Hiatal Hernia – Types, Symptoms, Causes, Treatment

Hiatal hernia – Types, Symptoms, Causes, Treatment. Hernia occurs when some organ or tissue is out of place. When some fatty tissue of the organ pushes through a small opening or a weak spot invading neighboring organ, it is described as hernia. There are many types of hernia based on the organ and tissue it has occurred. Inner groin hernia is known as Inguinal Hernia, incisional hernia occurs when fatty tissue pushes through the small opening where incision/cut is made during surgery, and femoral hernia occurs on the outer groin, and belly button hernia is described as Umbilical Hernia and upper stomach hernia is called as hiatal hernia.

Any deviation in the position of organs or group of tissues can create health problem. When part of the stomach tissues deviates from its original place and moves upward toward the diaphragm, it causes hiatal hernia. Diaphragm is a dome shaped organ (set of muscles) that plays a vital role in the process of respiration and breathing. The same diaphragm separates the stomach and abdominal cavity from the thoracic cavity. Hiatus is the term given for small opening of the diaphragm through which the esophagus (food pipe) passes before entering the stomach. Some part of the stomach pushes its way through hiatus opening to enter the diaphragm.

In most of the cases hiatus hernia do not cause any problem and you may not even know it. Many people come to know about this issue while examining and taking tests for other causes. In moderate cases hiatus hernia can cause Heartburn and acidity since the food particles of the stomach can enter through the tube of the esophagus. Only in severe cases hiatus hernia needs surgical intervention.

Hiatal Hernia Types :

There are 3 major types of hernias namely sliding hiatus hernia, rolling hernia and mixed hernia.

1. Sliding Hiatus Hernia – Most of the cases of hiatal hernia belong to this category. The junction point of esophagus and stomach always move upward and downward between the abdominal cavity and thoracic cavity. This sliding movement of the junction can exert some pressure on the thoracic cavity thus loosening the sphincter muscles of the esophagus. On such cases the opening of the esophagus may not close properly thus allowing some part of the stomach tissue into the diaphragm causing sliding hiatus hernia.

2. Rolling Hernia – Also known as Type 2 hernia, rolling hiatal hernia is a rare phenomenon. Here a part of the stomach protrudes into the thoracic cavity leaving the gastroesophageal junction in the same position. Whenever there is a defect in the junction point or some weakening of muscles, the stomach tissues herniates (moves upwards) through this opening. Thoracic cavity also puts pressure on this protrusion adding more problems. Rolling hiatus hernia occurs only in 4 out of 100 people with hernia.

3. Type 3 – This is mixed type wherein combination of sliding hernia and rolling hiatus hernia can be seen.

Hiatal Hernia Symptoms :

Mild hiatus hernia may not show any signs and often it goes unnoticed. If there is large fatty tissue pushing into the diaphragm it can cause symptoms like pain in the abdomen, burping and belching, heartburn, feeling of “fullness”, and pain in the chest region. In rare cases there can be blood spots with stools due to intestinal bleeding. It can cause regurgitation (pushing partially digested food particles into the throat and mouth) after meals along with heartburn. Regurgitation can become severe if large sized hiatus hernia is present and the affected person can experience regurgitation and presence of food particles in his mouth even if he bends down.

Heartburn can occur when food particles are pushed from the stomach into the esophagus and throat along with acid. Enzymes from the stomach can cause moderate heartburn with pain which is often misunderstood for an attack. GERD (Gastro Esophageal Reflux Disease) is another common symptom of hiatus hernia.

However the intensity of symptoms is high if it involves large hiatus hernia. It can cause persistent cough, abdominal pain and chest pain. Some people can face difficulty in swallowing solid foods which is described as dysphagia.

Causes Of Hiatal Hernia :

There is no clear cause for the formation of hiatus hernia. If the sphincter muscle or the junction of diaphragm and stomach gets weakened it can lead to the invasion of fatty tissue from the stomach into the diaphragm. But what exactly triggers weakening of the opening is not known. Some people are born with weakened muscle in that area and are prone to develop hiatus hernia.

Back pressure buildup on the stomach and old age can also cause hiatus hernia. Any injury in the area of gastroesophageal junction can cause hiatus hernia. Some people are born with large hiatus and hence they are likely to develop heartburn and acidity reflux.

Persistent coughing can cause considerable strain on the muscles of thoracic cavity. Frequent vomiting and straining of the muscles while passing hard dry stool can cause hiatus hernia. People whose daily job involves lifting of heavy objects are at increased risk of hiatus hernia.

Complications :

• Repeated reflux of acidity and food particles can cause narrowing of esophagus tube leading to esophageal stricture.


• Long term regurgitation can irritate the epithelial lining present in the esophagus which can cause Barrett’s esophagus which can later cause Cancer also.


• In severe cases hiatus hernia can cause gastrointestinal bleeding and anemia.


• Very large hernias can affect the normal respiration and working of the lungs leading to respiratory infection.

Diagnosis :

Hiatus hernia is often diagnosed while conducting tests for other health issues like abdominal pain and heartburn.

Barium swallow test is conducted to examine the condition of esophagus and stomach and while doing this test, hiatus hernia can be detected.

Endoscopy is a procedure in which small thin tube is sent through your mouth and monitored through small lighted camera placed on the other end of the tube. Any abnormality in the stomach and abdominal cavity can be detected in this test.

Manometry test can also be done to diagnose hiatus hernia during which thin catheter is sent through your nose down through the esophagus and stomach.

Treatment :

In most of the cases of hiatus hernia no treatment is required since there are no symptoms. For heartburn and acid reflux problem, antacids like Mylanta, Tums and Gelusil and other OTC drugs can be taken. Certain medications like Tagamet HB and Axid AR and other H2 receptor blockers are prescribed by the doctor for large hiatus hernia that causes heartburn and regurgitation. Proton pump inhibitors like Omeprazole and lansoprazole are also recommended for reducing acid production from the stomach.

• Surgery

Surgical intervention for hiatus hernia is considered only if it is large and causing too many complications. If medications and lifestyle modifications does not provide any relief then surgery is done for treating hiatus hernia. The surgeon would pull the fatty tissue from the esophagus pushing it into the stomach. He would also repair the weakened sphincter muscle. Often laparoscopic method is used and the entire surgery is done through tiny incision aided with camera and monitor.

Home Remedies :

• Avoid taking acidic food items which would increase heartburn and reflux reaction.


• Eat smaller meals many times a day instead of hefty meals.


• Quit smoking and drinking.


• Don’t go to bed after finishing your lunch or dinner since this would aggravate regurgitation.


• Add more pillows below your head and keep it elevated.

Hiatal Hernia Surgery

Hiatal Hernia Surgery

Hiatal hernias happen with part of your stomach pushes up through your diaphragm and into the thorax cavity. It is a very painful condition and can be the cause of severe Heartburn.It is often caused by being overweight, but can also happen due toinjury to the stomach, pressure on the abdominal area from repeated episodes of vomiting or coughing, and a birth defect in the hiatus.

Symptoms include upper abdominal pain, chest pain, and heartburn. Some people mistake the pain for a Heart Attackand end up in the emergency room. If you have severe pain in your chest, always see a doctor right away to rule out a heart condition.

Hiatal hernia surgery is sometimes necessary to relieve the painful symptoms th

at can occur with a hiatal hernia. Let’s take a deeper look at who may need surgery, the recovery, and hear from others who have dealt with this.

Who Is a Candidate for Hiatal Hernia Surgery?
The usual treatment is medications and lifestyle changes in milder cases. Doctors usually prescribe acid reducing medications and suggest losing excess weight, dietary changes and elevating your head and upper body when you sleep. If these methods are ineffective you may be a candidate for hiatal hernia surgery.The good news is not every person with this condition will require surgery to treat hiatal hernia. There are two types that most likely need surgical repair:

Paraesophageal Hiatal Hernia – This type occurs when a part of the stomach pushes through the diaphragm in a separate area and can be serious with complications. The people who need surgery to correct this type are young people that have severe GERD, patients with breathing problems, and people who cannot tolerate acid reducing medications. The complications of not having surgical correction include stomach strangulation, puncture of the digestive tract, and twisting of the bowel. These can be fatal.

Type IV Hiatal Hernia – This is a rare, but very severe form of hiatal hernia. In this type, the stomach, intestines, Spleen, and part of the colon can slide up into the herniation. This is extremely serious and requires surgery.

The Surgical Procedure
Hiatal hernia surgery can usually be done via laparoscope which is minimally invasive with easy recovery. The surgeon will just push the stomach and anything else that slipped through back into its proper place. They close up the opening with stitches. They can also stitch the stomach in place near the weakened area to prevent it from slipping back through. The surgeon may also do a technique called “fundoplication” to help reduce GERD symptoms. They literally wrap the top of the stomach around itself to create a tighter passage.

A laparoscope is inserted through tiny incisions to avoid making a large incision into the abdomen. The surgeon can perform necessary tasks through the scope and the patient has less healing time, less pain, and very tiny scars.

The Results and Recovery Period
The surgery requires around a one-night hospital stay for laparoscopy and a few nights for an open surgery. The day after surgery, a nurse will get you up walking to help get things moving again inside. The usual activity restrictions are about a week and you can expect to be fully healed within two or three weeks if you had a laparoscopy. If you had open surgery, expect about a six-week recovery time frame. The prognosis is very good for patients who have surgical repair of a hiatal hernia. The surgery is most often very safe and very effective and most patients have a large reduction of symptoms.

Tips for Better Recovery
Having abdominal surgery may need a little extra TLC to help you recover. You will be surprised how much you use your stomach muscles on a daily basis so expect it to be a bit sore for a while. These tips will help you recover faster and protect your stomach:

• Relieve pain from surgery and from gas. The pain usually isn’t excruciating with hiatal hernia surgery, but it can get uncomfortable. Use a pain reliever that your doctor recommends for the first few days. Also, if you had a laparoscopy you will have some carbon dioxide gas left in your abdomen. This can cause a pain that radiates up to your shoulders. Ask your doctor about gas relief and get up and walk.


• Follow your prescribed diet. The usual diet for post-op is clear liquids the first day or two and then advance to a soft diet. The biggest complaint with this surgery is the inability to completely pass food through the esophagus. This is due to the tightening procedure and will eventually pass after 6 to 8 weeks. Until then, surgeons usually recommend a very soft diet.


• Take care of your incisions. If you had a laparoscopy, you will just have some small “butterfly” bandages that will fall off on their own. Go ahead and shower with them and keep them clean. If you had open surgery, ask your post-op/recovery nurse how to care for your incision and stitches. Make sure you ask about having the stitches removed or if they dissolve.


• Take care of Constipation. The abdomen can slow down after abdominal surgery. Make sure you increase your dietary fiber, take walks a few times a day, and ask your doctor about a stool softener. Make sure you are drinking plenty of fluids to help keep things on the move.

Hiatal Hernia Surgery: Experiences of Others

“I was diagnosed in my 20’s with a hiatal hernia and they said I was born with it. I always remember being sick as a kid and couldn’t ever keep my food down. I constantly complained of stomach aches and threw up almost every meal. When they found the hernia they said I absolutely had to have surgery to fix it. The surgery took away all of my symptoms and I was finally able to keep a whole meal down. I felt like a new person.” --Kat

“I noticed around 14 years of age that I had a lot of heartburn and it was hard to swallow food all the way down. I started suffering from chest pain and my mom took me to the hospital. They found the hernia and did the lap band surgery. It took about two-weeks to recover and I don’t have any more issues at all.” --Sarah

“I had a Nissen fundoplication a few years back and my hernia actually came back. My hernia was the “rolling type” and I couldn’t breathe well. I had a car accident and it undid some of the surgical repair, so recently I had to go in for another surgery. So far, I am feeling much better.” --Mark

Hiatal Hernia

Hiatal Hernia






Hernia is a condition in which any internal organ of the body pushes itself exceeding its original area. Hiatus is a small muscular portion of opening through which the food tube or esophagus opens up to the stomach. Hiatal hernia or hiatus hernia is the condition in which the part of the stomach pushes itself into the chest area through the hiatus. Mild to moderate cases of hiatal hernia does not cause any problem.

There are many people who may not even know that they have hiatus hernia unless they are tested for other causes. However a large hiatal hernia is problematic since it will allow food particles and stomach acids into the esophagus causing Heartburn affecting the quality of life.

Symptoms :

Many people may not have any symptoms of hiatal hernia and may not even know about it until it was diagnosed later. Some of them may have symptoms like heartburn, acid reflux and other symptoms of GERD. It is not necessary that every person having GERD will develop hiatal hernia. These two are not connected in any way. The signs of heartburn may produce sharp chest pain and can be confused for Heart Attack. It is the large hiatal hernias that cause symptoms like heartburn and belching. Some people may have difficulty in swallowing food.

Causes :

Exact reason for the entry of part of stomach through the hiatus is not known. Some believe it is due to the weakening of muscles of the diaphragm which allows the bulging stomach through the tiny opening into the chest.

• Extreme pressure on the stomach may force its way into the hiatal opening.

• Any trauma or accidental injury to the hiatus area can weaken it causing hiatal hernia.

• When there is continuous pressure on the surrounding muscles due to repeated coughing or vomiting it would weaken the hiatus causing hiatal hernia.

• Some people are born with large sized hiatus which can easy give way for bulging of stomach region into the esophagus.

• If the attachment muscle is abnormally loose then it would give entry for the stomach to exert upwards.

Types :

There are two types of hiatal hernia namely sliding hiatal hernia and para-esophageal hiatal hernia. Sliding hernia is one in which part of the stomach slides up to the chest through the hiatus of the diaphragm. This type of hernia is the commonly found hernia. The points of junction in which the stomach and the esophagus fuse together are pushed back into the chest.

Very often this area resides well inside the chest portion permanently but gives trouble only when the person swallows something. Whenever the person swallows food the esophageal muscle contracts it shrinks the area making it easy for the stomach to be pulled up. Once the person finished swallowing, the herniated stomach falls back to its original position.

Para-esophageal hernia is one in which the hernia is large and the esophagus stays in its original position but allows the stomach to bulge through it to enter into the chest region beside it. This type of hernia will remain in the same position irrespective of the fact that a person completes swallowing or not. In rare cases, the stomach becomes trapped in this area and the blood supply may be cut off causing life threatening situations.

Who are at risk?

Hiatal hernias can occur on old age people above 55 years and those who are obese.

Tests and Diagnoses :

Imaging tests like X-ray and endoscopy of the stomach and esophagus can help the doctor to detect hiatal hernia. Hernia can be identified as separate sac between the portion of the stomach and the esophagus (food pipe). Most of the time, hernias are recognized while checking for reasons of heartburn.

Barium X-ray is also widely used for testing the presence of hernia. The person will be asked to drink barium liquid which will make a coated layer on the upper digestive tract. This will provide a clear image of the esophagus and stomach to the doctor.

Treatment :

Hiatal hernia will not cause any specific symptoms and hence need no treatment. People with acid reflux and heartburn due to hiatal hernia may require treatment. Medications are prescribed for managing heartburn. Over the counter antacids like Mylanta, Gelusil and RolAIDS will provide immediate relief from the symptoms of heartburn. Your doctor may prescribe H2 receptor blockers like Tagmaet HB, Pepcid AC or Axid AR for decreasing the amount of acid production from the stomach. Proton pump inhibitors an also be used for healing the scar in the esophagus due to recurrent acid reflux.

Most of the times you can get relief from the symptoms by over the counter medications like lansoprazole, omeprazole or the like. Only some people will need strong doses of drugs to control acid reflux.

In rare cases surgery is done for repairing hiatal hernia. People who undergo surgery for GERD will get treatment simultaneously for hernia. The surgeon will make incision on the stomach and pulls your stomach gently down into the abdomen. He will close the opening of the diaphragm to a short narrow one and removes the hernia sac. He would reconstruct the weakened sphincter muscles of the esophagus to strengthen it. Treatment options are almost the same for hiatal hernia and GERD.

Pictures of Hiatal Hernia :

Images, Pics, Pictures and Photos of Hiatal Hernia

Lifestyle Changes :

You can manage the symptoms like heartburn and acid reflux by making small changes in your daily life. Instead of having full course meal you should eat several times in small quantities. This will give time for the stomach for easy digestion. Foods that would trigger heartburn and acid production should be restricted or completely avoided. Do not go to bed with full stomach. Finish your dinner at least 3 hours before you sleep. If you are obese consult your doctor to reduce weight.