A hiatal hernia is an anatomical abnormality that occurs when a portion of your stomach pushes upward through the hiatus, a natural opening in your diaphragm. Hiatal hernias are common -- especially in adults over 50 years old -- and often cause no symptoms. Sometimes, however, a hiatal hernia can cause acid reflux, in which digestive fluids splash back up into your esophagus, causing painful heartburn symptoms.
Hiatal Hernia Features
The word "hernia" means "rupture" in Latin. Weakened tissue that allows your stomach to bulge upward through your diaphragm contributes to the formation of a hiatal hernia. Other factors include injury and persistent pressure on the surrounding muscles caused by coughing or straining during bowel movements. Lifting heavy objects can also make you susceptible to a hiatal hernia. You are more likely to have a hiatal hernia if you are obese, a smoker, and over 50 years old. Hiatal hernias are usually diagnosed with a barium X-ray. Rarely, hiatal hernias can cause complications such as pulmonary aspiration -- breathing food into the airway -- bleeding, iron deficiency anemia and strangulation of the stomach.
Hiatal Hernia Symptoms
Symptoms of a hiatal hernia include heartburn, often experienced as a burning sensation in the middle of the chest directly behind the breastbone. Often, the pain worsens when you are bending over or lie down. Difficulty in swallowing, nausea, belching and bloating can also occur.
A hiatal hermia can be treated with over-the-counter antacids, which can soothe heartburn by neutralizing stomach acids but are ineffective at healing an inflamed esophagus. H-2 receptor blockers -- such as cimitidine, famotidine and ranitidine -- decrease stomach acids, and can provide longer-lasting relief. Proton pump inhibitors such as omeprazole can block acid production and promote healing, and are available over the counter and in prescription form. In severe cases, surgery may be needed to decrease the size of the opening in your diaphragm or rebuild a weak esophageal sphincter. Operations are usually performed laparoscopically, using miniaturized surgical tools and video monitors.
To alleviate symptoms of hiatal hernias, doctors advise eating smaller, more frequent meals and avoiding common heartburn triggers such as chocolate, onions, spicy foods, citrus fruits, tomatoes and tomato sauce. Other lifestyle changes that may be helpful include restricting or avoiding alcohol and fatty foods, losing weight if you're overweight, stopping smoking and elevating your bed 6 inches at the head.
According to University of Maryland Medical Center, deglycyrrhizinated licorice may help ease hiatal hernia symptoms. The website advises taking 250 to 500 mg per day of an extract standardized to contain 20 percent glycyrrhizinic acid. The Doctor's Book of Home Remedies lists ginger root, bitters, fennel and apple cider vinegar as remedies worth trying. Consult your doctor before using herbs to treat a hiatal hernia.
According to UMMC, one alternative method that has not been shown to be effective is manipulation of the hiatal hernia by massaging the stomach or applying pressure. The website reports that there is no evidence that this technique works.