Hiatus Hernia

Hiatus Hernias are another one of those delightful conditions common in middle age.

Over a third of people over fifty have one.
Usually though, you wont know it.

The vast majority of cases are what's known as Asyptomatic.
(They don't produce symptoms)

"What is a Hiatus Hernia."
Hernias are a small tear or weakness along the fibers of a muscle which allow a piece of an organ to poke through.

In this case the muscle is the diaphragm, which is a large flat muscle that divides your body into chest,(above) and abdomen,(below).

There are three 'holes' in the diaphragm, called Hiatus, which allow tubes and nerve bundles through from your abdomen to your chest.


The tube in this case being your esophagus or gullet.


The condition is also known as Hiatial Hernia.



Diaphragm viewed from below

Causes of Hiatus Hernia
It is thought to be caused by a weakening or stretching of the diaphragm due to age.
Abdominal straining such as when passing stool, and passing urine whilst suffering from enlarged prostate.
Lifting heavy weights and obesity are also thought to increase the risk of Hiatial Hernia.

It seems to be another one of those conditions which are related to a 'western lifestyle'...

According to Dr. Dennis Burkitt, Surgeon and world renowned authority on diet and health...

"Hiatial hernia has its maximum prevalence in economically developed communities in North America and Western Europe....
In contrast the disease is rare in situations typified by rural African communities."

Dr Burkitt attributes the disease to insufficient dietary fiber and the use of the unnatural sitting position for defecation.

Both factors create the need for straining at stool, increasing intra-abdominal pressure and pushing the stomach through the esophageal hiatus in the diaphragm.

There is lots of help and advice on diet in this site, use it to form your own Hiatus Hernia diet.

There are two types of Hiatus Hernia...

Sliding Hiatus Hernia
Rolling Hiatus Hernia

As Hiatial Hernia's share a lot of symptom with other Gastroesophageal Reflux Diseases, such as GERD. Which is a disorder in which there is recurrent return of stomach contents back up into the esophagus,

They are usually diagnosed using a test called an X ray Barium Swallow.

You're given a drink which contains the chemical element Barium which shows up well on x ray. Then Images are taken which show up the presence and extent of any herniation.

Your doctor may also do an Endoscopy.
This is where a small telescope is fed down your gullet either through your mouth or up your nose. The doctor can then inspect your esophagus for ulcers and other damaged tissue.

Sliding Hiatus Hernia
The neck of your stomach, which contains a ring of muscles called a sphincter, slips up into the gap in the hiatus.
This is called a sliding Hiatus Hernia because it can also slide back again. It's the most common. About 80% of cases are sliding hiatus hernias.

When the sphincter gets caught in the Hiatus, it can allow stomach juices which are very acidic, to pass up into your gullet
(this is called reflux).
This causes the pain we know as 'Heartburn' or 'Indigestion'. Because your esophagus hasn't got the protective layer of mucus that your stomach has, to stop the acid from burning the tissue.

In severe cases these juices can pass all the way up your gullet, past where it joins your windpipe, and into your throat, burning all the way.
This can cause ulcers, which again in severe cases can bleed.

Sliding Hiatus Hernia Symptoms
Heartburn/Indigestion, a pain or burning sensation in the chest, is the main symptom.
(which as you can see is nothing to do with your heart)
Hiatial Hernia pain can be very bad, which is why sometimes people having a heart attack often mistake it for 'indigestion'.

It can be painful to swallow, especially hot drinks. This is due to acid burns in the gullet.
You may develop a painful cough. Again due to acid burns this time to the windpipe.

These symptoms are often worse at night when lying down.
This is because the acid reflux takes longer to return to your stomach, so is in contact with the delicate tissues longer.

Likewise, bending over can force more acid up, and this won't be able to return due to gravity.
Eating spicy foods, and drinking hot drinks, or alcohol, can make things worse, because they irritate your already tender esophagus.

Sliding Hiatus Hernia Treatment
The majority of cases can be treated with simple antacid medicines. These are available over the counter in most countries, and come both in liquid and tablet form.

They are usually made up from compounds of aluminum, or magnesium. Which work by nuetralising stomach acid in the affected area.

Some others have an alginate in them, which covers the top of the stomach acid with a chemical barrier which stops it from slopping up the gullet.

In the event Antacids don't help you, or you need large amounts to relieve your symptoms, Your doctor might prescribe...

Acid Blocking Medicines.
These work by slowing the production of stomach acid, known as H2 Blockers.
Or there is the option of a family of drugs called Proton Pump Inhibitors which slow production in a different way.

For More Information on Licensed Drugs:
US Licensed Drugs
UK Licensed Drugs

There are some lifestyle changes you can adopt which will help to ease the symptoms of Hiatus Hernia.Some may seem familiar...

Lose weight
There seems to be a link between obesity and Hiatus Hernia.
Quit Smoking
Nicotine can cause reflux and coughing can make your hernia worse.
Eat smaller meals
The less full your stomach the smaller the risk of reflux.
Avoid alcohol and spicy foods
These will irritate your already sore esophagus.
Sleep propped up on plenty of pillows
This will help to keep stomach juices from splashing up.

Rolling Hiatus Hernia.
This is when the sphincter stays in place but another part of the stomach or even another organ such as the spleen gets caught in the hiatus.
The resulting 'pinch' to the organ can be serious and potentially fatal. It often requires emergency surgery.

Rolling Hiatial Hernia Treatment
The Hiatial Hernia operation used to be a 'big' operation with all the associated dangers, as you can see from this video.

Nowadays Hiatial repair surgery is usually done by a process called Laparoscopy, or keyhole surgery.
A few small incisions are made in the abdomen and small instruments inserted.
One has a camera so the surgeon can see what he's doing, the others have various instruments on the end.
The actual repair is basically the same, but without a huge wound.


Living with it.
Like a lot of things we are experiencing, this condition seems to be a part of middle age.
But if we make a few changes to the way we go about our lives, there is no reason why we cant go on enjoying being active and healthy.

This website is chock-full of ideas and tips to help you make the most of the cards dealt.



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