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Hiatal hernia

A hiatal hernia occurs when a small portion of the stomach pushes upward through the diaphragm, a sheetlike muscle that separates the lungs from the abdomen. Usually this doesn't cause any symptoms, but it increases the risk of stomach acid backing up into the esophagus (reflux), which can lead to heartburn.

Normally the entire stomach sits below the diaphragm. The esophagus passes through an opening in the diaphragm called the hiatus before it enters the stomach. Weakened tissues within and around the hiatus allow a hiatal hernia to develop.

A hiatal hernia that is not causing symptoms does not usually need any treatment. Treatment for a hiatal hernia that causes heartburn is the same as for gastroesophageal reflux disease (GERD). This may include home treatment with lifestyle changes; nonprescription antacids, acid reducers, or acid blockers; prescription medicines; or, in severe cases, surgery.

  • Symptoms

    What are the symptoms of a hiatal hernia?

    Most people who have a hiatal hernia have no symptoms.

    One symptom you may have is heartburn, which is an uncomfortable feeling of burning, warmth, or pain behind the breastbone. It is common to have heartburn at night when you are trying to sleep.

    If you often have symptoms or they are severe, you may have gastroesophageal reflux disease (GERD). A hiatal hernia can lead to GERD, and people often have both conditions at the same time.

    If you have pain behind your breastbone, it is important to make sure it is not caused by a problem with your heart. The burning sensation caused by GERD usually occurs after you eat. Pain from the heart usually feels like pressure, heaviness, weight, tightness, squeezing, discomfort, or a dull ache. It occurs most often after you are active.

  • Causes

    What causes a hiatal hernia?

    A hiatal hernia often is caused by weak muscles and tissue within and around the hiatus.

    In a sliding hiatal hernia, a small part of the stomach pushes through the diaphragm and into the chest. A valve between the esophagus and the stomach also moves up and away from the diaphragm.

  • Diagnosis

    How is a hiatal hernia diagnosed?

    A hiatal hernia often is diagnosed when you see your doctor or have tests for another health problem.

    If you have symptoms, your doctor will ask you questions about them. If your symptoms happen often and are severe, you may have gastroesophageal reflux disease (GERD). If this is the case, your doctor may do more tests or give you medicine for GERD.

  • Treatment

    How is a hiatal hernia treated?

    If you have no symptoms, you don't need treatment.

    If you have mild symptoms, your doctor may suggest lifestyle changes and perhaps nonprescription medicines. Here are some things to try:

    • Change your eating habits.
      • It's best to eat several small meals instead of two or three large meals.
      • After you eat, wait 2 to 3 hours before you lie down. Late-night snacks aren't a good idea.
      • Chocolate, mint, and alcohol can make gastroesophageal reflux disease (GERD) worse. They relax the valve between the esophagus and the stomach.
      • Spicy foods, foods that have a lot of acid (like tomatoes and oranges), and coffee can make GERD symptoms worse in some people. If your symptoms are worse after you eat a certain food, you may want to stop eating that food to see if your symptoms get better.
    • Do not smoke or chew tobacco.
    • If you get heartburn at night, raise the head of your bed 6 in. (15 cm) to 8 in. (20 cm) by putting the frame on blocks or placing a foam wedge under the head of your mattress. (Adding extra pillows does not work.)
    • Do not wear tight clothing around your middle.
    • Lose weight if you need to. Losing just 5 to 10 pounds can help.

    If you often have symptoms or have severe symptoms, you may have GERD. Lifestyle changes may help, and your doctor may prescribe medicine. In severe cases, surgery can be used to pull the hernia back into the belly.

  • Self-care

    How can you care for a hiatal hernia?

    • Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
    • Do not take aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) or naproxen (Aleve), unless your doctor says it is okay. Ask your doctor what you can take for pain.
    • Your doctor may recommend over-the-counter medicine. For mild or occasional indigestion, antacids such as Tums, Gaviscon, Maalox, or Mylanta may help. Your doctor also may recommend over-the-counter acid reducers, such as famotidine (Pepcid AC), cimetidine (Tagamet HB), or omeprazole (Prilosec). Read and follow all instructions on the label. If you use these medicines often, talk with your doctor.
    • Change your eating habits.
      • It’s best to eat several small meals instead of two or three large meals.
      • After you eat, wait 2 to 3 hours before you lie down. Late-night snacks aren’t a good idea.
      • Chocolate, mint, and alcohol can make heartburn worse. They relax the valve between the esophagus and the stomach.
      • Spicy foods, foods that have a lot of acid (like tomatoes and oranges), and coffee can make heartburn symptoms worse in some people. If your symptoms are worse after you eat a certain food, you may want to stop eating that food to see if your symptoms get better.
    • Do not smoke or chew tobacco.
    • If you get heartburn at night, raise the head of your bed 6 to 8 inches by putting the frame on blocks or placing a foam wedge under the head of your mattress. (Adding extra pillows does not work.)
    • Do not wear tight clothing around your middle.
    • Lose weight if you need to. Losing just 5 to 10 pounds can help.

    Copyrighted material adapted with permission from Healthwise, Incorporated. This information does not replace the advice of a doctor.