Hiatal hernia (stomach hernia): causes, symptoms, and best treatment

A hiatal hernia appears during a medical examination as a result of feeling heartburn or chest pain, in addition to pain in the upper abdomen, and these symptoms are considered the most prominent signs of a hiatal hernia. You can learn more about this topic through the Dalili Medical website.

**What is a hiatal hernia?**

A hiatal hernia occurs when the upper part of the stomach pushes through an opening in the diaphragm into the chest cavity. The diaphragm is a thin muscular wall that separates the chest cavity from the abdomen, and the opening in it is the point of connection between the esophagus and the stomach.

**Does a hiatal hernia cause shortness of breath?**

Some patients may have difficulty breathing due to the presence of a large part of the stomach inside the rib cage, which puts pressure on the lungs.

**Is a hiatal hernia operation dangerous?**

Hiatal hernia repair is not considered dangerous, as the laparoscopic operation achieves success rates exceeding 90%. The more skilled the surgeon is and the more modern techniques are used, the lower the risks of the operation and the greater the chances of success.

**How ​​long does it take to recover after a hiatal hernia surgery?**

The patient needs about 6 to 8 weeks to return to work, but full recovery may take 10 to 12 weeks.

**Is a hiatal hernia dangerous for the fetus?**

The presence of organs such as the intestines, stomach, and liver in the chest cavity reduces the space available for the growth and development of the fetus's respiratory system, which leads to incomplete development of its lungs. This may cause loss of lung function, making it difficult for the infant to breathe normally at birth.

**What are the causes of a hiatal hernia?**

The most common cause of a hiatal hernia is increased pressure within the abdominal cavity, which contains the lower parts of the esophagus, stomach, small intestine, colon, rectum, liver, gallbladder, pancreas, spleen, kidneys, and bladder. This pressure can result from coughing, vomiting, straining during bowel movements, lifting heavy objects, or physical exertion. Pregnancy, obesity, and excess fluid in the abdomen may also contribute to the occurrence of a hiatal hernia.

**Who is most at risk for a hiatal hernia?**

Hiatal hernias can affect people of all ages and both sexes, but they are most common in people over the age of 50. They are also more common in smokers and people who are obese.

**How ​​effective is hiatal hernia surgery?**

Laparoscopic hiatal hernia and gastroesophageal reflux repair, also known as Nissen fundoplication, is about 90% effective in most patients. This surgery requires the patient to be under general anesthesia during the procedure, with a one-day hospital stay afterward. Most patients do not require long-term treatment, whether it is available by prescription or limited to over-the-counter antacids.

Causes of hiatal hernia

There are many causes of hiatal hernia, the most prominent of which are:

1. **Weak diaphragmatic muscles**: A hernia can occur as a result of weakness in the muscles surrounding the diaphragmatic opening, allowing parts of the stomach or intestines to bulge through it.

2. **Increased intra-abdominal pressure**: Increased intra-abdominal pressure resulting from obesity, pregnancy, chronic coughing, lifting weights incorrectly, or excessive stress may contribute to the development of a hiatal hernia.

3. **Genetic factors**: Genetic factors play a role in increasing the likelihood of developing a hiatal hernia in some people.

4. **Age**: As you age, the muscles surrounding the diaphragm may weaken, increasing the risk of a hernia.

5. **Muscle tension diseases**: Some conditions that lead to increased muscle tension in the abdominal area, such as an enlarged prostate or chronic constipation, may increase the likelihood of a hernia.

6. **Smoking**: Smoking can contribute to an increased risk of a hiatal hernia due to its negative effect on blood vessels and tissues.

7. **Overeating**: Eating large amounts of food or fluids before bed may increase intra-abdominal pressure, increasing the likelihood of a hernia.

 Types of hiatal hernia (hiatal hernia - stomach hernia)

Hiatal hernia (hiatal hernia - stomach hernia) can be classified into three main types:

1. **Type 1: Sliding Hiatus Hernia**: It is considered the most common, where the upper part of the stomach and the lower part of the esophagus are pushed into the chest cavity vertically, resulting in the lower part of the esophagus not being in its normal place.

2. **Type 2: Rolling Hiatus Hernia**: Also known as Paraesophageal Hiatus Hernia, it is less common than the first type. In this type, the upper part of the stomach is pushed into the abdominal cavity next to the esophagus from the diaphragmatic opening without changing the location of the lower part of the esophagus, and this hernia is considered more dangerous because it is more prone to strangulation than the first type.

3. **Type 3: Mixed Hiatus Hernia**: It is considered a combination of the two previous types.

4. **The fourth type: Compound Hiatus Hernia**: This type contains other components of the abdominal cavity such as the small intestine or colon, and is considered rare as it does not exceed 5% of the total cases of hiatal hernia.

Do the symptoms of hiatal hernia appear with the same severity in all patients?

No, the severity of symptoms varies from one patient to another, as it is affected by the type of hernia, its size, and the stage of its discovery, in addition to the extent of its effect on the stomach and esophagus. There are also certain categories of patients who may be more susceptible to hiatal hernia, such as:

- Women after repeated experiences of pregnancy and childbirth.

- Patients with

For chronic constipation.

- People who are obese.

- Patients with respiratory diseases who suffer from chronic cough.

- Athletes, especially those who practice violent sports and weightlifting.

Therefore, diagnosing the symptoms of hiatal hernia and developing an appropriate treatment plan for each patient requires high experience and skill from the specialist doctor, as the diagnosis depends on studying all aspects of the patient's life and medical history, in addition to conducting some necessary examinations.

Symptoms of hiatal hernia include:

- Bloating and swelling in the abdomen or thigh area, resembling a mass.

- Feeling of burning or pressure in or around the hernia area.

- Discomfort while standing or sitting for long periods.

- Nausea and vomiting.

- Increased gas and bloating.

- Heartburn and acid reflux.

- Difficulty swallowing.

- Abdominal and chest pain.

- Digestive disorders.

- Feeling of a mass or bloating in the upper abdomen.

- Shortness of breath and difficulty exhaling.

- Feeling of pressure and discomfort in the upper abdomen.

**Hiatal hernia grades (gastric hernia)**

- **First degree (hiatal hernia less than 3 cm):** The opening in the diaphragm is small, and the hernia is simple and imperceptible.

- **Second degree (hiatal hernia from 3 cm to 5 cm):** The hernia is larger and can be felt when bending or coughing.

- **Third degree (hiatal hernia greater than 5 cm):** The hernia is large and can be clearly seen.

**When does a patient with a hiatal hernia need surgical intervention?**

- Patients with a hiatal hernia adjacent to the esophagus if the blood supply to the stomach is cut off.

- Patients with a hiatal hernia accompanied by chronic reflux that does not respond to drug therapy.

**Surgical intervention aims to:**

- Reconstruct the esophageal wall affected by acids.

- Return the stomach to its normal position and narrow the hernia.

- Correct the position of the valve at the end of the esophagus.

The surgical intervention can be performed in the traditional way or using an endoscope. In both cases, the doctor wraps the upper part of the stomach around the lower part of the esophagus after the patient is completely anesthetized. This surgery aims to prevent food and liquids from passing from the stomach to the esophagus again. The traditional method provides a wider view, and is only used in advanced cases, which require a longer recovery time. Therefore, under normal circumstances, doctors prefer to use an endoscope to treat hiatal hernia.

**Advantages of using an endoscope to treat hiatal hernia:**

- Shorter recovery time.

- Reduced risk of infection.

- Smaller incisions.

- Reduced pain and scarring.

**Methods of detecting hiatal hernia**

The first method involves using a thin, flexible tube equipped with a light and camera (endoscope) that is inserted into the lower throat to examine the esophagus and stomach, to check for inflammation or not. This method is known as upper endoscopy, and is considered the most accurate in diagnosis.

The second method for diagnosing hiatal hernia involves performing an X-ray directed at the upper digestive system. This is done after the patient drinks a chalky liquid (barium dye) that coats the inner lining of the digestive tract, allowing the doctor to see a clear picture of the esophagus, stomach, and upper intestine.

The third way to detect a hiatal hernia is to measure esophageal motility (manometry), as this test measures the rhythmic muscle contractions in the esophagus during swallowing. Esophageal pressure also measures the coordination and force exerted by the esophageal muscles, and this is done by measuring esophageal pressure to determine muscle contractions during the swallowing process.

**Symptoms of hiatal hernia in children**

Children usually do not suffer from clear symptoms, but the mother may notice some signs such as:

- Continuous vomiting.

- Stomach pain.

- Weight loss.

- Hoarseness.

- Pneumonia.

- Loss of appetite.

- Wheezing while breathing.

- Change in stool color to a dark color.

- Frequent belching, which is considered one of the most prominent signs that help the mother detect the disease.

**Symptoms of hiatal hernia in men**

In the case of a small hiatal hernia, there may be no symptoms indicating problems. On the contrary, a large hernia may lead to some symptoms, which include:

- Feeling full quickly after eating.

- Reflux of food or liquids into the mouth.

- Difficulty swallowing.

- Heartburn.

- Reflux of stomach acid into the esophagus, known as acid reflux.

- Chest or abdominal pain, which is one of the most common symptoms.

- In some cases, the patient may suffer from shortness of breath.

- The presence of blood in vomit or black stool, which indicates bleeding in the digestive system, which is one of the most serious symptoms.

**Symptoms of hiatal hernia in women**

Symptoms of hiatal hernia in women often appear in the second trimester of pregnancy, although about 10% of pregnant women do not experience any symptoms. In many cases, some simple symptoms may appear that overlap with pregnancy symptoms, such as:

- Feeling heartburn.

- Indigestion.

- Acid reflux when lying down.

Symptoms of hiatal hernia in women can be controlled by using some medications and changing lifestyle, such as:

- Regulating meal times, especially at least three hours before bedtime.

Using antacids is a common way to relieve heartburn, which is one of the most prominent symptoms of hiatal hernia.

In cases of severe pain, indicating strangulation of the hernia and the interruption of blood flow to the organs, surgical intervention may be necessary.

**How ​​to diagnose hiatal hernia**

Diagnosing hiatal hernia requires a set of steps and tests performed by a specialist doctor. Here are the basic steps to diagnose this condition:

1. **Medical history and clinical examination**: The doctor usually begins by asking you about the

Your symptoms and medical history. Next, he will perform a clinical examination of the abdomen and chest to look for any signs or symptoms that may indicate a hernia.

2. **Radiological tests**: A chest X-ray may be ordered to assess the size and general shape of the stomach and intestines inside the chest cavity.

3. **Ultrasound**: This type of imaging is used to view the internal organs and detect the presence of a hernia, in addition to determining its location and size.

4. **Magnetic resonance imaging (MRI)**: In complex cases, MRI may be used to obtain accurate images of the internal structure of the body and the details of the hernia.

5. **Pharmacodynamic Test (PH Test)**: If heartburn and acid reflux are symptoms, the doctor may perform a test to measure the level of stomach acid in the esophagus over a period of time.

6. **Manometry**: This test measures the pressure of the esophageal muscles and helps evaluate how the esophagus works during swallowing and digestion.

**Hiatal Hernia Complications**

Hiatal hernia complications vary depending on the size of the hernia and its impact on surrounding tissues. Possible complications include:

1. **Bloating and pain**: A hiatal hernia may cause swelling in the affected area, as well as persistent or recurring pain in the lower abdomen.

2. **Intestinal distention**: In some cases, parts of the intestine can slip through the hernia, causing a noticeable bulge in the affected area.

3. **Intestinal obstruction**: Parts of the intestine may get stuck inside the hernia, which can lead to a partial or complete blockage of food and fluids, which is considered a medical emergency.

4. **Inflammation**: Inflammation of the affected tissues can occur as a result of the obstruction or continued stretching of the hernia, which can lead to infection.

5. **Blood blockage**: In some cases, blood flow to parts of the prolapsed intestine may be stopped, causing serious health problems.

6. **Fluid accumulation**: Fluid may accumulate inside the hernia, leading to increased swelling and bloating.

7. **Invasive stenosis**: Parts of the intestine or other tissues may become entrapped inside the hernia, which may put pressure on blood vessels and pose a risk to the affected tissues.

8. **Tissue damage**: In rare cases, a long-term untreated hernia may damage the surrounding tissues.

**How ​​to treat different degrees of hiatal hernia**

Given the different symptoms and body condition in hiatal hernia degrees, not all cases can be treated in the same way, as we will explain in the following lines.

**Treatment of simple hernia degrees**

The results of the esophageal acidity test appear positive in simple hernia cases, as the doctor begins with drug treatment first. If this method does not work, he may resort to performing a hiatal hernia operation for the child.

**Treatment of advanced hernia degrees**

A rolling hiatal hernia is a serious condition, so the child should be operated on as soon as possible.

**What happens if the hernia is not treated according to its degree and type?**

Some parents may give their children medications to relieve hernia symptoms without consulting a doctor, or ignore treatment under the pretext that the child does not show symptoms. This is dangerous, as it may lead to unwanted complications, such as:

- Formation of ulcers in the esophagus.

- Narrowing of the esophagus.

The best exercises to treat hiatal hernia

Some may see the importance of some exercises in strengthening the diaphragm muscle, or at least reducing the symptoms felt by the patient.

You should not do any exercises before consulting a doctor and making sure that these exercises are appropriate for your condition. 

Breathing through the diaphragm: This exercise helps increase the amount of blood flowing to the diaphragm, and continuing this exercise can strengthen the muscles of this area.

Sit in a comfortable position, place one hand on your stomach, and the other on your chest.

Breathe deeply until you feel your stomach under your hands.

Maintain this position for a few moments, then expel the air out until the abdominal pressure under your hands disappears.

Repeat this exercise several times a day.

Bridge exercise: This exercise aims to strengthen the abdominal muscles by:

Lying on your back, raising your lower body while keeping your feet on the ground.

Raising your lower back for a few moments.

Repeat the exercise several times.

Yoga for hiatal hernia Yoga promotes deep breathing, strength, and flexibility, and improves blood flow, but in cases of hiatal hernia, you should focus on gentle stretching positions, avoiding positions that put pressure on the abdomen, such as cobra and bow. You should consult a yoga trainer to choose appropriate hiatal hernia treatment exercises. Many yoga positions are specifically designed to strengthen the diaphragm and abdomen, such as:

The squat position is an effective exercise for treating hiatal hernia, as it helps strengthen the body, especially the lower part of it. The effectiveness of this exercise increases when combined with the diaphragmatic breathing exercise.

To perform the squat exercise, you must follow the following steps:

1. Stand straight with your feet next to each other.

2. Raise your arms straight above your head with your palms facing each other.

3. Bend your knees together and lower yourself down until your thighs are parallel to the ground, as if you were sitting on an imaginary chair.

4. Hold this position for as long as possible.

5. Return to standing and repeat the exercise.

As for the bridge exercise, it helps strengthen the abdominal muscles, making it a useful exercise for treating hiatal hernia.

To perform the bridge exercise, follow these steps:

1. Lie on your back with your knees bent and your feet flat on the ground.

2. Lift your lower back and buttocks off the ground while keeping your shoulders touching the ground.

3. Hold this position for as long as possible

Possible.

4. Return to the lying position and then repeat the exercise again.

It is recommended to repeat this exercise 10 times daily.

It is also preferable to take a deep breath through the nose while focusing on the rise of the abdomen, then exhale slowly while focusing on relaxing the abdomen, and repeat this exercise several times.

**Chair Pose Squatting** is a common exercise, and here is how to perform it: Start by standing straight while keeping your back straight. Raise your hands straight above your head. Bend your knees as much as possible until your thighs are parallel to the ground, as if you were sitting on a chair. Stay in this position for several seconds, then slowly return to the starting position. It is preferable to practice this exercise in three to four sets, with 10 repetitions in each set.

**Cat-Cow Stretch** is a useful exercise for improving breathing with movement, and has a positive effect on the spine. Start with your hands and knees on the floor, with your hands under your shoulders and your knees under your buttocks, keeping your spine in its natural position. Take a deep breath, then bend your back up and your head down, like a cat does. You will feel a comfortable stretch in your back, hold this position for three to five seconds, then exhale and lower your belly toward the floor, lift your head up, and hold this position for a few seconds as well. Repeat the exercise several times.

**Child’s Pose** is a beneficial stretching exercise for the body in general, as it improves flexibility and breathing. Start in a position similar to the cat and cow back position. Sit on your heels as much as possible, with your arms extended on the floor. Place your chest on your thighs and relax your forehead on the floor. Hold this position for 30 to 60 seconds, focusing on deep breathing. You should feel a stretch in your back, thighs, arms, and shoulders.

**Exercises to avoid in case of hiatal hernia** include exercises that strain the abdominal muscles, such as lifting heavy weights, as they put pressure on the abdominal muscles and diaphragm, which may aggravate the hernia.

**Tips for benefiting from the previous exercises**:

- Start slowly and gradually increase the intensity of the exercises. You can consult a physical therapist to develop an appropriate exercise plan.

- Avoid exercises that may aggravate the symptoms of hiatal hernia.

- Try low-impact exercises on the diaphragm such as walking, swimming, and cycling.

- If you are overweight, try to lose weight.

- Add these exercises to other treatment methods prescribed by your doctor.

**Hiatal hernia surgery damage**: The risks associated with any surgical procedure include infection, bleeding, injury to nearby organs, or failure of the procedure. However, these risks are rare and can be easily avoided by choosing an experienced doctor such as Dr. Mohamed Abu El-Naja.

**Hiatal hernia surgery failure symptoms**: They include persistent hernia symptoms such as heartburn and difficulty breathing, severe pain at the surgical site, and high body temperature. A doctor should be consulted immediately if any of these symptoms appear.

**Hiatal hernia treatment**: It depends on the severity of the condition (type and degree of hernia) and its symptoms. Treatment may be surgical or non-surgical using medications or lifestyle changes, such as losing weight, avoiding foods that cause heartburn, and controlling coughing.

**Hiatal hernia treatment medications**: The doctor may prescribe medications to treat the symptoms of gastroesophageal reflux associated with the hernia, but drug therapy is not a definitive treatment for the hernia itself. Examples of these medications include:

- Antacids.

- H2 receptor blockers.

- Proton pump inhibitors.

**Hiatal surgeries**: The doctor resorts to surgery in severe cases where medications or lifestyle changes do not succeed in controlling the symptoms, or in the event of serious complications such as interruption of blood flow to the strangulated part of the stomach. The aim is to

The aim of diaphragmatic surgeries is to repair the hernia by returning the organs to their correct positions within the abdominal cavity and closing the opening in the diaphragm.

The diaphragmatic hernia surgery is performed using a laparoscope, where 5 to 6 small incisions are made in the abdominal area, and the laparoscope and surgical instruments are inserted through them.

- The surgeon uses the laparoscope to take pictures of the internal organs of the body and display them on a screen.

- The hernia is pulled out of the diaphragm area and returned to the abdominal cavity.

- The function of the valve located in the lower part of the esophagus is improved, which helps prevent the reflux of stomach juices and contents into the esophagus.

- The surgeon wraps the upper part of the stomach, known as the fundus, around the lower part of the esophagus, which helps to permanently tighten the sphincter muscle, thus preventing the return of stomach contents to the esophagus in the future.

The advantages of laparoscopic surgery compared to open surgery include smaller surgical incisions, reduced risks of bleeding and pain during and after the operation, and a faster and shorter recovery period.