A hiatal hernia develops when a portion of the stomach slides upward into the chest cavity through the esophageal hiatus (opening) of the diaphragm, the broad tough muscle that separates the chest from the abdomen. If this opening becomes increasingly weakened, powerful stomach acid flows backward from the stomach into the esophagus, irritating it and producing symptoms of heartburn. In severe cases (which are rare) the stomach may protrude upward into the lower chest.
Hiatal hernias may develop in people of all ages and both sexes, but the condition is most common in those over 50. Many people, in fact, have a small hiatal hernia but aren’t aware of it until, complaining of chronic heartburn, they visit a doctor. Fewer than 20 percent of the individuals with hiatal hernias ever experience any symptoms. (Usually, the hernia shows up only incidentally on an x-ray.) Most hiatal hernias don’t need treatment, though surgery may be necessary when the hernia is in danger of becoming strangulated (constricted in such a way that blood flow is cut off)—a complication that is quite rare. Severe esophagitis (inflammation of the esophagus) may also necessitate treatment.
Symptoms of Hiatal Hernia
- Heartburn that occurs one to four hours after eating
- Severe chest pain
- Difficulty swallowing after eating
What Causes Hiatal Hernia?
The most frequent causes of hiatal hernia are muscle weakness due to normal aging and increased abdominal pressure from coughing, straining with constipation or sudden overexertion. Pregnancy, obesity, heredity, smoking, stress, and frequent bending over or heavy lifting can also contribute to a hernia.
What If You Do Nothing?
Small hiatal hernias are common and usually harmless. If you have been told by your physician that you have a hiatal hernia, you should take precautions to avoid episodes of heartburn, as described below. Otherwise, the hernia and associated heartburn can lead to inflammation, scarring, or narrowing of the esophagus.
Home Remedies for Hiatal Hernia
If hiatal hernia symptoms become troublesome, practice the following self-help measures (similar to those for heartburn).
- Keep meals small. Eat meals four to five times daily. Also, eat slowly and avoid lying down for two or three hours after eating—practices that help prevent heartburn.
- Watch what you eat and drink. Try to avoid high-fat foods, since they tend to slow gastric emptying. Likewise, alcohol can induce heartburn, so you should avoid it as well, along with citrus juices and caffeine, which can trigger or worsen symptoms.
- Don’t smoke. Smoking helps increase the production of stomach acids and the coughing caused by smoking can aggravate the hernia.
- Don’t wear constricting garments. Tight trousers, pantyhose, girdles and belts put undue pressure on the hernia.
- Avoid straining during bowel movements. The key to this is to avoid constipation.
- If heartburn does strike, take antacids. The discomfort of occasional heartburn—once or twice a month—can be relieved by taking an over-the-counter antacid, which should bring relief quickly.
There is no known way to prevent a hiatal hernia.
Beyond Home Remedies: When To Call Your Doctor
Contact your physician if you have persistent symptoms of a hiatal hernia. Also contact your doctor if symptoms fail to improve after one month of treatment.
What Your Doctor Will Do
After taking a careful history and performing a physical examination, your physician may suggest various diagnostic tests to discover if there is any obstruction (for which you may be referred to a gastroenterologist). Your physician may prescribe antacids to prevent stomach acids from irritating the hernia. If constipation is a problem, a change in your diet may be recommended.
Persistent reflux (regurgitation of stomach contents into the esophagus) can lead to changes in the esophageal tissue (such as the development of esophageal ulcers and/or Barrett’s esophagus) and so should be managed and monitored by a gastroenterologist.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media