You've got pain in your abdomen that you can't quite identify, though it does remind you of heartburn. Maybe you've begun noticing it more as you've gotten older. It could be a sliding hiatal hernia, common in people older than 50, especially people who are overweight, according to the Mayo Clinic.
What Causes a Hiatal Hernia?
Your chest is separated from your stomach by a muscle called the diaphragm. Normally the opening where your esophagus passes through your diaphragm to attach to your stomach — the hiatus — is tight enough to keep your stomach out of your chest cavity. But this opening can become weak and wide due to aging or from repeated pressure pushing the stomach against the diaphragm, states Mayo Clinic.
Other conditions that can push the stomach through the diaphragm include chronic coughing, straining to have a bowel movement (often from constipation), heavy lifting, previous surgery on the diaphragm or vomiting, adds Mayo Clinic. Pregnancy may also weaken the diaphragm, according to Johns Hopkins Medicine.
There are actually two main types of hiatal hernias, with sliding hiatal hernias being the more common, according to the Medical College of Wisconsin. The other is called a paraesophageal hernia because it occurs next to the esophagus, adds the college.
"A sliding hernia means the upper part of your stomach slides up through the opening between your chest and your stomach," explains Abdul Haseeb, MD, an assistant professor of gastroenterology at the Stritch School of Medicine in Chicago. "A larger hernia allows stomach juices that should stay in your stomach to seep up into your swallowing tube — your esophagus."
Read more: Exercising With a Hernia
Hiatal Hernia Pain and Other Symptoms
Small hiatal hernias rarely cause any symptoms, says Dr. Haseeb. When the hernia is larger, symptoms are likely to include heartburn and a sour taste in the back of your throat, the same symptoms as you'd have for gastroesophageal reflux disease, commonly called GERD.
"Most of these hernias are discovered when a person is being evaluated for GERD," says Dr. Haseeb. The acids in gastric juices produced in the stomach are not meant to be in your esophagus. When you have gastroesophageal reflux, those acids back up, causing the burning pain in the chest known as heartburn.
According to the National Institute of Diabetes and Digestive and Kidney Diseases, heartburn can be felt in your upper belly or behind your breastbone.
If you have a large hiatal hernia, Mayo Clinic says you might also experience symptoms such as:
- Regurgitation of foods or liquids into your mouth
- Swallowing difficulties
- Pain in your chest or abdomen
- Shortness of breath
Diagnosis and Treatment of Sliding Hiatal Hernia
"Most hiatal hernias are diagnosed when a gastroenterologist places a flexible scope with a camera through the mouth down into the stomach to evaluate symptoms of GERD," says Dr. Haseeb. "This is called an upper endoscopy. This procedure has mostly replaced X-ray studies called barium swallow."
"Treatment depends on the size of the hernia," he adds. "Small hernias that cause symptoms can be treated with lifestyle changes like losing weight and avoiding putting pressure on the hernia from coughing, heavy lifting or constipation. Your doctor might treat your cough or constipation."
Larger hiatal hernias may be treated with other lifestyle changes, like eating smaller and more frequent meals, not lying down for at least two hours after eating and raising the head of your bed off the floor. Medications that block or reduce stomach acid may be used to reduce symptoms. Surgery is rarely needed, Dr. Haseeb explains.
Read more: Hernia Abdominal Exercises
When to Call Your Doctor
"Sliding hiatal hernias are common and usually not dangerous, but you should let your doctor know right away if you have worsening symptoms, trouble swallowing or bleeding," says Dr. Haseeb.
Bleeding from a hiatal hernia can cause you to vomit blood, but it may pass through your digestive system and cause black stool, according to Mayo Clinic. These symptoms are rare, but they require immediate medical attention.
Is This an Emergency?
- Mayo Clinic: “Hiatal Hernia”
- Abdul Haseeb, MD, MPH, assistant professor of medicine, division of gastroenterology, Stritch School of Medicine, Chicago
- National Institute of Diabetes and Digestive and Kidney Diseases: “Symptoms & Causes of GER & GERD”
- Medical College of Wisconsin: “Paraesophageal Hernia”
- Johns Hopkins Medicine: "Conditions We Treat: Hiatal Hernia"