A hiatal hernia happens when a part of your abdomen pushes upward through your diaphragm. Your diaphragm normally contains a little opening (hiatus) through which your food tube (esophagus) passes on its way to connect with your abdomen. The abdomen can push up through this gap and cause a hiatal hernia. In a hiatal hernia (also referred to as hiatus hernia) the abdomen bulges up into the chest through that gap.
In most cases, a small hiatal hernia does not cause issues, and you’ll never recognize you have a hiatal hernia unless your doctor discovers it when checking for another condition.
But a large hiatal hernia can allow food and acid to back up into your esophagus, resulting in heartburn. Self-care measures or medications will usually relieve these symptoms, although a very large hiatal hernia generally needs surgery.
The exact reason for many hiatal hernias isn’t best-known. In some individuals, injury or other damage could weaken muscle tissue. This makes it possible for your abdomen to push through your diaphragm.
Another cause is putting an excessive amount of pressure (repeatedly) on the muscles around your abdomen. This can happen when:
- straining during bowel movements
- lifting heavy objects
Some individuals are also born with an abnormally large hiatus. This makes it easier for the abdomen to move through it.
Factors which will increase your risk of a hiatal hernia include:
Types of hiatal hernia
There are usually two types of hiatal hernia: sliding hiatal hernias and fixed, or paraesophageal, hernias.
Sliding hiatal hernia
This is the more common type of hiatal hernia. It happens when your abdomen and esophagus slide into and out of your chest through the hiatus. Sliding hernias tend to be little. They mostly don’t cause any symptoms. They may not need treatment.
Fixed hiatal hernia
This type of hernia isn’t as common. It’s also referred to as a paraesophageal hernia.
In a fixed hernia, a part of your abdomen pushes through your diaphragm and stays there. Most cases don’t seem to be serious. However, there’s a risk that blood flow to your abdomen might become blocked. If that happens, it might cause serious damage and is considered a medical emergency.
Common symptoms include:
- heartburn that gets worse when you lean over or lie
- chest pain or epigastric pain
- trouble swallowing
Medications your doctor may prescribe include:
- over-the-counter antacids to neutralize abdomen acid
- over-the-counter or prescription H2-receptor blockers that lower acid production
- over-the-counter or prescription proton pump inhibitors to prevent acid production, giving your esophagus time to heal
If medications don’t work, you may need surgery on your hiatal hernia. However, surgery isn’t usually recommended.
An operation for a hiatal hernia could involve pulling your stomach down into your abdomen and making the gap in your diaphragm smaller, reconstructing a weak esophageal sphincter, or removing the hernia sac.
To perform surgery, doctors either make a regular incision in the chest or abdomen, or use laparoscopic surgery, that shortens recovery time.