The diaphragm is a dome-shaped muscle which helps you breathe. It extends across the body below the chest cavity, separating the thoracic (chest) cavity from the abdominal cavity. It also prevents abdominal organs such as the stomach and intestines from being pushed into the chest cavity. The thoracic cavity contains the heart and lungs, among other organs. Hiatal hernia is a common condition, especially in elderly people. In Western countries, approximately 40% of people over 60 are diagnosed with a hiatal hernia.
9 symptoms of a hiatal hernia
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What is a hiatal hernia?
The diaphragm has a small opening (hiatus) for veins, nerves and the food tube (oesophagus) to pass through. Normally, the oesophageal sphincter is located where the oesophagus and stomach converge. A hiatal hernia is when this opening is wider than normal. The official term for hiatal hernia is diaphragmatic hernia.
There are two types of hiatal hernias:
- Type I: In type I (the sliding type), the upper part of the stomach and the section of the oesophagus that joins the stomach (lower oesophageal sphincter) slide up into the chest through the opening in the diaphragm. The upper part of the stomach slides up and down between the abdominal and chest cavities.
- Type II: In type II (the fixed type), there is no sliding up and down. The oesophageal sphincter and portion of the stomach remain stuck in the chest cavity.
What causes a hiatal hernia?
A hiatal hernia can be caused by various factors. It can be genetic, but it can also be age related.
Genetic
Some children are born with a hiatal hernia due to abnormalities in the development of their diaphragm. It can be a very serious condition, especially if the opening is so large that, for example, the small or large intestines or the spleen is pushed up into the chest.
As a result, the internal organs can be compressed and displaced. This congenital, life-threatening type of hiatal hernia is called congenital diaphragmatic hernia (CDH).
Age or injury related
A hiatal hernia can also be caused by age-related changes in the diaphragm or injury to the area (for example, after trauma).
As we grow older, our muscles tend to wither and weaken. When the diaphragm gets weaker the opening can become larger, resulting in a hiatal hernia.
Increased pressure
A hiatal hernia can also be triggered by insistent pressure on the hiatus muscles. That pressure can be caused by an increase in belly fat, persistent coughing, straining during bowel movements, pregnancy or an accumulation of fluid in the abdominal cavity (ascites).
9 symptoms of a hiatal hernia
For most people, a small hiatal hernia will not cause any symptoms. A hiatal hernia only causes problems when part of the stomach slides up through the enlarged opening in the diaphragm, disturbing the lower oesophageal sphincter for a shorter or longer period of time.
As a result, the oesophageal sphincter doesn't stay closed when it's supposed to and causes a symptom called heartburn. This is when acid from the stomach goes backward, or refluxes, up the oesophagus. The official medical term for this is gastroesophageal reflux (GER).
One of the most common symptoms of a hiatal hernia is acid reflux caused by a weak lower oesophageal sphincter.
This can cause:
- Heartburn or regurgitation of food or liquids into the mouth.
- Excessive belching.
- Painful or burning sensation in the chest.
- The feeling of food getting stuck in the throat.
- Pain when swallowing.
- Hoarseness.
- Dry cough.
- Bad breath.
- Anaemia (uncommon).
How is a hiatal hernia diagnosed?
The above-mentioned symptoms can be sign of a hiatal hernia in elderly patients. Specific tests are ordered in case the doctor suspects a hiatal hernia.
These include:
- Barium X-ray: This is an x-ray of the digestive tract. You will be asked to drink a white chalky liquid called barium. The barium will show up the shape of your oesophagus and stomach on the X-ray.
- Gastroscopy: During gastroscopy a flexible tube is inserted into the mouth. A tiny video camera and light at the tip of the tube allows the doctor to examine the inside of your digestive tract. If part of the stomach has slid up through the diaphragm, the doctor will be able to see the upper part of the stomach.
- Oesophageal pH monitoring: This test is used to record changes in the acidity of your oesophagus. A thin tube equipped with sensors, which is connected to a digital monitor, is fed through your nostril and down to your oesophagus.
What is the treatment for a hiatal hernia?
Treatment for a hiatus hernia usually focuses on relieving the symptoms of acid reflux.
Antacids
The doctor may prescribe antacids to reduce heartburn. This medication neutralises the acidity of gastric juice, which prevents inflammation and damage to the oesophagus. Antacid use can also reduce pre-existing inflammation and damage to the oesophagus and help with the healing process.
Lifestyle changes
Lifestyle changes, such as quitting smoking, avoiding alcohol, coffee, chocolate and spicy or greasy food, may also help reduce the frequency and severity of your symptoms. Other lifestyle changes can include eating dinner at least two to three hours before going to bed, and avoiding bending over or anything that constricts the abdomen (tight clothes, belts or seat belts). If being overweight contributes to your reflux, losing weight could help.
Surgery
If the above measures do not improve your reflux symptoms, then minimally invasive anti-reflux surgery might be an option. During this surgery, the top part of the stomach is 'wrapped’ around the lower end of the oesophagus, making the lower oesophageal sphincter stronger. This helps prevent the stomach from pushing through the diaphragm opening and the stomach juices from flowing back into the oesophagus.