Hernia is a common condition in which part of an internal organ or tissue bulges through a defect within the muscle. Hiatal hernia occurs when the upper part of stomach bulges through an opening (hiatus) within the diaphragm. The diaphragm is a large muscle, which separates your abdomen and chest.
1. Causes of Hiatal hernia
Your diaphragm has multiple small openings through which various structures move between the chest and abdomen. Your food tube (esophagus) passes through one of these small openings and connects to the stomach. Hiatal hernia occurs when the stomach pushes up through that opening and enters into your chest.
2. Symptoms of Hiatal hernia
A small hiatal hernia usually does not cause problems and most people are unaware of its existence unless detected during exams conducted for other purposes. A large hiatal hernia will cause the back flow of food and acid contents from your stomach to the esophagus, causing one or more of the following symptoms:
Heartburn
Sore throat
Bad taste in mouth
Regurgitation of food into the mouth
Chest or abdominal pain
Shortness of breath
Vomiting of blood
Black stools
3. Risk Factors of Hiatal hernia
Age 50 or older
Obesity
Pregnancy
Lifting heavy objects
Chronic constipation and straining
Chronic coughing
Fluid within the abdomen (ascites)
Smoking
4. Prevention of Hiatal Hernia
The risk of hiatal hernia can be reduced by decreasing the intra-abdominal pressure. It can be achieved by:
Maintaining a healthy weight
Preventing constipation by consuming high-fiber foods
Avoiding heavy lifting
Stopping smoking
Avoiding wearing a tight belt or tight clothing that can increase the pressure on the abdomen
5. Complications of Hiatal hernia
Most cases of hiatal hernia are not life threatening. Rarely, blood supply to the trapped part of stomach is reduced resulting in ischemia and gangrene. It is a surgical emergency and a surgery is needed to relieve the trapped part of stomach. When this condition occurs, you will experience:
Severe chest or abdomen pain
Nausea and vomiting
Constipation
Fever
Rapid heart rate
6. Diagnosis of Hiatal hernia
Your doctor will make a diagnosis of hiatal hernia by taking a detailed history and physical examination. Since hiatal hernia is present inside abdomen and through the diaphragm, it is not visible from outside and physical examination may be completely normal. Hiatal hernia is usually diagnosed when your doctor performs certain tests for the evaluation of heartburn, difficulty swallowing or bad taste in mouth. These tests include:
Barium swallow: In this test, you will be asked to drink a liquid called barium which is a contrast agent. It will light up on X-ray. As you will drink and swallow this barium liquid, a specialized series of x-rays will be taken.
Endoscopy: A specialized flexible tube with a camera will be passed to see your esophagus, stomach and upper small intestine.
Esophageal manometry: It measures the pressure of sphincter of lower esophagus.
7. Treatment of Hiatal hernia
If your hiatal hernia is not causing any symptoms and is not uncomfortable, your doctor may advise for a “wait and watch” approach. In the meantime, you will be advised to:
Lose weight, if you are over weight
Frequent small meals
Quit smoking
Increase physical activity
Antacids and other medicines to relieve heartburn.
Surgical Management of Hiatal hernia Surgery is the only treatment to cure hiatal hernia and bring the stomach back to the abdomen. The opening in your diaphragm will be made smaller to prevent recurrence of hiatal hernia. It can be achieved by open hernia repair and laparoscopic hernia repair.
Open hernia repair: In open hernia repair, your doctor will give an incision in the abdominal or chest wall. After incision, your doctor will move the bulged part of stomach back into the abdomen, and will then repair the diaphragm opening with stitches to fill the gap and prevent hernia to occur again. Your doctor may also place a synthetic mesh to provide additional support.
Laparoscopic hernia repair: In laparoscopic hernia repair, your doctor will not give a big incision but rather will make several small, half-inch incisions in the abdominal wall. Your doctor will then insert a laparoscope, which is a thin tube with a tiny video camera attached. Your doctor will then push back stomach into the abdomen and will repair the defect using synthetic mesh.
8. When you should see a Doctor?
You must visit your doctor, if along with heartburn you are having one or more of the following symptoms:
Incisional hernia continues to enlarge over time
Incisional hernia is very large and cosmetically unappealing
Incisional hernia bulge remains even when the patient is relaxed or laying down
Incisional hernia causes pain
9. Diet and Exercise
To prevent constipation, increase your water intake, use stool softeners, and increase dietary fiber intake. No limitations on physical activity. Standard moderate physical activity of at least 30 minutes for at least five days per week is recommended.
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