Everything You Need To Know About Hiatal Hernia

Hiatal hernia is a condition where the upper part of your stomach bulges through the large muscle separating your abdomen and chest (diaphragm). It obtained its name from hiatus which is a small opening in the diaphragm through which the food tube (esophagus) passes before connecting to the stomach. 

How dangerous is hiatal hernia?

The most dreaded danger of hiatal hernia is that it could hamper the blood supply to the stomach. That could be strangled or totally cut off. People with hiatal hernia are more likely to suffer from heartburn or esophageal reflux disease (GERD). Often both the symptoms are linked but not always. (Also Read: Difference Between GERD and Heartburn- Symptoms and Treatment )

Symptoms of hiatal hernia

Hiatal hernia does not show any symptoms. Most are found incidentally when a person has chest X- rays or abdominal X-rays, including an upper GI series or CT Scans in which the patient swallows some contrast material. It is also discovered incidentally during endoscopy of the stomach, duodenum, and esophagus. Some symptoms due to GERD are as follows:

• Heartburn

You may feel a burning sensation in your chest which is the result of acid reflux (GERD). You may feel it after eating food or even sometimes suddenly while sleeping.

• Difficulty in swallowing

You may feel dysphagia, i.e., difficulty swallowing, as hiatal hernia can cause delay and obstruction in emptying the lower part of stomach or esophagus which ultimately results in difficulty in gulping down the food or any drink.

• Abdominal pain and tenderness

Severe excruciating pain keeps on increasing making it unbearable.

• Cough

The acid present in the esophagus can cause a reflux phenomenon in the airway and cause you to cough.

• Vomiting blood

If you have strangulated hiatal hernia, your stomach can become blocked and can lead to ulcers which will cause you to vomit blood. The ulcers form in the lining of your esophagus.

• Passing of black stools

This indicates gastrointestinal bleeding and you will pass black stool which will be a sign of anemia and will indicate blood loss which may also be due to abdominal bleeding.

• Shortness of breath

This happens in very large para-esophageal hernia as the stomach may push on the diaphragm or compress the lungs contributing to a sensation of shortness of breath.

• Acid reflux

Back-flow of stomach acid into the esophagus as hiatal hernia will make the contents of the stomach to reflux more easily into the esophagus. 

• Water brash

You may feel the rapid appearance of a large amount of saliva in your mouth which is stimulated by acid reflux.

• Chest pain or burning

Because the top of the stomach pushes into the lower chest after eating, this will cause chest burn or chest pain. This could also be a result of acidity.

Also Read: Diet for Hiatal Hernia Patients

Causes of hiatal hernia

Although the causes of hiatal hernia are not clear, some possible reasons are as follows:

• Obesity
• Pregnancy or multiple pregnancies
• Persistent and intense pressure on the surrounding muscles due to strenuous weight lifting, coughing
• Constipation
• Being born with a larger hiatal opening than usual
• Aging that changes your diaphragm: 
• Damage from a surgery or an injury

  People who are at risk

The below-mentioned category of people is more likely to suffer from hiatal hernia. 

• Obesity
• 50 years of age or above
• Females during pregnancy
• Weight lifters

Also Read: What To Expect At the Doctor’s During A Hernia Test?

Tests and procedures that diagnose Hiatal Hernia

1. Barium swallow or upper GI series:
   Here, a radiologist uses fluoroscopy to observe in real-time as the barium that is swallowed outlines the esophagus, stomach and upper part of the small intestine. By this, he can see the anatomy and can also comment on the movement of the muscles that work to propel the barium and food into the stomach and beyond through the esophagus.
2. Endoscopy:
   Endoscopy procedure is performed by giving sedatives to the patient. The gastroenterologist then looks at the lining of the esophagus, stomach, and duodenum. It is used to determine complications of GERD through acid reflux or narrowing of the esophagus by the physician. 
3. CT scan, X-rays, EDG:
   Because hiatal hernia does not cause any signs as such, it is incidentally diagnosed through gastrointestinal x rays, EDG and sometimes CT Scan. Hence, with associated symptoms of GERD, a person is more likely to have hiatal hernia. 

What type of treatment can be helpful?

Treatment usually depends on the severity and symptoms. If you do not have any symptoms, you won’t need any treatment. You may look for a proper medical practitioner’s guidance and advice to treat symptoms of acid reflux, if any, exist. These may be:

• Antacids to weaken your stomach acid: 

Do not overuse antacids as they may result in some side effects. Medicines such as Mylanta, Rolaids and Tums may provide quick relief from acidity and acid reflux.

• Medications to reduce acid production: 

Medications that prevent your stomach from producing acids such as proton pump inhibitors or H-2 receptor blockers may help. You should strictly follow them as per the prescription.

• Prokinetics: 

Prokinetics to make your esophageal sphincter- the muscle that keeps stomach acid from backing up into your esophagus. 

How do you fix it? 

If medications do not work, your doctor may advise surgery as an option. By surgery, your stomach is pulled back into the abdomen and the opening of the diaphragm is made smaller. The procedure may also include repairing the esophageal sphincter or removing hernia sacs. 

Types of hiatal hernia surgery

There are majorly three types of hiatal hernia surgeries. These are all done under general anesthesia and require 2-3 hours to complete. These are:

• Open repair

During this procedure, your surgeon will make one large incision in your abdomen and pull the stomach back into place by manually wrapping it around the lower portion of the esophagus. This creates a tighter sphincter. Your doctor may find it appropriate to insert a tube to keep your stomach in place which is usually removed in 2-4 weeks. This procedure is invasive in nature.

• Laparoscopic repair

This procedure is less invasive, recovery is quicker and there is a very less chance of infection. In laparoscopic surgery, your surgeon will make 2-3 small incisions around the groin area and will insert a small camera in and through one of those incisions. Thereafter, the surgeons will put the stomach into the abdominal cavity where it belongs. They will wrap the upper part of the stomach with the lower part of the esophagus to create a tight sphincter and keep reflux from occurring. This surgery is preferred by those who want quick recovery, less scarring and discomfort.

• Endoluminal fundoplication 

This is the newest and least invasive procedure. No incisions. The surgeon will insert an endoscope which has a lighted camera, through your mouth and down into the esophagus. Thereafter, they place small clips at the points where the stomach meets the esophagus which will prevent the stomach acid and food from backing up into the esophagus.

How can you prepare yourself before the hiatal hernia surgery?

There are some ways that will prepare you for the surgery. These are:

• Take medicines only as prescribed by the doctor at least one week to surgery.
• Not taking non-steroidal anti-inflammatories at least one week before surgery.
• Walking 2 to 3 miles per day.
• Not smoking for 4 weeks before surgery.
• Performing several breathing exercises as many times a day.
• Not eating or drinking for at least 12 hours before the surgery.

Dos and don’ts for recovery

• Wash the incision area gently with soap and water after surgery
• Avoid baths, pools or hot tubs. Stick to shower only
• Follow the restricted diet suggested by the surgeon to prevent the stomach area from extending which involves 4 to 6 small meals per day instead of three large meals per day
• Start typically with a liquid diet and then move to soft diets such as mashed potatoes and scrambled eggs
• Do not consume food that might cause gas such as corns, cabbage, cauliflower, beans
• Avoid drinking through a straw
• Avoid citrus food and tomato products
• Stop Consuming alcohol
• Avoid carbonated drinks
• Perform breathing and coughing exercises suggested by your doctor to strengthen your diaphragm
• Start walking as soon as the doctor permits to avoid clotting in your legs

Also Read: Things To Do and Avoid During Hernia

Final Words

This is major surgery and will require 2-3 weeks to fully recover. You can perform normal routine activities after a week. But remember, take proper rest to avoid any complications later and do not perform strenuous acts until you are totally fit to do so. Keep your body relaxed for at least a month before performing more laborious work that demands a lot of hard work or physically demanding jobs.

After the recovery phase passes, you should still avoid certain food and beverages as per your doctor’s advice that could trigger GERD. Speedy recovery is in your hands. Just proper knowledge, awareness, and discipline are important. For more queries, you can call us or write to us anytime. Our medical coordinator will get back to you soon. 

Also Read: Effective Diet Tips for Hernia Patients