Hiatal Hernia: Symptoms, Treatment, and Surgery (2024)

A hiatal hernia, or hiatus hernia, occurs when the topmost part of your stomach pushes through the small opening in the diaphragm. This opening, known as the hiatus, is a muscle that separates the abdomen from the chest.

The cause isn't always clear, but common causes include being born with a larger-than-average hiatus, injury or trauma to the area, having obesity, and persistent or excessive pressure on the muscles that can lead to muscle weakening. Hiatal hernias often do not cause symptoms.

In this article, you’ll learn more about what causes hiatal hernias, symptoms to watch for, how diagnosis works, and what treatment options are available for someone with a hiatal hernia. You’ll also learn what complications can occur and get a sense of what to expect during recovery.

What Causes Hiatal Hernias?

While it’s not exactly clear what causes a hiatal hernia, there are several possible explanations. The main reasons why someone may experience this type of hernia are as follows:

Localized Pressure

Increased pressure in the abdominal cavity (middle body area that holds digestive organs like the lower part of your esophagus, stomach, and small intestine). Pressure in this area can be caused by:

• Excessive coughing
• Repetitive vomiting
• Straining during a bowel movement
• Heavy lifting and physical strain

Other Causes and Risk Factors

Anyone can have a hiatal hernia, although they are more common in certain people, including:

• Being born with a larger-than-average hiatus
• Being over 50 years old
• Pregnancy
• Having obesity
• Experiencing injury or trauma due to blunt force of excessive pressure (e.g., physical trauma caused by a seat belt during a vehicle accident)
• Smoking
  

Symptoms of a Hiatal Hernia

Symptoms of hiatal hernia are not always present or obvious. This means many people who have hiatal hernias never experience signs and symptoms. When symptoms do present, they may be very similar to symptoms of gastroesophageal reflux disease (GERD).GERD is a chronic digestive upset disorder.

GERD symptoms include:

• Heartburn
• Sour or bitter taste in the back of the mouth
• Stomach bloating
• Belching (burping)
• Regurgitation (acid reflux)
• Halitosis (chronic bad breath)
• Chest pain
• Anemia
• Fatigue

Diagnosing a Hiatal Hernia

There are specific tests that can help your healthcare provider diagnose a hiatal hernia. Diagnostic tests for hiatal hernias include:

• Barium swallow radiography: You’ll be asked to drink a liquid before an X-ray so your healthcare provider can locate any issues in the esophagus or stomach.
• Endoscopy: A long, thin, flexible tube will be used to view your upper digestive system.
• Esophageal manometry: Your esophagus muscle strength and coordination is examined in this test to determine possible causes.
• A pH test: A pH test can measure the acid levels in your esophagus and determine if they’re within an average range.
• Gastric emptying test: This measures how quickly food leaves the stomach to determine whether the digestive process is working correctly. You’re likely to get this test if you have symptoms of nausea and vomiting.
  

When Is a Hiatal Hernia a Medical Emergency?

In most cases, a hiatal hernia isn’t a medical emergency.You should seek immediate medical emergency care, however, if the following occurs:

• You have a high fever (over 100.4 degrees F) and acid reflux at the same time.
• You are experiencing severe chest pain.
• Your heart rate is over 100 beats per minute (rapid beating).
• You are dry heaving or retching.
• Swallowing becomes more difficult.
• You see blood in your stools.

Some symptoms are also signs of potentially life-threatening hernia-related complications like strangulated hernia (blood flow is cut off to the stomach) or other health concerns like heart problems or peptic ulcers. While they’re not common, these symptoms should always be met with seriousness.

Nonsurgical Treatment for Hiatal Hernia Symptoms

Most cases of hiatal hernia won’t require treatment. When symptoms are present, nonsurgical treatments include medications as well as lifestyle changes including diet modifications.

Medication

Medication for hiatal hernias is geared toward reducing symptoms of excessive stomach acid or acid reflux.Over-the-counter (OTC) antacids are the most common option for acid reflux. Taking H2-blockers like Pepcid AC or Zantac may also be recommended.

Proton-pump inhibitors (PPIs) are sometimes used to treat hiatal hernias. They work by targeting stomach acid and helping prevent acid reflux. Prescription medications may be needed when OTC options are not providing adequate relief.

Diet

Dietary changes can be particularly useful in helping manage or reduce symptoms of hiatal hernia. Changes you can make include:

• Eat smaller meals more frequently rather than larger meals less often (i.e., aim for six smaller meals instead of three larger ones).
• Avoid acidic foods that upset the esophagus lining like tomato sauce, citrus juice, vinegar, mustard, and citrus fruits.
• Limit foods containing caffeine (including coffee and chocolate), peppermint, and alcohol, which can all irritate the digestive tract lining.
• Avoid carbonated beverages.
• Avoid eating meals or snacks a few hours (three to four hours) before lying down or going to bed.

Surgery on Hiatal Hernia

Surgical options for hiatal hernias are also available, and are typically used if other treatment methods haven't worked. There are several types of surgeries for treating hiatal hernias. Which surgery is most appropriate will depend on several factors including the stage or size of your hiatal hernia.

Surgical options for hiatal hernia include:

• Repair surgery to decrease the size of the hiatus: This surgery includes sutures and a prosthetic mesh to tighten the enlarged muscle.
• Nissen fundoplication to hold the stomach in place and add pressure to the end esophagus' endpoint: This is done by stitching the fundus (upper stomach). It prevents stomach acid and food particles from flowing into the stomach.
• Collis-Nissen gastroplasty to lengthen an unusually short esophagus: This is reserved for complex cases in which lengthening the esophagus using tissue from your upper stomach may help reduce hiatal hernia.

Recovery

Recovery time after surgery for hiatal hernia depends on the method used. Some surgeries are performed through an incision in your abdomen (an open repair); others are performed through several small cuts in your abdomen and using a thin tube with a camera (laparoscopic surgery).

Laparoscopy has a shorter recovery time since it is a less-invasive procedure carrying less risk of infection, pain, and scarring.

Unless otherwise specified by your surgeon or healthcare provider, you should be able to return to physical activities after surgery, which includes walking, climbing, exercising, and having intercourse.

Complications of Hiatal Hernia

Complications associated with hiatal hernias are rare. You're much more likely to experience complications associated with paraesophageal hernias or, which is when the esophagus or parts of the stomach or other organs move up into the chest cavity.

Nonetheless, if you experience chest pains with hiatal hernia, contact your healthcare provider or seek immediate emergency medical support to avoid potential complications like blood flow restriction.

When to Seek Care for Hiatal Hernia

A hiatal hernia may require medicalcare if symptoms get progressively worse or are persistent and ongoing despite your efforts to reduce symptoms at home. You should seek care for a hiatal hernia if you are experiencing any symptoms (even if they are not chronic or consistent).

Since many cases of hiatal hernia present without symptoms, you should also be aware of GERD symptoms as they may be related to a hiatal hernia.

Summary

A hiatal hernia is when part of the stomach pushes through the hiatus, separating the abdomen from the stomach. They may or may not have noticeable symptoms. If symptoms are present, they are similar to acid reflux. Treatment includes lifestyle modifications and/or surgery where necessary. Complications are rare.