A hiatal hernia occurs when the upper part of your stomach bulges through your diaphragm into your chest cavity.
A hernia occurs when one part of the body protrudes through a gap or opening into another part. A hiatal hernia forms at the opening in your diaphragm where your food pipe (esophagus) joins your stomach. Part of the stomach pushes through this opening causing a hiatal hernia.
Most small hiatal hernias don't cause problems, and you may never know 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, leading to heartburn and chest pain. Self-care measures or medications can usually relieve these symptoms, although very large hiatal hernias sometimes need surgical repair.
Signs and symptoms
These signs and symptoms tend to become worse when you lean forward, strain, lift heavy objects or lie down, and they can also worsen during pregnancy.
In rare cases
Pressure on the abdomen
You may have an increased risk of hiatal hernia if:
Children with the condition are usually born with it.
When to seek medical advice
Many people discover they have hiatal hernias when they see their doctors about heartburn. Most cases of heartburn are mild and temporary. But if your symptoms are severe, occur often, or are accompanied by coughing, wheezing, asthma, a sore throat, difficulty swallowing or chest pain, talk to your doctor.
If you know you have a large hiatal hernia and experience severe chest pain, difficulty breathing or trouble swallowing, seek medical care immediately.
Screening and diagnosis
Your doctor may discover a hiatal hernia while trying to determine the cause of heartburn or chest or upper abdominal pain. In that case, it's likely to be found during one of the following procedures:
Bleeding and anemia
Reduced blood flow to stomach
Ordinarily, the diaphragm is aligned with the lower esophageal sphincter, which relaxes to allow food and liquid to flow into your stomach when you swallow. The diaphragm supports and puts pressure on the sphincter to keep it closed when you're not swallowing. But a hiatal hernia raises the sphincter above the diaphragm, reducing pressure on the valve. This permits the sphincter muscle to open at the wrong time, allowing stomach acid to back up into the esophagus.
A hiatal hernia can also cause heartburn if the herniated portion of your stomach becomes a reservoir for gastric acid, which can then easily travel up your esophagus.
Recurrent GERD itself can lead to complications, including:
If you don't have any signs or symptoms from a hiatal hernia — and most people don't — you probably won't need any treatment. But if you're experiencing recurrent gastroesophageal reflux, you may get relief from a few simple changes in your lifestyle. If you're overweight, losing weight alone may relieve your symptoms.
An operation for a hiatal hernia may involve pulling your stomach down into your abdomen and making the opening in your diaphragm smaller, reconstructing a weak esophageal sphincter, or removal of the hernia sac. In some cases, this is done using a single incision in your chest wall (thoracotomy) or abdomen (laparotomy). In other cases, your surgeon may insert instruments and a fiber-optic camera through several small incisions in your abdomen. The operation is then performed while your surgeon views the images on a video monitor (laparoscopic surgery).
Laparoscopic surgery generally causes less pain and scarring and requires a shorter hospital stay than does thoracotomy or laparotomy. The procedure that's best for you may be determined by the kind of hernia you have and the experience of your surgeon.
A variety of lifestyle changes can help ease the gastroesophageal reflux that may accompany a hiatal hernia. Some or all of the following measures may help: