Hiatus hernia : A guide to Hernias

A hiatus hernia occurs when part of the stomach protrudes upwards into the chest. The upper part of the stomach pushes up into this area which results in pain, discomfort and heartburn. : A guide to Hernias

A hiatus hernia is common in people aged 50 and over, women, smokers and people who are overweight or obese.

Hiatus hernia and a brief overview of the abdominal cavity

Your chest and abdomen are separated by a thin sheet of muscle called the diaphragm. The diaphragm contains an opening called the ‘hiatus’ through which the oesophagus (long tube which runs from your mouth to your stomach) passes through. Food is transported down this tube into your stomach where it is broken down by acids.

What can go wrong?

Unfortunately the hiatus is a weak point in the diaphragm and this weakness results in the stomach pushing up into the chest cavity – hence the name ‘hiatus hernia’.

This is further compounded by the failure of the oesophageal sphincter – a ring-shaped muscle at the base of the oesophagus where it joins the stomach. This normally closes to prevent the contents of the stomach from flowing up this tube.

This sphincter acts as a valve but if a hiatus hernia has developed then this protrusion stops it from closing off the bottom of the oesophagus. Acid and other contents of the stomach are able to flow up the oesophagus which causes damage over a period of time.

Two types of hiatus hernia

There are two types of hiatus hernia which are:

• Sliding hiatus hernia
• Rolling hiatus hernia

Sliding hiatus hernia

This is the most common type of hernia and accounts for eight out of ten hiatus hernia cases. It gets its name from the fact that this type of hernia slides in and out of the chest area.

The top part of the stomach and the oesophageal sphincter (ring-shaped muscle) pushes up through the hiatus into the chest. The problem with this is that it prevents the sphincter muscle from closing properly which then allows stomach acid to flow up through the oesophagus.

Rolling hiatus hernia

This is less common than the sliding hiatus hernia and only affects around two out of ten hiatus hernia cases. Part of the stomach pushes up into the chest via the hiatus (opening in the diaphragm) but the oesophageal sphincter remains below the diaphragm.

Another name for this is a ‘para-oesophageal hernia’.

The causes of a hiatus hernia

A hiatus hernia is caused by several factors rather than just the one overriding factor. These include:

• Age: people aged 50 and above are more prone to this type of hernia due to a weakening of the structure of the diaphragm.
• Pregnant women: pregnancy puts a strain on the abdomen, which weakens muscles and increases the risk of a hernia.
• Obesity: being severely overweight can put undue pressure on the abdomen, resulting in weakened muscles and the risk of a hernia.
• Smoking: smoking often causes bouts of coughing which put a strain on the abdominal muscles, resulting in a weakness and the formation of a hernia.
• Straining: straining during a bowel movement can weaken the abdominal muscles and result in a hernia.
• Birth defect: this type of hernia occurs in babies due to incomplete development of the diaphragm or abdomen.

The symptoms of a hiatus hernia

These include:

• Heartburn
• Acid reflux: this is caused by the flow of stomach acid into the oesophagus.
• Difficulty in swallowing (due to stomach acid)
• Chest pain
• Belching
• Severe hiccups
• Croaking voice
• Asthmatic-like symptoms

In some cases, people don’t experience any symptoms and only discover they have a hernia if they have undergone an investigative procedure such as an endoscope.

But others will experience some or all of the symptoms listed above. You may recognise some of these symptoms and also find that these worsen after a meal, if you bend forward or if you lie down.

Can these symptoms be reduced?

They can be eased or even prevented if you adopt any of the following:

• Losing weight if you are overweight or obese
• Stopping smoking
• No alcohol
• Not eating last thing at night
• Avoiding spicy, hot or acidic meals
• Eating small, healthy meals and ‘little and often’
• Raising the head of the bed by about six inches to prevent acid reflux
• Avoid wearing anything tight

Complications of a hiatus hernia

In most cases, a hiatus hernia doesn’t present any problems but occasionally, it can turn nasty. The main problem is the formation of ulcers within the oesophagus which is caused by the flow of stomach acid. This can also damage the oesophageal sphincter.

If these ulcers bleed then this may cause blood to be vomited. If you experience this then seek immediate medical attention

A bleeding ulcer can also result in anaemia –a condition in which there are too few red blood cells in the body. This leads to tiredness, heart palpitations and breathlessness. If left untreated it can then lead to complications such as heart disease.

Another problem is that of a strangulated hernia: this is where a part of the stomach that has protruded into the chest area is tightly squeezed within that area.

Diagnosing a hiatus hernia

If you think you may have a hiatus hernia or any other type of hernia then book an appointment with your GP. He/she will discuss your symptoms with you as well as your medical history. He or she will also examine you.

Your GP will refer you to a specialist if necessary who will conduct a series of tests which include:

• Barium meal and X-ray: this involves you swallowing liquid containing barium which coats the inside of your stomach. This will clearly show the inside of your abdomen and problems such as a hernia.
• Blood test
• Endoscopy: a popular test for detecting a hernia. It involves passing a long, thin tube with a camera mounted at one end through your mouth and into your stomach. This enables the specialist to check the condition of your oesophagus and stomach and to see if you have developed a hernia.

Treatment for a hiatus hernia

If you are not experiencing any symptoms then you are unlikely to require treatment although there are a few self-help steps you can take. These include eating healthily, watching your weight and avoiding any heavy lifting.

But if you do experience symptoms then changing your current lifestyle and taking antacid medicines may help.

The danger with a hernia is that it can increase in size and in some cases, become squeezed or strangulated which then cuts off the blood supply. If this occurs then emergency surgery is required to prevent further damage.

Surgery is the preferred option and is discussed in greater detail in our treatment for hernias section.

Other types of hernia you may be interested in:

• Inguinal hernia
• Femoral hernia
• Umbilical hernia
• Incisional hernia
• Epigastric hernia
• Spigelian hernia
• Sports hernia