Hiatal Hernias 101: Types, Causes and Treatments

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A common and sometimes silent condition, a hiatal hernia happens when your stomach bulges up into your chest through an opening in your diaphragm, which is the muscle that separates the two areas. In some cases, if the hiatal hernia is small, it may not cause you any problems. You might not even know you have one unless your doctor discovers it when checking for another condition.

A large hiatal hernia, on the other hand, can allow food and acid to back up into your esophagus, which may cause you heartburn. “In the case of a very large hiatal hernia, your doctor could recommend surgery,” says AdventHealth board-certified general surgeon Carlos Ortiz-Ortiz, MD.

4 Types of Hiatal Hernias

There are four main types of hiatal hernias, including:

1. Sliding Hiatal Hernia

This is one of the more common types, where your stomach and lower part of your esophagus slide into your chest through the diaphragm.

2. Fixed Hiatal Hernia

Also known as a paraesophageal hernia, this is considered more dangerous than a sliding hiatal hernia. In this case, “Your esophagus and stomach are where they’re supposed to be, but part of your stomach squeezes through the hiatus — which is the opening of the diaphragm — and sits next to your esophagus,” says Dr. Ortiz-Ortiz.

With a fixed hiatal hernia, your stomach could become squeezed, causing a loss of blood supply.

3. Combination of Sliding and Fixed Hernias

“With a combination of these two hernias, the gastroesophageal junction is herniated above the diaphragm,” explains Dr. Ortiz-Ortiz, “and the stomach is herniated alongside the esophagus.”

4. Stomach or Another Organ Herniated Into the Chest

In addition to the stomach, other organs, like the colon, small intestine and spleen, can also herniate into the chest.

Causes of Hiatal Hernias

If you’re diagnosed with any of the above types of hiatal hernias, Dr. Ortiz-Ortiz explains that your hernia could have various causes, including:

  • An injury to the area

  • Being born with a larger hiatal opening than usual

  • Changes in the diaphragm as you age

  • Pressure in the surrounding muscles due to pregnancy, coughing, heavy lifting, straining or vomiting

“Your physician can work with you to understand the causes of your hernia, as well as the best path forward,” says Dr. Ortiz-Ortiz.

Hiatal Hernia Symptoms and Risk Factors

Hiatal hernias are more common in women than men, as well as those who are:

  • Doing a lot of heavy lifting

  • Overweight

  • Over the age of 50

And while some people with smaller hernias do not experience symptoms, others with larger hernias may experience:

  • Bloating
  • Burping

  • Chest pain

  • Heartburn from acid reflux

  • Shortness of breath

Dr. Ortiz-Ortiz recommends that you seek medical attention immediately if you experience these symptoms, as they could be signs of a strangulated hernia:

  • Cannot pass gas or empty your bowels

  • Severe pain in your chest or belly

  • Upset stomach and vomiting

Diagnosis and Treatment for Hiatal Hernias

For your doctor to get an accurate diagnosis and recommend the best possible treatment plan, you may undergo a barium swallow, which is where you are asked to drink a liquid and then have an X-ray done to get a better look at the esophagus and stomach.

If your doctor performs an endoscopy, a long, thin tube will be inserted with a camera on the end to show the inside of your esophagus and stomach. With an esophageal manometry, the tube goes down your throat to check the pressure in your esophagus when you swallow.

Treatment Options

If you have acid reflux, your doctor may recommend antacids to weaken the stomach acid, along with proton pump inhibitors or H-2 receptor blockers to prevent your stomach from making so much acid. In the case of very large paraesophageal hernias, surgery may be necessary.

This operation would likely be laparoscopy surgery, where a few small incisions are made in your stomach area so a laparoscope can be inserted. Pictures from the laparoscope are then sent to a monitor for the care team to review.

Laparoscopic surgery is minimally invasive, with smaller incisions allowing for less pain and scarring and a quicker recovery. A successful surgery can result in a rebuilding of the weak esophageal muscles, the stomach being put back into place and a smaller hiatus.

Your doctor may also recommend lifestyle changes to help with acid reflux symptoms, such as:

  • Avoiding certain foods

  • Citrus

  • Spicy foods

  • Fried or fatty foods

  • Chocolate

  • Alcohol

  • Caffeine

  • Avoid smoking

  • Eat smaller meals

  • Do not exercise or lie down immediately after eating (wait three or four hours)

It’s important to remember that hiatal hernias can come back after surgery. To reduce this risk, it is recommended to maintain a healthy weight, get help when lifting heavy objects and avoid straining your abdominal muscles.

We’re Here to Help You Heal From Hiatal Hernias

Our team is dedicated to listening to your concerns, offering a quick, accurate diagnosis and offering leading-edge treatment options that get you back to the life you love. To learn more about hiatal hernias and to schedule an appointment with Dr. Ortiz-Ortiz, click here.

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