A hiatal hernia is a larger-than-normal opening in the diaphragm, the sheet of muscle that separates the chest and abdominal cavities. A hiatal hernia occurs when the upper part of the patient's stomach protrudes into the chest, allowing food and stomach acids to back up into the esophagus. Although many patients with hiatal hernias have no symptoms, some have indigestion, heartburn, difficulty swallowing, nausea and vomiting, abdominal pain and bloating. Medication and lifestyle changes often relieve these symptoms, but sometimes surgery is necessary, according to the Merck Manuals Online Medical Library.
Dietary Adjustments
Food and stomach acids backing up from the stomach into the esophagus are the source of many of the unpleasant symptoms experienced by hiatal hernia patients. Patients should eat small meals four to six times a day, stop eating two to three hours before going to bed and limit fluids during meals to minimize acid reflux , according to Aurora Health Care. Eliminating certain foods and beverages can also be helpful. Peppermint, coffee, fatty foods, alcohol and coffee should be avoided because they relax the the muscle in the opening between the stomach and esophagus, allowing reflux. Foods that irritate the esophagus, including citrus, tomatoes, carbonated beverages and hot peppers, should also be limited or avoided. Losing excess weight reduces the pressure on the abdomen, helping to relieve symptoms of hiatal hernia.
Lifestyle Changes
Smoking weakens the sphincter between the stomach and esophagus, so patients with hiatal hernias should quit smoking, according to the Merck Manuals. Wearing loose clothing to prevent constriction around the abdomen and raising the head of the bed on 6-inch blocks are simple measures that many patients find helpful. After meals, patients should avoid lying down, exercising or bending over to reduce the risk of reflux.
Medication
Over-the-counter antacids taken at bedtime can help relieve heartburn and reflux symptoms by neutralizing stomach acids, says the Merck Manuals, but these medications do not heal the underlying condition. Other medications--proton pump inhibitors and histamine-2 blockers--reduce the amount of stomach acid produced and can help to heal ulcers if taken for a full four- to 12-week course. H2 blockers are available by prescription and some are also sold over-the-counter. Proton pump inhibitors are prescription medications while omeprazole is available over-the-counter and by prescription. Other types of medications, including bethanechol or metoclopramide, help to strengthen the muscle that controls the flow of stomach acid into the esophagus, but these drugs are only used on a limited basis because of their side effects.
Surgery
Although many patients find relief through lifestyle changes and medication, those who continue to have symptoms related to gastroesophageal reflux disease may need surgery to correct the hiatal hernia, according to the Merck Manual. A strangulated hernia, characterized by nausea or vomiting, inability to have a bowel movement or pass gas, pain with eating or an early feeling of fullness, also requires surgery. The procedure may be done through an incision in the abdomen or laparoscopically, using a tiny camera and special instruments to operate through several small incisions in the abdomen or chest.
