What does a hiatal hernia feel like?

A hiatal/hiatus hernia forms when a section of the stomach gets pushed upwards across the diaphragm. The diaphragm comprises of a tiny opening or hiatus via which the esophagus or the food pipe passes through before joining the stomach. The stomach may sometimes force its way upwards via this opening and result in the development of hiatus hernia.

A minor hiatus hernia does not cause any issues in most instances. It may often get diagnosed during a routine checkup for some other underlying condition. A large hiatus hernia can however provide access for upward passage of the stomach acid and food into the esophagus and cause heartburn. Medications and self-care methods can generally help alleviate hiatus hernia symptoms, though a very big hiatus hernia may occasionally need surgical treatment.

Symptoms of hiatal hernia and complications

Small hiatus hernia rarely cause any adverse signs and symptoms. Larger hiatus hernias can however cause varied symptoms such as:

• Belching
• Heartburn
• Fatigue
• Problems in swallowing
• Regurgitation
• Abdominal pain
• Pain in the chest that radiates from under the breastbone
• Breathlessness
• Feelings of bloating after meals
• Difficulties in passing gas
• Vomiting
• Bowel movement problems or anomalies

Persistent burning of the esophagus by stomach acid can result in an ulcerated and inflamed esophagus, i.e. esophagitis; scarring or bleeding of the esophagus; or esophageal cancer. It is therefore important to consult a doctor whenever anyone experiences any hiatus hernia symptoms.

Causes of hiatal hernia

A hiatus hernia is formed due to presence of impaired muscle tissue which permits the stomach to protrude through the diaphragm. The reasons for this are not always detectible, but doctors believe that increased pressure on the stomach can precipitate the occurrence of hiatus hernia.

The process of hiatus hernia development

The diaphragm is a big muscle shaped like a dome, which divides the abdominal area from the chest cavity. The esophagus typically makes its way to the stomach via a small opening in the diaphragm known as the hiatus. Hiatus hernia forms due to weakening of the muscle tissue that surrounds this opening, thereby allowing the upper section of the stomach to protrude across the diaphragm into the lower chest cavity.

Some of the possible causes of hiatus hernia are listed below:

• The presence of an abnormally big hiatus from birth
• Any type of injury to the region
• Extreme and prolonged pressure being exerted on the adjacent muscles, like during vomiting, coughing, lifting heavy items, or excessive straining at the time of stool elimination.

The below listed risk factors can increase the vulnerability to developing hiatus hernia symptoms:

• Obesity or being overweight
• An increased age of 50 years and above

Treatment of hiatus hernia

A majority of individuals affected by hiatus hernia do not elicit any adverse signs or symptoms, and thus do not require any medical treatment. Patients who experience different symptoms like persistent acid reflux or chronic heartburn need to consult a doctor for proper diagnosis and relevant treatment. Hiatus hernia symptoms are usually corrected with OTC and prescription medicines as well as surgery in some cases.

Acid reflux and heartburn can be alleviated and corrected with the intake of the below listed drugs:

• Antacids to overcome the effects of stomach acid. Different non-prescription antacids like Maalox, Gelusil, Mylanta, Tums, and Rolaids can quickly ease the symptoms.
• Intake of medicines to block the production of stomach acid and heal the esophageal damage. The primary drug recommended by doctors for blocking the secretion of stomach acid and allowing sufficient time for the healing process of the esophageal tissue are proton pump inhibitors. Patients may opt for OTC proton pump inhibitors like omeprazole or lansoprazole. You may also consult a doctor to get prescriptions for stronger forms of these drugs.
• H-2-receptor blockers to decrease the production of stomach acid. Patients can take famotidine, cimetidine, ranitidine, and nizatidine, or stronger prescription versions.

Surgical repair of a hiatus hernia involves the following:

• Sometimes certain instances of hiatus hernia, although few in number, may need to be corrected via surgery. Surgical treatment of hiatus hernia is usually performed in emergency situations where medicines do not help in alleviation of acid reflux and heartburn. In most cases, hiatus hernia repair surgery is carried out along with surgical correction of GERD or gastroesophageal reflux disease.
• Hiatus hernia surgical repair typically involves pulling down the stomach back into the abdomen and reducing the size of the opening in the diaphragm, removal of the hernia sac, or surgical reconstruction of an impaired esophageal sphincter.
• In some instances, hiatus hernia surgery is performed by making a single incision in the abdomen, i.e. laparotomy; or in the chest wall, i.e., thoracotomy.
• In other instances, the surgeon may opt for a laparoscopic surgery wherein he/she will make many tiny incisions in the abdomen. A special instrument with an attached tiny camera is then inserted into the abdomen through any one of the incisions. The doctor will then carry out the surgery by using special surgical instruments inserted via other incisions and using the images displayed by the camera on a video monitor, for reference.