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Hiatal Hernia Hiatal Hernia
A hiatal hernia develops when the top portion of your stomach pushes up through the opening in your diaphragm that allows the esophagus through... Hiatal Hernia

by Kimberly Allen, RN

A hiatal hernia develops when the top portion of your stomach pushes up through the opening in your diaphragm that allows the esophagus through to connect with the stomach.  Hiatal hernias can affect anyone at anytime, however, they are more common in adults over 50 years of age. In fact estimates are that approximately 60% of adults over 50 years of age have a hiatal hernia.  Obesity is also a significant risk factor for developing a hiatal hernia.stomach_diagram
There are several possible reasons why a hiatal hernia develops though the cause is not always clear.  Children that have hiatal hernias usually are born with an unusually large opening in the diaphragm for the esophagus to pass through.  Any injury to the diaphragm or the muscles in the area can cause a hiatal hernia.  The most common cause is persistently placing severe pressure on the muscles surrounding the stomach and diaphragm.  For example, severe coughing episodes that can occur during an upper respiratory infection, straining during a bowel movement, and lifting objects that are too heavy without using proper body mechanics.  These activities weaken the muscles around the diaphragm and stomach.
There are two types of hiatal hernias, the sliding type and the fixed type of hiatal hernias.  The sliding type is by far the most common with approximately 95% of all hiatal hernias being this type.  In this type the junction between the esophagus and stomach slides up through the opening in the diaphragm at times of increased pressure on the stomach and/or muscles surrounding the stomach and diaphragm.  Then once the pressure is removed the stomach slides back down into it’s normal position.  The fixed type also known as para esophageal hiatal hernia as the name implies does not slide.  Fortunately only 5% of hiatal hernias are this type.  People with this type of hiatal hernia can develop severe complications especially of the hernia is large.  Because this type of hernia stays up through the opening in the diaphragm and can put pressure on the esophagus interfering with the food passing through and into the stomach.  This can also cause ulcers to develop in the stomach.
The symptoms of hiatal hernia depends on the type and size of the hernia you have.  Most hernias are the sliding type and rarely have symptoms unless they are larger.  The larger the hernia the greater your chances of having symptoms.  When people with sliding hernias have symptoms they are usually the same as the symptoms associated with GERD,  heartburn, regurgitation, and nausea.  People with the fixed type may also experience increased difficulty swallowing and have some upper abdominal pain depending on the size of the hernia.
Treatment of hiatal hernias depends on the severity of symptoms.  For those that experience recurrent heartburn and/or acid reflux the Dr will usually recommend the same medications as those used to treat GERD.  Most recommend starting with over the counter antacids and medications that decrease acid productions known as H-2 receptor blockers like Zantac and Pepcid Ac or if there is damage to the esophagus the Dr may recommend medications that both block acid production and heal the esophagus, like Prilosec OTC, and Prevacid 24HR.  If your hiatal hernia is large and impairing your ability to swallow your Dr may recommend surgery.  Surgery usually involves pulling your stomach back through the opening in the diaphram into the abdomen and making the opening in the diaphragm smaller and repairing and damage to the band of muscle tissue that surrounds the opening into the stomach called the LES.
Maintaining a healthy weight and avoiding overeating as well as learning to use proper body mechanics when lifting heavy objects can help to prevent hiatal hernias.

Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to HealthAndFitnessTalk.com, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at  mussatti3@gmail.com.

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