A large muscle separates the belly and chest spaces. A small opening in the muscle lets the esophagus pass from the chest into the belly. There it connects to the stomach. A hiatal hernia occurs when the stomach presses up into the chest through this hole.
Different types of hiatal hernias include:
- Sliding hiatal hernia—Part of the stomach slides into and out of the chest cavity. This is the most common type.
- Fixed hiatal hernia—Upper part of the stomach stays in the chest cavity.
- Several other types may be seen. They are uncommon, but more serious. May need surgery.
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The exact cause of hiatal hernias is not clear. Some people are born with a hiatal hernia. Others will develop it later in life.
An injury to this opening can allow a hiatal hernia to start. This can happen in a trauma like a car accident. Increased pressure in the belly can also put a lot of stress on the area. Over time the area may weaken and allow the stomach to move up.
Hiatal hernias are more common in adults over 50 years of age. Other factors that increase your chance of getting hiatal hernia include:
- Injury to the belly
- Activities that increase pressure such as:
- Severe coughing
- Sudden physical exertion such as weight lifting
Hiatal hernias do not always cause symptoms.
Pressure on the stomach may push stomach acid move up into the throat. It can cause:
- Heartburn, especially after eating or lying down
- Pain or discomfort in the stomach, chest, or esophagus
- Frequent clearing of the throat from irritation
- Chest pain
- Difficulty swallowing
Hiatal hernias are often accidentally found. It may be seen on tests for other issues. If you have symptoms, you will be asked about your past health. A physical exam will be done.
Images may be taken of your stomach. It will show the stomach in the chest. Test options include:
- Upper GI series—xrays that use special dye
- Upper GI endoscopy—scope with camera is passed down the throat
Hiatal hernias do not always need treatment. Symptoms may need to be managed.
If acid is pushing up into esophagus often, the doctor may recommend:
Certain foods increase chance of heartburn. Try cutting out:
- Fatty foods
- Alcoholic beverages
Avoid foods and beverages that can irritate the area such as:
- Citrus fruits and juices
- Tomato products
- Hot peppers
- Carbonated beverages
Other habits that may help include:
- Eat small meals 4 to 6 times a day instead of 3 large meals.
- Do not eat within 2 to 3 hours of bedtime.
- If you smoke, talk to your doctor about ways to quit. Smoking can weaken tissue in the body.
- Lose weight if you are overweight. Extra weight can increase pressure in the belly.
- Avoid tight clothes or belts around the waist.
- Avoid stooping or bending after meals. It puts increased pressure on the abdomen.
- Lift head of bed to relieve heartburn at night.
- Over-the-counter antacids—to relieve heartburn.
- Prescription medicine—for regular heartburn. H2 blockers and proton pump inhibitors (PPIs) can decrease acid in the stomach.
Surgery may be needed if:
- Symptoms are severe.
- Hernia has twisted and cut off the flow of blood to the stomach. This is an emergency. It will need immediate surgery.
There are no steps to prevent a hiatal hernia. The cause is mostly unknown.