Most people know that heartburn and acid reflux can sometimes be caused by hiatus hernias. The question is, exactly what is a hiatus hernia? What are hiatus hernia symptoms and how can it be treated? Read on to find out…
What is a Hiatus?
Let’s begin by looking at what the hiatus is, where in your body it is located and how it normally functions…
Your chest is separated from your abdomen by a predominantly horizontal, thin and flat muscle at the lower end of your rib cage. Known as the diaphragm, this muscle moves up and down to regulate respiration.
For any structure (like your oesophagus, for instance) to pass through this muscle, there must, of course, be an opening. This opening is called a hiatus.
The oesophagus is a muscular tube that:
- Runs from your mouth via the chest (behind the heart and lungs) and through a tight hiatus (the oesophageal hiatus) within the diaphragm to the stomach
- Contracts regularly to propel food from your mouth down and into the stomach.
When the oesophageal hiatus works properly, it tightly grips the oesophagus just above your stomach. At this, the thickest point of the oesophagus’ wall, there is a muscle that seals off the stomach by contracting.
Called the lower oesophageal sphincter (LOS), this muscle opens after swallowing to allow food to pass into your stomach. It then quickly closes again and stays closed to prevent reflux of food or acidic stomach contents back into your oesophagus.
What is a Hiatus Hernia?
A hiatus hernia occurs when the opening (the hiatus) within the diaphragm loses its tightening effect (i.e. it becomes wider than normal), which allows:
The oesophagus to divert from its normal position, and
Part of your stomach to bulge upwards through the widened opening.
In most cases, the resulting hernia allows the stomach to regularly move up and down via the hiatus. This is known as a sliding hernia.
In some cases, however, the widening of the hiatus combines with a defect or weakening within the oesophagus’ outer membrane to allow a so-called peritoneal sac to form alongside the oesophagus. This is called a rolling hiatus hernia.
What Causes Hiatus Hernias?
While the exact causes of hiatus hernias are unclear, pressure within sufferers’ abdominal cavity is believed to be a potential contributing factor. Doctors investigating the causes of a patient’s persistent acid reflux may therefore ask whether the patient has recently experienced intense, frequent periods of:
- Severe vomiting
- Constipation (and consequent straining)
- Sneezing or coughing
- Bending or heavy lifting
Other possible risk factors for the development of hiatus hernias are obesity and pregnancy, both of which may in some people generate extra pressure inside the abdominal cavity.
Hiatus Hernia Symptoms
Symptoms can vary between individuals, although heartburn resulting from acid reflux into the lower oesophagus is the most symptom. Other possible symptoms may consist of:
- Bad breath
- A bitter taste
- Food regurgitating into the mouth
- Coughing due to acid reflux irritating the throat
- The latter may also trigger oesophagus spasms, which in turn may cause extensive, potentially severe chest pains.
Many people experience no symptoms at all or only when engaged in activities likely to increase pressure onto the diaphragm (i.e. when they are lying or bending down).
Diagnosis of Hiatus Hernias
Doctors are likely to perform various tests to rule out potential other causes of their patient’s symptoms and/or confirm a hiatus hernia. Such tests may include:
X-rays of the gastrointestinal tract. This involves the patient drinking a liquid containing barium prior to a series of x-rays being taken. The barium will provide contrasting images of the upper gastrointestinal tract and its function during x-rays by showing up bright white.
A gastroscopy, which involves the insertion of a flexible, hollow tube with a tiny camera and light into the body through the mouth to enable a closer examination of the oesophagus and stomach.
Having diagnosed a hiatus hernia, doctors will then suggest a suitable treatment plan.
Hiatus Hernia Treatments
Hiatus hernia treatment may, like with many other digestive conditions, involve a combination of lifestyle and dietary changes, medication and/or surgery.
Lifestyle & Dietary Changes: The first goal of treatment is preventing acid reflux, so doctors are likely to suggest:
- Limiting or eliminating foods likely to cause discomfort (which may vary between patients).
- Eating smaller meals more frequently, which reduces stomach distension and consequently upward pressure.
- Achieving/maintaining a healthy (average) weight.
- Avoiding bending (i.e. squatting instead).
- Giving up smoking, which is believed to encourage symptoms by relaxing the lower oesophageal sphincter.
- Minimising pressure onto the diaphragm while sleeping by elevating the head approximately six inches off the bed.
- Refraining from eating within 2 to 3 hours prior to bedtime and avoiding lying down immediately after meals.
- The second goal is to minimise stomach acid to make the contents of reflux less irritating. This is achieved by avoiding:
- Leaving the stomach empty for prolonged periods.
- Substances (i.e. alcohol, aspirin) likely to increase acid secretion.
- Taking suitable medication.
Medication: There are numerous types of over-the-counter medications that either neutralise acid, block its production or both.
Your doctor will advise you on which one of these medications is most suitable for you, especially if you are taking other medications that may aggravate production of acid.
Surgery: Depending on circumstances, doctors may recommend surgery like, for instance, fundoplication.
This type of surgery involves wrapping part of your stomach around your lower oesophagus to tighten the hiatus opening but is, unfortunately, not always enough to resolve the issue.
While acid reflux due to hiatus hernias can frequently be successfully controlled by a combination of these measures, they may ultimately be partially effective only, meaning symptoms may persist.
If this is the case for you, silicolgel may help you get relief from your symptoms.
NB: Always consult your doctor to gain a correct diagnosis of your condition and to discuss taking over-the-counter medications.