What Is a Hiatal Hernia and How Does It Impact Digestion?
If you landed on this page, you may be here out of curiosity or from a diagnosis your doctor recently gave you that includes the words: hiatal hernia.
After reading this post, I hope you can walk away with a better understanding of what hiatal hernia actually is, how it may impact digestion, and what can be done about. If that all sounds like what you’re looking for, keep reading!
What is a hiatal hernia?
A hiatal hernia is a condition in which in the upper part of the stomach pushes up through the diaphragm (a muscle between the abdomen and chest) and into the chest. If you are struggling to visualize this, place your hand on your throat (this is where your esophagus starts!) and slowly move your hand down your chest to highlight your esophagus. As you get to the bottom of your rib cage, you will go over your diaphragm, which is located at the base of your lungs (behind your rib cage), and then reach your stomach.
With a hiatal hernia, the stomach goes trough the muscle and creates an opening called a hiatus. How far the stomach goes can vary between people and can worsen with time. In some cases, the stomach may push up through the esophagus, causing the esophageal sphincter (the opening between the esophagus and stomach) to remain open and gaping. This sphincter should be closed unless food is moving through it, in order to prevent acid and other contents of the stomach from moving up through the esophagus. Stomach acid can damage tissues and this “reflux” of contents can cause pain and discomfort.
Hiatal hernias typically occur in individuals aged 50+ and will impact around 60% of people ages 60 years or older. (source: Esophageal Cancer Awareness Association)
Potential causes of hiatal hernia:
Putting too much pressure (repeatedly) on the muscles around your stomach: coughing, vomiting, straining during BMs, lifting heavy objects
Injury or damage that weakens muscle tissue
Large hiatus at birth
Pregnancy
The different “types” of hiatal hernia, include:
Sliding hiatal hernia (most common) - occurs when the stomach and esophagus slide into and out of the chest through the hiatus
Fixed hiatal hernia (aka paraesophageal hernia) - the stomach pushes through the esophagus and stays there
Want to learn more about IBS? Sign up for a free IBS mini course here!
Symptoms of hiatal hernias
Hiatal hernias don’t always cause symptoms for those who have them.
Symptoms that can happen include:
Heartburn (typically worsens when someone leans over or lies down)
Chest pain or epigastric pain
Trouble swallowing
Belching
Constipation (likely due to slow motility in the upper GI tract)
Nausea
There’s usually no major risk of having a hiatal hernia, but occasionally an issue can arise, including an obstruction or strangulated hernia. Signs of this can include severe nausea, vomiting, and the inability to pass gas or empty bowels. Another concern could be Barrett’s Esophagus, which happens when acid from the stomach damages esophageal tissue, which then increases the risk of esophageal cancer. Typically, proton pump inhibitor (PPI) medications will be prescribed to prevent this.
Due to decreased risk associated with the hernia, treatment typically revolves around symptom management. Surgery can be used to fix the hernia, but is not commonly recommended due to risks.
Hiatal hernia surgical options include:
Fundoplication: surgeon wraps the upper part of the stomach (fundus) around the lower portion of the esophagus to create a permanently tight sphincter so the stomach contents will not move back into the esophagus.
Nissen fundoplication: several small incisions are made via laparoscopy to create a sphincter at the bottom of the esophagus.
After surgery, it’s possible for the hernia to come back. With that known and the risks that can come with surgery, these options aren’t always used.
For symptom management, this may include the use of medications and diet/lifestyle changes. Medications can be used to help with symptoms and prevent any damage to the esophagus due to reflux. They will not “treat” or fix the hernia. These include:
Over-the-counter antacids - neutralize stomach acid
Over-the-counter or prescription H2-receptor blockers - lower acid production
Over-the-counter or prescription proton pump inhibitors (PPIs) - prevent acid production (can help short term with esophagus healing)
Diet and lifestyle changes may include:
Optimizing meal times with smaller meals, spacing between meals, adequate chewing, and separation of liquids from meals.
Smoking cessation if smoking is a factor.
Modifying foods that trigger reflux and heartburn.
Elevating the head of the bed while sleeping to avoid overnight reflux.
Adjusting posture during and after meals to avoid excess reflux.
Most of these changes can be made with the help of a registered dietitian (schedule a consult with our team if you’re looking for 1:1 care). In some cases, a referral to a physical therapist with a specialty in visceral manipulation could also be helpful. This is something you could ask your doctor about!
Do you want clear guidance to manage your IBS so you can feel confident in your body again?
