A hernia is when any organ or tissue pushes through a weakness in the tissue barrier that normally contains the organs.  A hiatal hernia is the most common type of hernia.  It is when the top of your stomach bulges through an opening in your diaphragm.  The diaphragm is the muscle barrier that separates the abdominal cavity to the chest cavity.  The opening here is called the hiatus.  

There are different types of hiatal hernia.  The first one is the most common.  Types two, three, and four, are all called paraesophageal hernias as well because the hernia pushes into the chest next to the esophagus. 

Type one is also called a sliding hernia.  About 95% of hiatal hernias are type one.  Type one is when the part of the esophagus that is connected to the stomach rises up through the widened hiatus, and then after some time slides back down. 

Type two also called a rolling hiatal hernia occurs when the stomach pushes up through the hiatus next to the esophagus and forms a bulge. 

Type three is a mix of types one and two.  The connecting part of the esophagus and stomach slides up sometimes or your stomach pushes up next to the esophagus. 

Type four is rare and much more complicated.  When type four is present the hiatus is so large that multiple organs can fit through it at the same time.  This will lead to a hernia to occur with multiple organs from the abdomen. This could be your stomach, intestines, pancreas, or spleen herniating at the same time. 

 

Causes Of Hiatal Hernias

The exact cause of how hiatal hernias occur is unknown to doctors.  So there is little to no way to prevent them.  There are some things that have been linked to lead to a hiatal hernia though.  Hiatal hernias are more common in women.  Some people are born with a large hiatus.  Injury or trauma to the area can be the cause, such as a seatbelt injury.  Obesity or pregnancy can be a cause.  Persistent or intense pressure surrounding the muscles can also lead to a hernia.  This could be things like persistent coughing, lifting a heavy object, repetitive vomiting, or straining during a bowel movement.  

 

Hiatal Hernia Symptoms

Most hiatal hernias aren’t serious.  In some cases you may not even know you have one and live with it for years.  Small hernias sometimes cause no symptoms or problems at all.  The most common symptom of a hiatal hernia is acid reflux.  Acid reflux from a hiatal hernia can turn chronic.  Complications of chronic acid reflux are esophagitis, esophageal stricture, or Barrett’s esophagus.  Other symptoms can include chest pain, bloating, burping, trouble swallowing, bad taste in the mouth, upset stomach, vomiting, regurgitation, or shortness of breath.  More serious symptoms are severe pain in your chest or belly, persistent upset stomach, or the inability to pass a bowel movement or gas.  These symptoms need medical attention immediately.  It could be signs of a strangulated hernia or an obstruction. 

 

Diagnosing Hiatal Hernia

To diagnose a hiatal hernia your doctor may want to run a few tests.  A barium swallow test is when you drink a liquid while having an X-ray done, so your doctor can get better pictures of your esophagus and stomach.  An endoscopy is a procedure where a doctor will put a tube down your throat that will hold a tiny camera.  The tiny camera helps the doctor be able to see your esophagus and stomach from the inside.  An esophageal manometry is done with a tube down your throat as well but this tube checks the pressure in the esophagus.  A pH test is done to measure the acid levels in the esophagus.  

 

Treatment for Hiatal Hernia

Treatment can be a combination of surgery, medication, and diet changes.  Surgery is usually done when the hernia is rather large, or to treat heartburn or acid reflux that can’t be treated successfully with medications.  The first type of surgery is a hiatus repair surgery.  This can be done either open or laparoscopic.  The surgery takes between 1-3 hours.  During the surgery you are under general anesthetic so you will be asleep for the whole procedure.  The surgery consists of the surgeon using sutures and mesh to reinforce the hiatus making it so your organs can not push through the gap anymore.  Surgery is usually 90% effective.  Another surgical treatment is a nissen Fundoplication.  Stitches are placed to wrap the upper part of the stomach to the bottom portion of the esophagus.  This helps hold the stomach in place as well as helps prevent acid and food from flowing back up.  A Colis-Nissen gastroplasty is done in the rare case that the esophagus is too short.  This surgery lengthens the esophagus.  

Over the counter medications can be a first way of treatment to see if they help alleviate symptoms.  Over the counter antacids can help neutralize acid reflux.  Over the counter H2 receptor blockers help lower the stomach acid production.  Over the counter proton pump inhibitors can help prevent stomach acid production. 

Along with medication, diet changes can be made to also help alleviate symptoms.  Eating smaller, more frequent meals can help instead of eating larger meals.  Making sure you don’t eat too close to bed can also help with reflux at night.  Propping your head up after you eat, or while you sleep.  Avoid eating foods that are spicy, chocolate, have tomatoes, caffeine, onions, citrus fruits, or alcohol.  

 

 

READ MORE:  Digestive Aids: Help Your Digestion & Ease Discomfort


Leave a Reply

Your email address will not be published. Required fields are marked *