A hiatal hernia occurs when part of your stomach pushes upward through your diaphragm. Your diaphragm normally has a small opening (hiatus) through which your food tube (esophagus) passes on its way to connect to your stomach. The stomach can push up through this opening and cause a hiatal hernia.
In most cases, a small hiatal hernia doesn’t cause problems, and you may never know you have a hiatal hernia unless your doctor discovers it when checking for another condition.
But a large hiatal hernia can allow food and acid to back up into your esophagus, leading to heartburn. Self-care measures or medications can usually relieve these symptoms, although a very large hiatal hernia sometimes requires surgery.
Most small hiatal hernias cause no signs or symptoms. However, larger hiatal hernias can cause signs and symptoms such as:
- Difficulty swallowing
- Chest or abdominal pain
- Feeling especially full after meals
- Vomiting blood or passing black stools, which may indicate gastrointestinal bleeding
A hiatal hernia occurs when weakened muscle tissue allows your stomach to bulge up through your diaphragm. It’s not always clear why this happens, but pressure on your stomach and age-related changes in your diaphragm may contribute to the formation of a hiatal hernia.
How a hiatal hernia forms
Your diaphragm is a large, dome-shaped muscle that separates your chest cavity from your abdomen. Normally, your esophagus passes into your stomach through an opening in the diaphragm called the hiatus.
Hiatal hernias occur when the muscle tissue surrounding this opening becomes weak, and the upper part of your stomach bulges up through the diaphragm into your chest cavity.
Possible causes of hiatal hernia
Hiatal hernia could be caused by:
- Injury to the area
- Being born with an unusually large hiatus
- Persistent and intense pressure on the surrounding muscles, such as when coughing, vomiting or straining during a bowel movement, or while lifting heavy objects
Hiatal hernia is most common in people who are:
- Age 50 or older
Most people with a hiatal hernia don’t experience any signs or symptoms and won’t need treatment. If you experience signs and symptoms, such as recurrent heartburn and acid reflux, you may require treatment, which can include medications or surgery.
Surgery to repair a hiatal hernia
In a small number of cases, a hiatal hernia may require surgery. Surgery is generally reserved for emergency situations, which are rare, and for people who aren’t helped by medications to relieve heartburn and acid reflux.
An operation for a hiatal hernia may involve pulling your stomach down into your abdomen and making the opening in your diaphragm smaller, reconstructing a weak esophageal sphincter, or removing the hernia sac.
In some cases, surgery is done using a single incision in your chest wall (thoracotomy) or abdomen (laparotomy). In other cases, your surgeon may insert a tiny camera and special surgical tools through several small incisions in your abdomen. The operation is then performed while your surgeon views images from inside your body that are displayed on a video monitor .