A hernia, a process where the contents of the abdomen push through a weak point to protrude outwards, is quite common these days. Especially prevalent in people involved in straining and weight lifting, a hernia can be of different types. It all depends on which part protrudes out to what area. 

A hiatal hernia is a relatively uncommon type of hernia that occurs when the contents of the abdomen come out through the diaphragm. This type of hernia can be confusing to spot since some of its symptoms closely mimic other conditions. For a proper diagnosis, it is important to keep yourself updated about how to suspect it and seek timely management.

This article will explore hiatal hernia’s in detail, focusing on its symptoms, treatment, and different lifestyle tips to manage them.

The Anatomy of Hiatal Hernia 

To understand a hiatal hernia and how it occurs, it is important to familiarize yourself with the diaphragm. 

The diaphragm refers to a membrane responsible for keeping the abdominal organs in place. It also separates these organs from the lungs and heart, all of which are found in the chest cavity. It has a dome shape and two cavities with a center layer of muscles that contract and relax to support breathing movements.

The diaphragm is smooth with no holes; however, several key structures pass through it. The esophagus, or the food pipe, is one of these structures that run through it, connecting the back of the mouth with the stomach. The diaphragm closely surrounds the esophagus just above its entry into the stomach so that the stomach cannot protrude upward through this space. However, in some cases, a part of the stomach moves up and comes out of this hole in the diaphragm, causing what is known as a hiatal hernia.

Hiatal Hernia Symptoms

It is very unusual for a hiatal hernia to trigger symptoms. Even if you do acquire some discomfort or issues, it is likely due to stomach acid or air moving into the esophagus from the stomach.

In some cases, hiatal hernias can cause the following symptoms:

• Gastroesophageal reflux disease (GERD) or acid reflux
• Difficulty in swallowing
• Pain in chest or epigastric region
• Heartburn that becomes severe upon lying down
• Excessive belching

Determining the Risk of Hiatal Hernia

The exact cause of structural weaknesses leading to hiatal hernia is not known. However, multiple theories have been proposed that seem to increase the risk of acquiring this condition. For example, an increased pressure on the diaphragm, usually determined by genetic factors, is likely to be one cause.

Studies also reveal that hiatal hernias are more commonly seen in the obese and those above the age of 50 years. This makes advancing age and high BMIs two risk factors that contribute to the development of hiatal hernia in general populations.

Other risk factors include:

• Frequent exposure to an upward force, such as during lifting heavyweight, persistent vomiting or cough, or straining for emptying the bowels.
• Upward pushing of the abdominal contents by the growing fetus during pregnancy.
• A congenital defect in the diaphragm.
• Injury to the diaphragm due to a traffic accident, fall, or a surgical procedure.

How is Hiatal Hernia Managed Medically?

The management plan for hiatal hernia depends on the severity of the issue and whether or not you are experiencing any symptoms. If it is symptomatic, the best treatment is to introduce certain lifestyle changes (described in later sections), and use medication, if necessary. If none of it works, surgery is considered the last resort.

Traditional Medications 

Medicines are mostly prescribed to relieve the symptoms associated with a hiatal hernia; such as GERD or heartburn. While there are natural ways to help manage symptoms such a GERD, the most common medicines used to reverse the symptoms caused by a hernia include the following: 

H2-receptor blockers

These include medications like famotidine and ranitidine that work by reducing the acid production in the stomach. Less acid in the stomach means less reflux back into the esophagus which relieves heartburn.

Proton pump inhibitors (PPIs)

These include lansoprazole and omeprazole that work by blocking the production of stomach acid and healing the esophagus.

Surgery

Surgery might be required to fix a hiatal hernia, especially when it is too large or the symptoms of heartburn do not respond to medications. In contrast to the old times when open surgery was the only option, surgeons today prefer laparoscopic surgeries or keyhole procedures to treat a hiatal hernia. These types of surgeries are performed under general anesthesia through tiny holes instead of making a huge incision on the body.

Lifestyle Modifications for Hiatal Hernia

As mentioned above, a hiatal hernia does not usually cause any symptoms in most people. However, it can induce indigestion and heartburn in a handful of patients. While these symptoms are usually well-controlled with medication, experts suggest making some lifestyle modifications to cope with them in a better way.

From changing your diet to controlling your body weight, the following lifestyle tips can go a long way in managing your condition.

Dietary Modifications

It is common knowledge that symptoms like heartburn are chiefly controlled by the type of food you eat. Certain types of food can cause flare-ups, while others can help control it. Similarly, the amount of food you eat and how you consume it also makes a difference. Let’s talk about these factors in detail below.

Choice of Food

Research investigating the association of acid reflux with common food triggers suggests avoiding the following types of food to reduce the problem of GERD:

• Alcohol
• Fresh fruit/ fruit juices
• Peppermint tea
• Fatty and sugary food
• Fried food
• Spicy food
• Sour food

While the research failed to take into account some common food triggers like caffeine, the list covers a large portion of food which limiting consumption can help minimize acid reflux. Different people may have different triggers so it's important to determine which triggers impact you personally. 

Pattern of Eating 

When it comes to a hiatal hernia, the way you eat your food also plays a critical role in minimizing the symptoms it causes, including acid reflux. But why is it so?

As the stomach protrudes into the chest cavity in a hiatal hernia, it changes the alignment of the sphincter present at the lower end of the esophagus. This sphincter is responsible for protecting the esophagus from receiving a back flow of the stomach contents. When this sphincter loses control, the food in your stomach starts moving freely into the food pipe, leading to acid reflux and other irritative symptoms.

To contain the damage and reverse the problem, you must be careful about how your stomach is positioned as you are eating. Moreover, it is also important to be mindful of not overloading your stomach so that the food can easily pass through your gut without any issue. 

To achieve these goals, the following tips should be kept in mind:

• Make sure to sit up as you eat. This keeps your stomach well-aligned to receive food without causing any regurgitation back into the food pipe. In contrast, eating while you are lying down can be dangerous as the stomach is in a horizontal position that compresses its junction with the esophagus and can cause back flow.
• Try eating at a table for a more mindful eating experience. Munching in front of a television or a laptop screen can make you end up stuffing your body with more food than you need. As a result, the back flow increases, leading to heartburn.
• Break down your daily meals to five or six meals a day. At the same time reduce the portion size in each of them. This will help you control your body weight while preventing overeating.
• As you eat your favorite meal, make sure to take small bites. Moreover, chew each bite properly before swallowing it as it takes the stomach less time to digest it. What this means is that by chewing your food properly, you can control how much acid your stomach secretes which ultimately controls heartburn.
• Do not immediately lie down for at least an hour after eating.
• Do not eat anything within three hours of bedtime. Sleeping on an empty stomach significantly reduces the risk of experiencing acid reflux, especially during the middle of the night.

Body Weight Optimization

• Obesity has been described as an independent risk factor for heartburn in people with a hiatal hernia. The excessive weight pushes the stomach against the diaphragm, worsening the symptoms to a great extent. Hence, try controlling your body weight as soon as possible by:
• Following a high-fiber, low-fat diet, including complex carbohydrates that do not cause sugar spikes in your body. The fiber content in the diet can also provide relief from constipation, a common risk factor for hiatal hernia.
• Stay hydrated by drinking at least eight glasses of water per day. This can dilute the acid in your stomach to relieve heartburn while curing constipation. As a rule of thumb, try drinking half of your total body weight in ounces of water. For example, if you weigh 300 pounds, aim to drink at least 150 ounces of water per day.
• Join a fitness program or start exercising every day for weight loss. Start with 15 minutes of walking and gradually move up the ladder. Make sure to be consistent and try finding an accountability partner to stay on track.

The Bottom Line

For most people, a hiatal hernia is asymptomatic; thus, requires no urgent care. However, those with severe symptoms or large-sized hernias need medical treatment along with lifestyle changes and surgery, in rare cases. Keep in mind that hiatal hernias have high recurrence rates, so make sure to alter your lifestyle permanently to make it healthier and safer for good health.