Hiatal Hernia: Get the Facts
Hernia is formed when an internal organ of the body protrudes into a weak area where it does not belong. Hiatal hernia is a type of hernia which is caused when the stomach protrudes up into the chest through hiatus, an opening in the diaphragm. The diaphragm acts as a separation between chest and the abdominal cavity. The food pipe (esophagus) moves through the hiatus and then joins the stomach.
Who Gets Hiatal Hernia?
Hiatal hernia occurs mostly in people aged 50 or more. As reported by the Esophageal Cancer Awareness Association, this condition affects up to 60% of the population by the time they reach the age of 60. Pregnant women and obese people are also at a risk of getting hiatal hernia. Any disorder which puts a strain on the abdominal region like vomiting or straining when constipated can also weaken the respective muscles and put the patient at risk for developing hiatal hernia. A condition called Ascites which occurs when excess fluid gets collected in the abdominal cavity can also lead to hiatal hernia.
Causes of Hiatal Hernia
While the exact cause of hiatal hernia is not yet known, an abdominal surgery in the past or any injury that weakens the abdominal wall can increase its risk. Normally a thin elastic membrane called the phrenoesophageal seals the gap around the esophagus as it passes through the hiatus. But sometimes with age, this phrenoesophageal membrane weakens allowing the stomach to get pushed through it. When the abdominal muscle gets weak, it becomes easy for the internal organs to bulge through the wall when the pressure is applied during coughing, vomiting, lifting heavy objects and bowel movements when constipated. Some people have large hiatus by birth which makes it easy for the stomach to move through it causing hernia. Smoking, aging and obesity are other factors that could increase the risk of hiatal hernia.
Symptoms of Hiatal Hernia
Hiatal hernia usually does not exhibit visible symptoms, but the person suffering from it may experience stomach acidity, heartburn, belching and chest pain. He or she may also have difficulty in swallowing. In severe cases, strangulation of stomach may occur shutting off its blood supply. Therefore, it is important to get the condition diagnosed if you experience any of these symptoms to avoid the condition getting worse.
Types of Hiatal Hernia
Hiatal hernia is of 2 types – sliding hiatal hernia and fixed hiatal hernia. The fixed type of hernia is also known as paraesophageal hernia.
1) Sliding Hiatal Hernia: Sliding hiatal hernia is caused when the stomach and the food pipe (esophagus) slide up into the chest through the diaphragm opening called hiatus. It is a very common type of hiatal hernia. Sliding Hiatal Hernias do not cause any symptoms.
2) Paraesophageal Hernia: Paraesophageal or fixed hernia is caused when a part of the stomach moves through the diaphragm and remains there. This type of hernia can be serious when blood supply is blocked to stomach. When this happens, it is considered a medical emergency.
Symptoms of Paraesophageal Hernia:
- Pain in the chest and abdomen
- Nausea and vomiting
- Difficulty passing stools
- Difficulty passing gas
In some cases both the stomach-oesophagus junction and part of the stomach bulge into the chest cavity and remain there resulting in a combination of both sliding and paraesophageal hernia.
Diagnosis Of Hiatal Hernia
Diagnosis of hiatal hernia can be difficult because of the lack of symptoms but sometimes the condition is discovered when the doctor investigates some other disorder of the gastrointestinal (GI) or gastroesophageal (GE) tracts. During digestion the food we eat enters our stomach and mixes with stomach acids as part of the digestion process. The inner stomach lining is well protected from the concentrated stomach acids. under normal circumstances the flow of stomach acids into the esophagus is prevented by a muscle called the lower esophageal sphincter (LES). In the case of a hiatal hernia the LES is unable to prevent stomach acids from entering the esophagus. The esophagus not having the same protective lining as the stomach, gets damaged by the acid and results in a condition called gastroesophageal reflux disease (GERD). Often when a doctor examines a patient for GERD, hiatal hernia is discovered.
The doctor diagnoses the hiatal hernia with specialized X-rays which involves the swallowing of barium by the patient. This allows the doctor to see the esophagus clearly. Endoscopy may also be done to diagnose the condition.
Treatment of Hiatal Hernia
Hiatal hernia is normally asymptotic, but when stomach strangulation occurs in the case of fixed hiatal hernia, surgery may be required. Depending on your condition, the surgery may be performed either to put back your stomach in place, make your hernia smaller or rebuild the weak muscles of your esophagus. For less serious symptoms like stomach acidity, over-the-counter or prescription medicines can be taken to neutralize the acidity. Apart from that, the person can also resort to herbal remedies or alternative treatment options like acupuncture to ease the discomfort.
How to Prevent Hiatal Hernia?
Hiatal hernia can be prevented with simple lifestyle changes such as managing weight, avoiding excess strain and certain abdominal exercises that may weaken the muscles further. Certain foods that cause heartburn such as caffeine, alcohol, chocolate, citrus fruits and spicy foods should be avoided. Quit smoking immediately if you are having symptoms of hernia.
Conclusion
Hiatus is an opening in the diaphragm through which the esophagus passes to connect with the stomach. The gap around the esophagus when it passes through the hiatus is sealed with an elastic membrane called the phrenoesophageal which keeps the abdominal cavity separate from the chest cavity. In some cases where the phrenoesophageal or the surrounding muscles are weakened, a portion of the stomach and the esophagus push through into the chest cavity and form a bulge. This is termed as hiatal hernia. These types of hernias are usually asymptomatic and do not require treatment. However in the case of a paraesophageal hernia, a part of the stomach protruding into the chest cavity might get strangulated and the blood supply cut off. Patients might experience symptoms of pain, nausea, vomiting, difficulty passing stools, gas and require medical attention.
