatal hernias, it's important to understand the common causes, risk factors, and symptoms associated with them.

What causes a hiatal hernia?

According to the Cleveland Clinic, the most common cause of a hiatal hernia is an increase in pressure in the abdominal cavity. This cavity encompasses the lower part of the esophagus, stomach, small intestine, colon, rectum, liver, gallbladder, pancreas, spleen, kidneys, and bladder.

Pressure can come from various sources: coughing, vomiting, straining during a bowel movement, heavy lifting, physical strain, pregnancy, obesity, or extra fluid in the abdomen.

Other potential causes of a hiatal hernia are:

• Injury to the abdominal area, such as after a trauma or surgery
• Age-related changes to the diaphragm
• Being born with an unusually large hiatus -- the opening in the diaphragm is where the esophagus and stomach join.

Who is at risk?

Although a hiatal hernia can develop in people of all ages and both genders, it tends to occur more frequently in people over the age of 50, smokers, and those who are overweight.

Common symptoms

Small hiatal hernias typically don't cause any problems. In fact, the Mayo Clinic reports most are discovered while a doctor is searching for the cause of another condition. Conversely, large hiatal hernias can allow food and acid to back up into your esophagus, causing symptoms such as heartburn and, in more severe cases, damage to the esophagus.

Common symptoms associated with a larger hiatal hernia include:

• Heartburn
• Regurgitation of food or liquids into the mouth
• Backflow of stomach acid into the esophagus, known as GERD (Gastroesophageal Reflux Disease) or acid reflux
• Difficulty swallowing
• Chest pain
• Abdominal pain
• Shortness of breath
• Vomiting blood or passing black stools, which might indicate gastrointestinal bleeding

Non-surgical treatment options

Since many patients with a hiatal hernia experience symptoms of GERD, initial treatment often begins with methods to manage it. Doctors might advise a combination of lifestyle changes and medications that include:

• Losing weight
• Quitting smoking
• Decreasing meal portion sizes
• Avoiding certain acidic foods such as tomato sauce and citrus fruits/juices
• Limiting fried and fatty foods and carbonated beverages
• Eating meals at least three to four hours before bedtime
• Taking medications such as:
• Antacids to neutralize stomach acid (i.e. Tums, Rolaids, Mylanta)
• Medications to reduce acid production, known as H-2 receptor blockers (i.e. Pepcid, Zantac, Tagamet)
• Medications to block acid production -- proton pump inhibitors that allow the esophagus time to heal (i.e. Prevacid, Prilosec)

Surgical treatment options

When medications to relieve heartburn and acid reflux don't work, or complications such as severe inflammation or narrowing of the esophagus occur, surgery is often required to repair the hernia.

Two approaches to hernia repair surgery are generally used. One is an "open" procedure. This surgery is performed through long incisions. Recovery time takes longer, and there are greater risks for complications.

The second option is a less-invasive, laparoscopic repair. This procedure allows for use of smaller incisions, enabling less scarring, a faster recovery time, and less chance of complications. This surgery has an estimated 90 percent success rate.

Reid Health makes access to high-quality, cutting-edge technologies a priority. Laparoscopic surgery with the da Vinci Surgical System is a minimally invasive procedure in which a tiny camera and special surgical tools are inserted through several small incisions in the abdomen. The operation is performed while the surgeon views images from inside the body that are displayed on a video monitor.

Don't live in discomfort. Contact a Reid Health physician if you have concerns about a hiatal hernia.