Hiatal Hernia

What Is a Hiatal Hernia?

When an organ pokes out past the muscle wall that is supposed to hold the organ in place, you have a hernia. A hiatal hernia occurs when the upper part of the stomach pushes through an opening in the diaphragm, the muscle that separates the abdomen from the chest. This opening is called the esophageal hiatus. After you swallow food, it travels between your mouth and stomach through a muscular tube called the esophagus. The esophagus passes through the hiatus to enter the abdominal cavity. At the bottom of the esophagus is a muscle called the lower esophageal sphincter, which acts as a valve. The hiatus itself acts like a second valve. Normally the hiatus and the lower esophageal sphincter line up with each other to keep stomach contents from backing up into the esophagus (a condition called reflux). But the hiatus can stretch because of muscle weakness or too much abdominal pressure. When this occurs, the stomach can slip through the hiatus, causing a hiatal hernia.


A hiatal hernia can be caused by:


  • obesity
  • pregnancy
  • tight clothing
  • sudden physical exertion, such as weight lifting
  • straining, coughing
  • abdominal injury

    Although most hiatal hernias cause no symptoms, some people experience heartburn. Heartburn is caused by gastric reflux, in which the acid from the stomach refluxes up into the esophagus, causing an irritating and burning sensation. People with reflux symptoms have gastroesophageal reflux disease (GERD) and may need drug therapy. In certain people, reflux damages the lining of the esophagus, resulting in erosions. In extreme cases, the normal lining is replaced by abnormal cells, a condition called Barrett's esophagus. You should not worry about having a hiatal hernia. Many people over the age of 50 have such a hernia, and it does not need treatment unless heartburn or GERD is present and causes significant discomfort, or unless the hernia is in danger of becoming twisted and cutting off the stomach's blood supply. Treatment may also be considered if you have complications such as severe GERD or esophagitis, which is an inflammation of the esophagus. In such cases, the doctor may recommend surgery to repair the hiatal hernia.


    If a hiatal hernia is causing symptoms, the following tips may help:


    Costochondritis - which is inflammation of the cartilage of your rib cage, particularly the cartilage that joins your ribs to your breast bone or sternum. This pain may occur suddenly and be intense, which may cause some people to assume that it is a heart attack. However, with costochondritis it hurts when you push in your sternum or the ribs near the sternum. Heart attack pain is usually more wide spread and the chest wall usually is not tender. This is treated with rest, heat, and nonsteroidal anti-inflammatory drugs such as ibuprofen.


    Miscellaneous Causes


  • Eat smaller, more frequent meals.
  • Avoid foods and drinks that may cause symptoms.
  • Avoid lying down for 3 hours after eating.
  • Raise the head of your bed 4 to 8 inches.
  • Avoid wearing tight clothing around your waist.
  • Take acid-reducing medications.
  • Lose weight
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