Hiatal Hernia: Symptoms, Causes & Treatment

What is Hiatal Hernia?

Resting transversely between your chest and abdomen is a muscle called the diaphragm. The heart lies above it, the stomach below it and the esophagus runs through it. The diaphragm has an opening called a hiatus and, sometimes, the muscles of the stomach can press up against the diaphragm and bulge through the hiatus. This is what’s known as a hiatal hernia.

Small hiatal hernias often do not pose much of a threat and may not produce any symptoms. However, larger hiatal hernias may cause food and acid to reflux, leading to heartburn and GERD.

A hiatal hernia occurs in two main forms — sliding and paraesophageal. The most common type is the sliding hiatal hernia, which causes the stomach and the esophagus to slide up through the hiatus. A paraesophageal hernia, on the other hand, is rare, but has more severe consequences. It causes a section of the stomach to squeeze through the hiatus where it can get trapped, causing “strangulation” to the displaced part of the stomach.

Since a hiatal hernia may not produce any symptoms, a person may never realize he or she has one. When symptoms do arise and medical help is sought, x-ray, endoscopy and/or esophageal manometry is used to diagnose this condition.

Unless more severe complications arise, treatment mainly focuses on reducing the discomfort associated with heartburn and GERD. This includes diet and lifestyle changes, medication and/or dietary supplements. In some cases, laparoscopic surgery might be required.

Hiatal Hernia Symptoms

Hiatal hernias may not cause any noticeable problems, especially if they’re small. However, more serious hiatal hernias can cause a whole range of symptoms. They include:

• Heartburn
• Involuntary food regurgitation
• Acid reflux
• Problems swallowing
• Indigestion
• Hiccups
• Coughing
• Shortness of breath
• Chest or abdominal pain
• Vomiting blood
• Passing black stool, which is often a sign of gastrointestinal bleeding

The symptoms of a hiatal hernia can mimic those of a heart attack. In fact, many people only realize they have a hernia when they seek treatment for what they think is a cardiovascular event. For example, chest pains that radiate to the back, neck and arms can occur during heart attacks and as a result of a hernia. During a heart attack, however, people may also experience jaw ache, pain located mostly in the shoulders and arms, heart palpitations, sweating and extreme weakness or fatigue. Chest pains are always a cause for concern, so when in doubt, seek help right away.

Also, see a doctor if you are vomiting blood, experiencing palpitations, feeling faint, having a persistent cough or fever, experiencing shortness of breath, having dark, tarry stool or unable to swallow liquids or solids.

Causes of Hiatal Hernia

Several factors can cause the stomach to herniate through the hiatus. Women who are pregnant, people over 50 and smokers are more likely to experience one. Sudden physical exertion like coughing, vomiting or lifting something heavy can cause it as well.

Hiatal Hernia Remedies and Supplements

Some people with hiatal hernia do not experience symptoms. Therefore, they don’t seek treatment. However, many others experience symptoms such as recurring heartburn and acid reflux, which can be treated with diet and lifestyle adjustments, medication, dietary supplements and/or surgery.

Diet and Lifestyle

Most of the causes of hiatal hernia cannot be prevented. However, obesity is one of the preventable causes of hiatal hernia. Maintaining a healthy weight and not smoking are two ways to minimize risk.

Since gastrointestinal reflux (GERD) is a common complaint with hiatal hernias, following treatment protocol for GERD is recommended. This means avoiding acidic foods that can trigger reflux, eating smaller, more frequent meals, not eating a few hours before bedtime, remaining upright after eating and wearing loose-fitting clothing.

Foods to Avoid:

• Citrus fruits including lemon, lime, grapefruit and orange
• Cranberries and cranberry juice
• Peppermint
• Spearmint
• Fried and fatty foods
• Coffee
• Tea
• Garlic
• Onions
• Alcohol
• Carbonated beverages
• Tomato-based foods including pizza, spaghetti sauce and salsa
• Butter

On the other hand, some foods have low acid levels and are not likely to exacerbate the symptoms of hiatal hernia. These foods include:

• Grains
• Green beans
• Bananas
• Apples
• Carrots
• Broccoli
• Cheese
• Lean meat
• Rice
• Pasta
• Bread
• Fish
• Chicken
• Low-fat milk or yogurt
• Low-fat chocolate or sweets

Since fatty foods can exacerbate GERD caused by a hiatal hernia, certain cooking methods make food easier to digest. Steaming, broiling and baking keep the fat content down compared to cooking methods like frying. In addition, consider skimming off the fat from meat if possible before cooking.

Medication

Recommended medications for GERD caused by a hiatal hernia focus on reducing the acid in the stomach. Over-the-counter or prescription antacids like omeprazole or lansoprazole may provide relief. Consult with your healthcare professional before starting any medications.

Supplements

Aloe Vera

Just like how it can soothe irritated skin, aloe vera soothes and relieves irritation of the esophagus caused by acid reflux. As a dietary supplement, take 1,000 mg once daily with 8 oz of water or as directed by a physician. People with diabetes, kidney problems or ulcerative colitis shouldn’t use aloe.

Fennel 

Fennel may help promote digestive health. The recommended dosage for this supplement is 1,000 milligrams once or twice per day. However, avoid using this product if you are allergic to carrots and celery. Consult your doctor first before taking this supplement if you are pregnant, breastfeeding or have skin sensitive disorders or hormone-sensitive disorders.

Ginger

This supplement is known for its anti-inflammatory properties. In addition, it eases abdominal and digestive discomfort. Ginger also contains bioactive compounds with antacid effects. The recommended dosage for ginger is 1,000 milligrams per day taken with lots of water. Discuss with your doctor before using this supplement, especially if you are pregnant or have diabetes.

Surgery

Surgery may be recommended for the treatment of hiatal hernia and associated symptoms in some cases. This, however, is often the last resort and is commonly used on patients who are unresponsive to heartburn and acid reflux medication or have severe inflammation and narrowing of the esophagus. Surgery is also the most appropriate treatment in cases where blood flow is cut off from the stomach as a result of the hernia.

The Bottom Line

A hiatal hernia occurs when stomach muscles push the esophagus against the muscles of the diaphragm. Many times, this condition does not produce any symptoms. However, patients may experience acid reflux and complications resulting from reflux. The symptoms of hiatal hernia may look similar to those of a heart attack. Therefore, seek medical advice if you are not sure whether what you are experiencing are signs of a hiatal hernia or heart attack. Anyone can get a hiatal hernia, but obesity and old age increase the risk of having the condition. Treatments include antacids and/or surgery. Supplements are also recommended to promote gut health and soothe irritation.