Hiatal hernia — How to handle the hidden cause of heartburn
You have a 60-percent chance of having a hiatal hernia if you’re over age 60. The good news is, even if you have a hiatal hernia — no matter what your age — it’s probably not a problem. You may not even know you have one. That’s because most hiatal hernias are small and don’t cause any symptoms. When they do, it’s usually only mild heartburn. Small hernias often go undetected until doctors find them while looking for something else. Large hiatal hernias, however, can become a problem.
What is a hiatal hernia?
It’s a bulging of your stomach out of your abdominal cavity into your chest cavity. Your stomach normally stays beneath your diaphragm, a muscle that separates your chest cavity from your abdominal cavity. There’s an opening, or hiatus, in the diaphragm where the esophagus comes through the abdominal wall and connects to your stomach. Where the stomach and esophagus connect, the lower esophageal sphincter (LES) muscle opens up to let food into your stomach, then closes to keep stomach contents from backing up into your esophagus.
When the opening gets weak or stretches, part of the stomach slips up through the diaphragm and bulges out. This bulge — a hiatal hernia — traps digestive materials and puts extra pressure on the LES, which no longer has the diaphragm to help it stay shut. Chronic heartburn, or gastroesophageal reflux disease (GERD), may result as stomach acid creeps through the weakened LES and up into your esophagus.
Common symptoms and early warning signs
Doctors once thought hiatal hernias caused almost all reflux. They now think only large hiatal hernias may result in GERD and that many people with reflux problems don’t actually have hiatal hernias.
Larger ones, however, can cause serious reflux and other major complications. When too much of the stomach pushes through, it puts pressure on the diaphragm, throat, and lungs. It can also create friction that causes lesions and bleeding.
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Are you at risk?
Your risk of developing a hiatal hernia increases with age. Most occur in people over the age of 40, and women tend to get them more often than men. Certain activities play a big part in causing hiatal hernias. Anything that puts too much pressure on your abdomen can contribute to hiatal hernia. For example:
- persistent or severe coughing or vomiting
- straining to go to the bathroom
- lifting heavy objects
- pregnancy or obesity
Medical procedures your doctor may order
Doctors usually find hiatal hernias by chance while looking for the cause of reflux, or chest or abdominal pain using one of these tests.
- Barium swallow. After you swallow barium, a liquid contrast dye, an X-ray machine may find the hernia sticking out near the bottom of the esophagus.
- Upper GI endoscopy. Thanks to throat anesthetic, your doctor can use a long, thin tube tipped with a tiny camera to see your esophagus — and any hernias — on a television monitor.
Nutritional defense against hiatal hernia
What and when you eat makes a difference in reflux symptoms caused by a hiatal hernia.
- Citrus fruits and juices, tomato products, and pepper can irritate a damaged esophageal lining.
- Fatty foods, alcohol, chocolate, and, especially, caffeine encourage reflux because they relax the LES muscle that keeps acid in the stomach.
- Overeating makes your stomach overflow, so several small meals are better than large ones.
- Eating two or three hours before bedtime gives food time to digest.
- Sitting upright during and after meals helps gravity move food quickly through your digestive system.
Additional steps to take
The most likely trouble your hiatal hernia will cause is reflux and the heartburn that goes with it. This advice can help ease that discomfort.
- Stop smoking. Nicotine promotes reflux by relaxing the valve between your stomach and esophagus and, at the same time, stimulating the production of stomach acid.
- Slim down to a healthy weight. Being overweight puts extra pressure on your belly and squeezes stomach acid up into your esophagus.
- Wear loose clothing. Tight-fitting clothes and belts also put the squeeze on your stomach and force digestive juices into the esophagus.
- Raise the head of your bed 6 to 9 inches. Gravity helps keep stomach acid down where it belongs while you sleep.
- Practice relaxation techniques, such as deep breathing. Stress slows your digestion, which can make GERD worse.
- Be careful about lifting, straining, and other activities that put pressure on your diaphragm and abdominal cavity. They can cause or intensify a hiatal hernia, especially as you get older.
- Stay alert for signs that a hiatal hernia is getting bigger. If you know you have one and suffer severe chest pain, difficulty breathing, or trouble swallowing, get immediate medical attention.
Medical treatment options
No medicine will “cure” a hiatal hernia, but medication will help relieve the heartburn it can cause.
- Antacids neutralize stomach acid that gets into your esophagus.
- H2 blockers reduce acid production by slowing down histamines. Stronger doses are available by prescription, but find out about side effects and interactions with other drugs.
- Proton pump inhibitors are the most effective drugs for GERD but also the most expensive. They work by directly blocking acid production.
Talk with your doctor before taking any drugs or discontinuing any medication.
Lifestyle adjustment and medicine to relieve the effects of GERD are the preferred treatments for hiatal hernia, but surgery may be appropriate in a few extreme cases, such as when:
- lifestyle adjustments and medication fail to control severe reflux.
- the hernia leads to chronic bleeding.
- the hernia blocks your esophagus.
Using either open or laparoscopic surgery, the surgeon will pull your stomach back into your abdomen and then fix the opening in your diaphragm. He may also do a fundoplication, where he wraps part of the stomach around the esophagus to support the LES muscle and prevent the stomach from slipping again.
- FC&A Staff Writer