When I was a child, I remember my father using an expression that meant “Don’t get so worked up” or “don’t get so upset about it.”
The expression was, “Don’t have a hernia!”
Well, now I understand why he’d say that.
You see, hernias happen when fat tissue, part of an organ, or some other tissue pushes through a weakened area of muscle. This usually happens in the area of the groin or abdomen, and the evidence is a noticeable lump or bulge in one of those areas.
It’s as if you’ve “bust a gut.”
Exerting oneself in some way is usually the cause: heavy lifting, vomiting, persistent coughing or sneezing, or constipation can all cause a hernia. It’s as if you’ve pushed that tissue right through the muscle wall.
However, there’s one type of hernia that’s more “internal.” You usually won’t see that bump, or even know you’ve had a hernia until one particular symptom shows up.
It’s called a hiatal hernia.
What is a hiatal hernia?
While more common hernias involve the intestine pushing out into the groin area or into the thigh, a hiatal hernia is caused by weakness in the diaphragm muscle, together with increased pressure on the abdominal cavity.
The diaphragm, of course, is that mushroom-shaped muscle that sits below your rib cage. It separates your abdomen from your chest cavity and helps you breathe by allowing your lungs to expand.
A weak diaphragm together with some physical exertion can cause part of the stomach to bulge up into the chest cavity through a natural opening in the diaphragm called the hiatus.
There are actually two possible types of hiatal hernia:
A sliding hiatal hernia is more common. It happens when the stomach and esophagus slide into and out of the chest through the hiatus. These are small hernias that don’t tend to cause symptoms and may not require treatment.
A fixed hiatal hernia, also called a paraesophageal hernia, is not as common, and is of much greater concern. The esophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus and lands next to the esophagus.
The danger here is that the stomach can become “strangled” or have its blood supply cut off. Of even more concern is that a fixed hiatal hernia can occur with no symptoms at all.
Who is at risk?
Anything that weakens the diaphragm muscle puts you at higher risk for a hiatal hernia. Surgery or traumatic injury in the area of the abdomen will do that.
Age is another factor. The older we get, the weaker our muscles become, and the diaphragm is no exception. That’s why hiatal hernias frequently occur in people age 50 and older.
Obesity is one of the biggest risk factors for a hiatal hernia. It puts constant pressure on the diaphragm and weakens the muscle.
Smoking also weakens the diaphragm and makes it easier for the stomach to protrude through the hiatus.
Hiatal hernia and GERD
Most people who have a hiatal hernia don’t have any symptoms at first. However, a more severe or untreated hiatal hernia will often lead to another condition known as gastroesophageal reflux disease or GERD.
Acid reflux is when the lower esophageal sphincter, a muscle at the base of your esophagus, fails to keep the contents of your stomach where they belong: in your stomach. Those contents travel back up into the esophagus, causing the sensation most people call heartburn.
According to the American College of Gastroenterology, GERD is acid reflux that occurs more than a few times a week. Having half-digested food and stomach acid continually back up into your esophagus leads to more severe complications.
GERD can interrupt life and lead to health complications. These symptoms include:
- Frequent heartburn
- Regurgitating food or stomach contents
- Difficulty swallowing
- Damaged teeth from stomach acid
Left untreated, possible complications from GERD include:
- Esophageal stricture – a narrowing of the esophagus and problems swallowing
- Esophageal ulcer – open sores, also due to stomach acid
- Barrett’s esophagus – a precancerous condition where the lining of the esophagus changes to more closely resemble the lining of the intestines
Which comes first?
When it comes to a hiatal hernia and GERD, it’s a bit of a “chicken-and-egg” scenario.
As GERD progresses, it can cause the lower esophageal sphincter to weaken, causing a hiatal hernia. On the other hand, a hiatal hernia could make symptoms of GERD worse.
You can have a hiatal hernia without GERD, and vice versa.
Hiatal hernia: lifestyle changes that can help
If you have been diagnosed with a hiatal hernia, certain symptoms should have you reaching for the phone to call your doctor immediately:
- Severe chest or stomach pain
- Nausea and vomiting
- Are unable to pass gas or move bowels
In the case of a fixed hiatal hernia, surgery may be called for to bring the stomach back into place and avoid loss of blood supply.
Your doctor may also recommend over-the-counter medications to control acid stomach.
Of course, as with everything, there are natural ways to lower your risk and control symptoms.
Regular exercise is also a low-cost, non-medical way to maintain a healthy weight and ‘keep things moving.’ Maintaining a healthy weight will avoid obesity, the biggest risk factor.
Avoiding constipation and the need to “push” is another way to avoid a hiatal hernia.
A diet that consists of whole foods, and does not include processed foods, is the simplest way to do this.
The Mediterranean diet is a good plan to follow. It is centered around fruits and vegetables that are fiber-rich and fish and nuts that provide healthy fats.
Also, here are some recommendations by my colleague Dr. Mark Wiley on how to eat a “more-fiber diet”.
Finally, although each person with a hiatal hernia reacts differently to foods, here is a general list of foods to avoid:
- Citrus fruits
- Fried foods
- Garlic and onions
- Tomato-based foods
- Connecting the Dots: Understanding the Link Between Hiatal Hernia and GERD — everydayhealth.com
- Hiatal Hernia — healthline.com
- Coping With a Hiatal Hernia — verywellhealth.com
- Hiatal Hernia — Cleveland Clinic