How to Treat a Hiatal Hernia

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Hiatal hernias don't always create symptoms, but they can be painful.
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Most hiatal hernias rarely cause symptoms. But if yours bothers you, there are some steps you can take to feel better. Changes in diet and losing weight are a good place to start, according to the Cleveland Clinic.

What Exactly Is Hiatal Hernia?

There is an opening in the diaphragm, the muscle that separates your chest from your belly, for your esophagus to pass through and attach to the upper part of your stomach. The opening is called the hiatus.

A hiatal hernia occurs when the upper part of your stomach slips up into your chest cavity, states the Mayo Clinic. It means your hiatus is too wide or weak to hold your stomach in its normal place. Your diaphragm gets weaker with age, so these hernias are more common in people who are over age 50 and overweight.

Though many people with hiatal hernia have no symptoms, it's possible to experience the same symptoms as with GERD, or gastroesophageal reflux disease, which stems from acidic stomach juices from your stomach backing up into your esophagus, says Mayo Clinic. This acid is what causes the burning pain commonly known as heartburn.

You might also experience the unpleasant taste of stomach acid in the back of your mouth, belching and stomach discomfort, according to the Cleveland Clinic. The main cause of a hiatal hernia is pressure in your belly pushing your stomach through your hiatus, and that can create chest pain as another symptom, says Cleveland Clinic.

Read more: Exercising With a Hernia

Treating Symptoms of Hiatal Hernia

People sometimes wonder, "If I lose weight, will my hiatal hernia go away?" Fact is, losing weight can't correct a hernia, but it can help you manage symptoms.

"If you have a small hiatal hernia that causes occasional symptoms, simple lifestyle changes can help," explains Abdul Haseeb, MD, an assistant professor of gastroenterology at the Stritch School of Medicine in Chicago. "These include losing weight if you are overweight, and avoiding increased abdominal pressure. This pressure can come from coughing, straining to have a bowel movement or heavy lifting." Your doctor may need to treat you for a long-term cough or constipation.

"For a larger hernia that causes more persistent symptoms, other lifestyle changes may be needed," says Dr. Haseeb. "These include diet changes, like eating smaller meals and avoiding meals for two to three hours before lying down or going to bed. It also helps to raise the head of your bed off the ground."

"Over-the-counter antacids can help mild heartburn, but they can cause rebound heartburn," he says. "Your doctor may recommend an over-the-counter medication to block acid, [and] for more severe symptoms, you may need a prescription or over-the-counter medication called a proton pump inhibitor."

And, according to Cleveland Clinic, making lifestyle changes may also help. These include:

  • Avoiding foods that irritate your esophagus, like citrus fruits, fatty foods, coffee, peppermint and alcohol
  • Quitting smoking because smoking increases acid and heartburn
  • Not wearing tight-fitting clothing, which increases pressure on your belly

Fixing a Hiatal Hernia

When lifestyle changes, weight loss and medications are not easing your hiatal hernia symptoms, your doctor may want to do an imaging test of your esophagus to assess your condition. Called an esophagoscopy, it uses an instrument called a scope that's outfitted with a camera, explains Columbia University Irving Medical Center's Department of Surgery. It can detect if your stomach is being squeezed too much and can spot any signs of damage like an ulcer, bleeding or scarring.

If results show that just managing your hiatal hernia isn't enough, you may need surgery to fix it. This is often done as laparoscopic surgery, considered a minimally invasive technique.

"Surgery is usually done through a few tiny incisions using an operating scope and long thin instruments," says Dr. Haseeb. The goal of the surgery is to tighten the hiatus and the valve between the esophagus and the stomach — the esophageal sphincter — and return the stomach to its normal position.

Keep in mind that hiatal hernias are only a problem when they cause gastroesophageal reflux symptoms, says Cleveland Clinic. Work with your doctor to manage these symptoms, and let him or her know if your treatment isn't helping, especially if your symptoms are getting worse.

Read more: Exercise and Inguinal Hernias

Is This an Emergency?

To reduce the risk of spreading COVID-19 infections, it is best to call your doctor before leaving the house if you are experiencing a high fever, shortness of breath or another, more serious symptom.
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