Hiatal Hernia

A hiatal hernia is a condition that is not visible from the outside. It occurs when your stomach bulges up through an opening in the diaphragm. The stomach pushes up through this small opening known as hiatus and into your chest, but it usually remains below the diaphragm. There are two types of Hiatal Hernias:- sliding and paraesophageal. 

1. In a sliding Hiatal hernia, the stomach and lower part of the oesophagus (food pipe) slide up into your chest. 
2. In para esophageal hernia, the stomach and oesophagus stay at their place, but a part of your stomach slides up through the hiatus and sits next to your oesophagus. 

Hiatal Hernia symptoms include:-

1. Chest or abdominal pain
2. Upset stomach
3. Vomiting
4. Acid Reflux or GERD (Backflow of stomach acid into the oesophagus)
5. Heartburn from Gastroesophageal Reflux Disease (GERD)
6. Bloating
7. Shortness of breath
8. Difficulty swallowing
9. Bad taste in the mouth

As stated earlier, a Hiatal hernia occurs when your weakened muscle tissues allow your stomach to bulge up. Doctors aren’t always clear about why this happens. However, some of the hiatal hernia causes may include:-

1. Changes in diaphragm due to ageing
2. Born with an uncommonly large hiatus
3. Injury to the area
4. Increased pressure on the muscles surrounding your stomach due to coughing, vomiting, lifting heavy objects, pregnancy, obesity, or straining during bowel movements
5. Smoking, as it weakens and relaxes the abdominal muscles

A hiatal hernia occurs commonly in people:-

1. Older than the age of 50
2. Obese or overweight
3. Who smoke
4. Higher chances in women

To diagnose a hiatal hernia as being the cause of heartburn or chest pain, the doctor usually starts with taking the complete medical history of the patient and conduct a clinical examination with tests including:-

1. Endoscopy: It is the most common and preferred test to diagnose hiatal hernia. In this test, the doctor puts a long, thin tube down your throat with a camera at the end. The endoscope instrument allows the doctor to look inside the abdomen and see if the stomach has protruded into the oesophagus, and diagnose the stage of hernia. It also helps to identify inflammations and ulcers. 
2. pH Test: The test is used to measure the acid level in your oesophagus.
3. Ultrasound: Ultrasound, also known as sonography, is another test to diagnose hiatal hernia, especially in infants and young children. 
4. Barium Swallow: In this test, you are made to drink a liquid that shows up in an X-ray. This helps the doctor to examine your stomach and oesophagus better. 
5. Oesophageal Manometry: A tube is inserted down your throat to check the pressure in the oesophagus when you swallow.

Most people with hiatal hernia do not experience any symptoms and thus require no treatment. However, in severe cases, when you do experience hiatal hernia symptoms, such as acid reflux and heartburn, you may need medication or surgery. 

1. Over-the-counter medication like antacids neutralises stomach acid or H2-receptor blockers to lower acid production.
2. Some other medicines can act on the lower oesophageal sphincter (LES) and help relieve the symptoms to some extent. However, please note that these medicines cannot cure the hernia completely. 
3. Adopt some lifestyle changes - quit smoking, lose weight, and raise the head of your bed to help gravity keep your stomach’s contents in the stomach itself. 
4. Most women are at risk of developing a hernia during their pregnancy. If the hernia is not causing any symptoms, the doctor may decide to wait until the time of birth. However, if the hernia causes discomfort, the doctor may treat it while you are still pregnant. 
5. Since hernia is an anatomical defect caused by the displacement of the stomach from its original position, surgery for hiatal hernia is sometimes required to treat larger hernias with the help of stitches or sutures. Surgery is the only option to treat hiatal hernia completely. The most common surgery is Laparoscopic surgery for hiatal hernia, in which several small incisions are made to pull the hiatal hernia back into the abdomen. 
6. The traditional open hernia repair surgery is another option to treat hiatal hernia. In this method, the surgeon makes a larger incision in the abdomen to fix the hernia. This procedure carries more risk and slower recovery time than laparoscopic surgery.

If not treated promptly, you can face the following complications:-

1. Hernias Grow: If hiatal hernia treatment is not undertaken at the correct time, your hernia will continue to grow and weaken. A grown hernia will increase your symptoms, causing you more pain and bringing changes to your lifestyle. Moreover, smaller hernias are easier to cure than larger hernias. 
2. Incarcerated Hernias: Another risk of not fixing a hernia is that it can get stuck outside the abdominal wall, stopping the blood supply to the hernia and resulting in a strangulated hernia. This condition required an urgent surgical repair. So to avoid this emergency, you should not delay the treatment for your hiatal hernia.