Lapsurgery.com.au, What Causes Hiatus Hernia? – A hiatus hernia, also known as a hiatal hernia, occurs when part of the stomach pushes up through the diaphragm into the chest cavity. The diaphragm is a muscle that separates the chest from the abdomen and has a small opening (called the hiatus) through which the esophagus passes before connecting to the stomach. When the stomach pushes through this opening, it is referred to as a hiatus hernia.
Types of Hiatus Hernia
There are two main types of hiatus hernia:
- Sliding Hiatus Hernia: The stomach and the lower part of the esophagus slide up and down into the chest cavity. This is the most common type.
- Paraesophageal Hiatus Hernia: Part of the stomach pushes up next to the esophagus, which can sometimes lead to complications such as strangulation of the stomach tissue.
Causes of Hiatus Hernia
Several factors can contribute to the development of a hiatus hernia. These include:
1. Weakness in the Diaphragm Muscles
One of the primary causes is a weakness in the diaphragm muscles, which can allow the stomach to push through the hiatus. This weakness may be due to aging or congenital (present at birth).
2. Increased Pressure in the Abdomen
Excessive pressure in the abdominal cavity can push the stomach upward. Common causes of increased abdominal pressure include:
- Obesity: Excess body weight puts pressure on the abdomen.
- Pregnancy: The growing uterus during pregnancy can increase abdominal pressure.
- Chronic Coughing: Conditions like asthma, bronchitis, or smoking-related lung disease can cause persistent coughing, leading to pressure buildup.
- Heavy Lifting or Straining: Activities that require straining, such as lifting heavy objects or even constipation, can also contribute.
3. Age
Hiatus hernias are more common in people over the age of 50. Aging can lead to the weakening of connective tissues and muscles, making it easier for the stomach to protrude through the diaphragm.
4. Genetic Factors
A family history of hiatus hernia may increase the risk of developing the condition, as some individuals are genetically predisposed to having weaker diaphragm muscles.
5. Injury or Surgery
An injury to the diaphragm or complications from abdominal or chest surgery can create a weakness or opening in the diaphragm, leading to a hernia.
6. Other Contributing Factors
Certain lifestyle and dietary habits may also exacerbate the risk, including:
- Smoking
- Excessive alcohol consumption
- Frequent overeating, which can increase abdominal pressure
Symptoms of Hiatus Hernia
While some people with a hiatus hernia may not experience symptoms, others may develop:
- Heartburn or acid reflux
- Difficulty swallowing
- Chest pain
- A feeling of fullness after eating
- Regurgitation of food or acid
Prevention and Management of Hiatus Hernia
While it may not always be possible to prevent a hiatus hernia, certain lifestyle changes and habits can reduce the risk or help manage the condition. These include:
1. Maintain a Healthy Weight
Being overweight or obese increases pressure in the abdomen, which can lead to the development or worsening of a hiatus hernia. Losing excess weight through diet and exercise can help reduce this pressure and alleviate symptoms.
2. Avoid Heavy Lifting and Straining
Repetitive heavy lifting or straining can contribute to increased abdominal pressure. Practice proper lifting techniques and avoid activities that strain the abdominal muscles.
3. Eat Smaller, More Frequent Meals
Large meals can increase abdominal pressure and aggravate symptoms such as heartburn and acid reflux. Eating smaller, more frequent meals can help ease digestion and reduce discomfort.
4. Avoid Trigger Foods
Certain foods and beverages can trigger reflux symptoms associated with hiatus hernia. These include spicy foods, fatty or fried foods, citrus fruits, chocolate, caffeine, and alcohol. Keeping a food diary can help identify and avoid personal triggers.
5. Stop Smoking
Smoking can weaken the diaphragm muscles and worsen acid reflux symptoms. Quitting smoking is not only beneficial for managing a hiatus hernia but also improves overall health.
6. Elevate the Head of Your Bed
If you experience nighttime reflux or discomfort, elevating the head of your bed by 6–8 inches can prevent stomach acid from flowing back into the esophagus. Using extra pillows is less effective, as it may increase pressure on the abdomen.
7. Wear Loose Clothing
Tight clothing around the abdomen can increase pressure on the stomach and worsen symptoms. Choose loose-fitting clothes that allow for proper movement and digestion.
8. Practice Good Posture
Slouching or poor posture can increase abdominal pressure. Sitting and standing upright can help minimize symptoms and reduce strain on the diaphragm.
Medical Treatment for Hiatus Hernia
If lifestyle changes are not enough to manage symptoms, medical intervention may be required. Common treatments include:
1. Medications
- Antacids: Help neutralize stomach acid to provide quick relief.
- H2 Receptor Blockers: Reduce acid production in the stomach.
- Proton Pump Inhibitors (PPIs): Stronger medications that significantly decrease acid production and promote healing of the esophagus.
2. Surgery
In severe cases, particularly with paraesophageal hiatus hernias or when complications such as strangulation or chronic reflux occur, surgery may be recommended. The most common surgical procedure is Nissen fundoplication, where the stomach is repositioned and the opening in the diaphragm is tightened.
When to See a Doctor
It’s important to seek medical attention if you experience:
- Persistent or severe heartburn and acid reflux.
- Difficulty swallowing or frequent choking.
- Unexplained chest pain that mimics heart attack symptoms.
- Vomiting, especially if accompanied by blood.
These symptoms may indicate complications, such as esophagitis, ulcers, or strangulation of the hernia, which require prompt medical care.
Conclusion
A hiatus hernia can often be managed effectively with lifestyle adjustments and medical treatment. Understanding the causes and triggers can help prevent the condition from worsening and improve quality of life. For those with severe symptoms or complications, timely medical intervention can lead to successful outcomes. Always consult a healthcare provider for a proper diagnosis and personalized treatment plan.
