Hernia is a common condition in which part of an internal organ or tissue bulges through a defect within the muscle. Hiatal hernia occurs when the upper part of stomach bulges through an opening (hiatus) within the diaphragm. The diaphragm is a large muscle, which separates your abdomen and chest.
Your diaphragm has multiple small openings through which various structures move between the chest and abdomen. Your food tube (esophagus) passes through one of these small openings and connects to the stomach. Hiatal hernia occurs when the stomach pushes up through that opening and enters into your chest.
A small hiatal hernia usually does not cause problems and most people are unaware of its existence unless detected during exams conducted for other purposes. A large hiatal hernia will cause the back flow of food and acid contents from your stomach to the esophagus, causing one or more of the following symptoms:
The risk of hiatal hernia can be reduced by decreasing the intra-abdominal pressure. It can be achieved by:
Most cases of hiatal hernia are not life threatening. Rarely, blood supply to the trapped part of stomach is reduced resulting in ischemia and gangrene. It is a surgical emergency and a surgery is needed to relieve the trapped part of stomach. When this condition occurs, you will experience:
Your doctor will make a diagnosis of hiatal hernia by taking a detailed history and physical examination. Since hiatal hernia is present inside abdomen and through the diaphragm, it is not visible from outside and physical examination may be completely normal. Hiatal hernia is usually diagnosed when your doctor performs certain tests for the evaluation of heartburn, difficulty swallowing or bad taste in mouth. These tests include:
If your hiatal hernia is not causing any symptoms and is not uncomfortable, your doctor may advise for a “wait and watch” approach. In the meantime, you will be advised to:
Surgery is the only treatment to cure hiatal hernia and bring the stomach back to the abdomen. The opening in your diaphragm will be made smaller to prevent recurrence of hiatal hernia. It can be achieved by open hernia repair and laparoscopic hernia repair.
In open hernia repair, your doctor will give an incision in the abdominal or chest wall. After incision, your doctor will move the bulged part of stomach back into the abdomen, and will then repair the diaphragm opening with stitches to fill the gap and prevent hernia to occur again. Your doctor may also place a synthetic mesh to provide additional support.
In laparoscopic hernia repair, your doctor will not give a big incision but rather will make several small, half-inch incisions in the abdominal wall. Your doctor will then insert a laparoscope, which is a thin tube with a tiny video camera attached. Your doctor will then push back stomach into the abdomen and will repair the defect using synthetic mesh.
You must visit your doctor, if along with heartburn you are having one or more of the following symptoms:
To prevent constipation, increase your water intake, use stool softeners, and increase dietary fiber intake. No limitations on physical activity. Standard moderate physical activity of at least 30 minutes for at least five days per week is recommended.