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Hiatal Hernia: Causes, Symptoms & Treatment

Instructor: Justine Fritzel

Justine has been a Registered Nurse for 10 years and has a Bachelor's of Science in Nursing degree.

Do you know what a hiatal hernia is? In this lesson, we will learn what it is. We will also learn about the causes of hiatal hernias as well as the symptoms associated with them. Treatment options will be reviewed also.

Annual Physical

Brian is a 55-year-old semi-truck driver that spends many weeks on end on the road. Part of his license requirements includes an annual physical with his doctor. He always worries when it comes to this time of year. He knows he doesn't eat well, has gained a lot of weight, and isn't physically active. It's hard when you spend your life in a semi-truck on the road. He feels like the heavy lifting he does to load and unload his truck at destinations counts as exercise, right? Besides, he doesn't really have any health issues to complain about.

At his physical, the doctor asks him lots of questions. Upon questioning, he realizes he does have a lot of heartburn and feels really full after eating. Sometimes to the point of feeling like chest pain. The doctor tells him he may have GERD and/or may have a hiatal hernia and wants to run further tests.

What is a Hiatal Hernia?

Your body has different cavities. The chest cavity contains your lungs and heart and your abdominal cavity contains organs like your stomach and intestines. The diaphragm is a thin layer of muscle that separates your chest cavity from your abdominal cavity.


Abdominal Anatomy
Anatomy


When you eat, the food you swallow travels down your esophagus which is the tube from your mouth that leads to your stomach. The stomach is where the food is further broken down. A hiatal hernia occurs when the upper part of your stomach pushes through the diaphragm muscle and is now in the chest cavity.


Hiatal Hernias
Hiatal Hernias


In the picture, illustration A represents the normal anatomy of the stomach and esophagus. The pink line represents the diaphragm. Illustrations B-D show the progression to different types of a hiatal hernia.

What Causes a Hiatal Hernia?

After further tests, the doctor confirms that Brian has a hiatal hernia. Brian asks why he would have this. The doctor explains that when there is increased pressure in the abdominal cavity, it forces the stomach to push through the diaphragm causing the hiatal hernia. The pressure can be caused by different things, but in Brian's case the heavy lifting and his obesity were to blame.

Hiatal hernia's are cause by increased pressure in the abdominal cavity as the doctor explained to Brian. In Brian's case this was caused by heavy lifting and obesity. But other causes of increased pressure can be pregnancy, vomiting, and coughing. If someone is constipated and straining when having bowel movements, this also can cause increased pressure in the abdomen.

Symptoms of a Hiatal Hernia

Brian asked his doctor what made him suspect a hiatal hernia in the first place. The doctor explained he suspected this based on Brian's risk factors and symptoms.

Many times there are no symptoms of a hiatal hernia. When there are symptoms, they are typically symptoms related to gastroesophageal reflux disease (GERD). GERD is when stomach contents are backing up into the esophagus. This results in heartburn, belching, and discomfort. Sometimes it can feel like chest pain. Bloating and having a bitter taste in your mouth are all symptoms of GERD. Another symptom is feeling extremely full after eating a meal.

Although there is a connection between GERD and hiatal hernias, you can have one without having the other.

Treatment

Brian's biggest question is how his hiatal hernia can be treated. The doctor advises diet modifications such as avoiding fatty, fried foods, caffeine, and foods that are high in acidity. It is best to eat a few hours before lying down to help prevent the food from refluxing into the esophagus. When lying down, elevate the head of bed slightly to help as well.

Other suggestions include avoiding tight fitting clothing around the waist as it can increase the pressure in the abdomen. Losing weight and smoking cessation are also important. Medications such as antacids or acid blockers should also be taken to decrease the symptoms of GERD.

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