A hernia occurs any time that one part of the body protrudes through a tear or an opening into another part of the body. This is quite commonly seen in the abdominal area but, in truth, can happen anywhere in the body. Hiatal hernias, or diaphragmatic hernias, form down at the opening of diaphragm, right where your esophagus joins your stomach. Normally, these small hernias don’t cause any noticeable problems and, in fact, it is very common that people can have them and not even know it. A large hiatal hernia, however, can cause food and stomach acid to leak back up into your esophagus, causing heartburn and sharp or burning chest pains, as well as paving the path for other problems to move in. So what are the symptoms of a hiatal hernia, and what can be done to treat them? Join us as we take a closer look at hiatal hernias and what can be done to both prevent, and to treat existing ones.
Signs and Symptoms
Quite often, people do not even realize they have a hiatal hernia until the doctor diagnoses one, while examining the patient for another condition. In most cases, small hiatal hernias cause little or no problems. Larger hernias, however, may cause conditions such as belching, heartburn, or chest pains as the acid moves up into the base of the esophagus. Quite often, these symptoms may worsen when a person is pregnant, leaning forward, straining, or attempting to lift any heavy objects. Sometimes, this condition may be even more uncomfortable when the person attempts to lay down and, in rare cases, part of the stomach may twist or lose blood flow, resulting in difficulty swallowing and an obstruction of the esophagus. Not only is this extremely uncomfortable, but it can also cause severe chest pains.
What Causes a Hiatal Hernia?
Your esophagus connects to your stomach after passing through a dome-shaped muscle, known as the diaphragm. Important for breathing, the diaphragm also helps to prevent the stomach from pressing up into the esophagus but, in some cases, this muscle will become weakened and its ability to prevent that from happening is severely hampered. Anything that puts pressure on the abdomen, such as severe coughing, vomiting, straining when having to go to the bathroom, lifting heavy objects, or even pregnancy, can cause a hiatal hernia to occur. Hiatal hernias are a major contributor to many cases of gastro esophageal reflux, the condition created when the lower esophageal sphincter is displaced, allowing stomach acid to back up into the esophagus.
Numerous complications can arise with people who suffer from a hiatal hernia, particularly if it is large. Some of the larger hernias have been known to cause lesions in the upper stomach, due to friction; if these lesions become severe enough, they can cause bleeding and the patient may suffer from anemia, due to chronic blood loss. Sometimes, the hernia may be so large that as much as one third of the stomach, sometimes more, protrudes up through the diaphragm, putting additional stress on this muscle, as well as the lungs. In rarer cases, the part of the stomach that protrudes up into the esophagus may become twisted, or strangulated, reducing blood flow to the rest of the stomach, and causing extreme chest pains and difficulty swallowing. Quite often, these require immediate surgery, in order to alleviate the problem.
Gastroesophageal reflux disease, or GERD, is believed to be the most common complication of the hiatal hernia. A condition created when stomach acid repeatedly backs up into the esophagus, GERD itself can also lead to further complications, including inflammation and scarring of the esophagus, a condition known as Barret’s esophagus (when cells, much like those that make up the lining of the stomach, begin to grow in the esophagus), or even esophageal cancer. While it was originally thought that all hiatal hernias contributed to GERD, it is now believed that only the larger ones contribute to gastro esophageal reflux disease.
Your Doctor: Diagnosis and Treatment
Most often, hiatal hernias are discovered when the doctor attempts to determine the reason for an existing condition, such as a recurring case of heartburn or chest pains. These hernias are normally discovered through one of two means; either by barium x-ray, where the patient is required to drink a chalky liquid that will allow the doctor to x-ray their esophagus, stomach, and the upper part of the small intestine, or by endoscopy, where a small, flexible tube equipped with a tiny light and video camera system, is passed down the throat and into the esophagus and stomach, checking for signs of inflammation. Endoscopy is also helpful in that, not only is it a gentler method of checking for a hiatal hernia, but it is also a sensitive method of checking for any kind of damage to the esophagus, resulting from reflux.
In many cases, hiatal hernias do not require any treatment and are usually go unnoticed by the patient. If you are experiencing recurring gastroesophageal reflux on a regular basis, however, you may wish to speak with your doctor about it, and the possibility of a hiatal hernia. There are various options available; for mild cases, over-the-counter antacids can provide temporary relief for heartburn and, if your problems continue, you can also speak to your physician about H-2 blockers to reduce the amount of acid that your stomach secretes, or proton pump inhibitors, which blocks the production of stomach acid.
Sometimes, surgery is required in order to alleviate the problems associated with hiatal hernias – usually only if medications and changes in lifestyle fail to relieve the symptoms, or if there is chronic bleeding or obstructions in your esophagus. In most cases, this surgery is fairly simple and consists of pulling the stomach down into the abdomen and making the opening into the diaphragm smaller. In some cases, the esophageal sphincter may require reconstruction, if it has become too damaged, but most of these surgeries are completed, either by creating a small incision in the chest wall or in the abdomen. Your doctor can advise which type of surgery is best for you, if surgery is needed.
If you’re diagnosed with a hiatal hernia, there are several things that you can do, in order to alleviate some of the discomfort that may be associated with these, and help to prevent the condition from worsening. These include the following:
Eat smaller meals: Smaller meals are easier for you to digest but, even more importantly, do not distend your stomach and push it upwards.
Limit fatty intakes: Fatty foods are slow to digest and they tend to relax the lower esophageal sphincter. This allows more time for acid to back up into your esophagus.
Avoid problem foods: Some foods, such as onions, cucumbers, spicy foods, mints, and chocolate. Alcohol and caffeinated drinks can also help to increase stomach acid, and it’s a good idea to avoid tomatoes and citrus fruits, as they can irritate the stomach or an inflamed esophagus.
Rest after you eat: While we might joke about needing to run around the block a few times, after eating a large meal, ideally, you want to wait at least 2-3 hours prior to engaging in any kind of strenuous activity, giving your stomach a chance to start digestion and to settle down.
No bedtime snacks: Stop eating at least 3 hours prior to your bedtime. Not only will it help avoid weight gain, but it ensures that most of the food you have eaten has passed through the stomach and into the small intestine, preventing it from refluxing back up into your esophagus.
Stop smoking: Smoking increases the risk of acid reflux, as well as drying up the saliva that helps lubricate the throat, protecting it from reflux.
Lose weight: Slimming down will help you feel better in many ways, but it also helps to alleviate some of the pressure on your stomach. Many doctors believe that this is one of the most important things that can be done, in order to alleviate the symptoms of a hiatal hernia.
There are many ways of alleviating the problem, should you find yourself diagnosed with a hiatal hernia. In most cases, the best options can be reached, simply by discussing it with your doctor. In the meantime, try and stick to a healthier lifestyle and take care of yourself; losing weight, stopping smoking, and eating smart can go a long way in the treatment of a hiatal hernia. Start today and make the right changes.