Hiatal Hernia Symptoms

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You may find that certain lifestyle changes can help to control the symptoms of acid reflux caused by a hiatal hernia. For example:

• Eat more than three times, taking smaller meals throughout the day and not just three large meals.
• Make sure to avoid foods that trigger symptoms such as  heartburn - for example, onions, spicy foods, citrus fruits, tomatos, and so on.
• Cut down or give up alcohol
• Don’t eat fatty foods in abundance
• Sit up after eating and avoid lying down
• Take food three hours before bedtime
• Lose weight if you happen to be overweight or even obese
• Stop using cigarettes
• Prop up the head of your bed by about 6 inches
• Reduce the stress in your daily life.

Most people who have a hiatal hernia don’t have any symptoms, and don’t need any treatment. But if you have recurrent heartburn and acid reflux, it might be advisable to look at treatment, either medication or surgery.

Medication for heartburn & acid reflux

If you experience either heartburn or reflux medications such as these may be helpful:

• Over-the-counter antacids, such as Maalox, Gelusil and Tums, may provide short term relief. But these antacids alone cannot heal the inflammation of the esophagus caused by stomach acid. Furthermore, overuse of some antacids may cause diarrhea or constipation.
• H-2-receptor blockers such as Tagamet (cimetidine), Pepcid AC, Zantac and Axid AR stop the production of stomach acid. They provide longer relief and can be obtained on prescription if you require a stronger version. 
• Proton pump inhibitors stop acid production and allow damaged esophageal tissue to heal. Lansoprazole (Prevacid 24HR) and omeprazole (Prilosec OTC) are available over the counter, while stronger versions are available in prescription form.

Surgery for hiatal hernia

Sometimes a hiatal hernia may require surgery, but this is generally reserved for emergency cases such as people who aren’t helped by medications. Hiatal hernia repair surgery is often done at the same time as surgery for gastroesophageal reflux disease.

Hiatal hernia surgery can involve pulling the stomach down into the abdomen, then making the opening in the diaphragm smaller, as well as reconstructing the muscles of the weak esophageal sphincter.  This may be done with a single incision in your chest wall (thoracotomy) or abdomen (laparotomy). But it can also be done with key hole surgery, a tiny camera and special surgical tools being inserted through several small incisions in your abdomen. The images from inside your body are displayed on a video monitor (laparoscopic surgery) for the surgeon to work from.

What exactly is a hiatal hernia (also known as a hiatus hernia)?

The wall of the diaphragm is made of muscle and separates your chest cavity from your abdomen. The esophagus – the tube down which you swallow food and liquids – enters your stomach through a hole in the diaphragm called the hiatus. As you might expect, a hiatal hernia occurs when the muscles which surround this hole lose their normal strength, permitting the upper part of your stomach to move up through the diaphragm and enter the chest cavity.

What causes a hiatal hernia?

A hiatal hernia – also known as a hiatus hernia – happens when weakened muscle tissue permits part of your stomach to move up through the wall of your diaphragm. It’s not clear why this sometimes occurs, but part of the reason may be pressure on your stomach; this is thought to contribute to the appearance of a hiatal hernia. This means there are several possible causes, including:

• injury to the area
• natural weakness of the msucles in the area
• having an unusually large hiatus
• pressure and strain on the muscles of the area caused by persistent coughing, vomiting, straining on the toilet, or lifting heavy objects

Symptoms of hiatal hernia

Most small hiatal hernias don’t show any signs or symptoms.

Large hiatal hernias can cause heartburn, belching, nausea, acid reflux, and chest pain. Note that hiatal hernia is most common in people over 50 who are overweight. Another risk factor is being a smoker.

Do I need to see a doctor?

Obviously you should see a doctor if you have persistent worrying symptoms. Start with your family doctor or general practitioner. And if he diagnoses a hatus hernia, but it doesn’t respond to treatment,  ask to see a gastroenterologist. Whenever you see a doctor, be prepared:  make a note of symptoms you’re experiencing, whether or not you think they are hiatal hernia related. Also, make a note of key events or changes in your life that may be related to your symptoms. Don’t be afraid to ask questions, and make sure you understand what is being said.

If you have a  hiatal hernia, some basic questions are:

• What might have caused this hiatal hernia?
• Will I need treatment?
• Do I need more tests to confirm the diagnosis?
• What treatment is available?
• What are the benefits and risks of each option?
• What else do I need to do? (e.g. lifestyle changes)

Tests to confirm a hiatal hernia

A hiatal hernia may be found during some other procedure, but is usually discovered when a doctor investigates the cause of heartburn, acid reflux, and chest or upper abdominal pain. Diagnostic methods include:

• X-rays of the digestive tract. Patients usually have a so-called barium X-ray, which means you drink a liquid containing barium, a compound that does not transmit X rays. It coats your esophagus, and gives a silhouette of your esophagus and stomach on an X ray pictures, which will show if you have a hiatus hernia. 
• An endoscopy exam involves your doctor passing a thin tube equipped with a light and telescopic camera into your esophagus and stomach to check for inflammation – he or she can literally see the hernia if one is present.

If you have suspected hiatal hernia, you may need to attend the doctor’s surgery for a series of tests. These examinations may seem daunting and may take some time, but you should not get stressed over this issue. Here I explain the various tests that a suspected hiatal hernia patient undergoes during the diagnostic procedure.

The first visit to the surgery may call for tests to rule out more serious or life threatening causes such as heart disease. A thorough medical history will be taken to establish associated symptoms, health circumstances and risk factors for various diseases. You will need to tell the doctor about foods or activities that lessen or worsen the symptoms. A physical examination will focus on the digestive, pulmonary (lungs), and cardiovascular (heart) systems. Also a rectal test and stool test for blood may be necessary to assess if there is bleeding  from the digestive tract.

As the symptoms of hiatal hernia are similar to those of other diseases, you will probably be asked to undergo other tests to rule out heart or lung problems. These are some of the tests that may be used in the examination. An electrocardiogram (ECG) looks for electrical disturbances of the heart.  This device is a diagnostic tool that measures and records the electrical activity of the heart in minute detail. Interpretation of its results allows diagnosis of a wide range of heart conditions. The patient is ‘wired’ to a machine, which may seem scary but there is nothing to fear.

When problems that produce hital hernia symptoms need to be eliminated, a chest X-ray may be used to look for pneumonia, collapsed lung, or other problems in the chest.  The test is a common non-invasive radiology test that produces an image of the chest and the internal organs. The chest is briefly exposed to radiation from an X-ray machine and an image is produced on a film or into a digital computer. To prepare for a chest X-ray, the patient wears a gown and removes all metallic objects around the upper body. No other specific preparation, such as fasting, is necessary.

 A simple blood test is taken to look for anaemia, infection, or injury to the heart, pancreas, or liver. This involves simply taking a small sample of blood using a syringe.

Also, in checking for a hiatal hernia, a barium swallow may be performed by a radiologist. The patient drinks some contrast material, and X-rays are taken as the stuff goes down. The material is barium sulphate, a metallic compound that shows up on X-ray and is used to help see abnormalities in the oesophagus and stomach. The X-rays track its path throughout the digestive system.

And finally, to eliminate stomach problems which can produce the sypmtoms of hiatal hernia, a gastroenterologist may perform an endoscopy. Endoscopy is a broad term used to described examining the inside of the body using a lighted, flexible fiberoptic scope called an endoscope. The endoscope is introduced into the body through the mouth and although it can include examination of other organs, the most common procedures evaluate the oesophagus, stomach, and portions of the intestine. It can detect an ulcer, tumour, or other tissue damage.

So that is what you may experience for suspected hiatal hernia. Some doctors prescribe just some of these procedures. Others go through the whole course of action. The important thing to remember is that these tests may seem frightening but they are perfectly safe.