Hiatal Hernia: Symptoms, Causes, Types, Treatment & Diagnosis Guide

If you have ever been in a situation where you finished a delicious meal only to be met with a sharp, burning sensation in your chest or the feeling that your food is stuck, you are not alone. Many of us reach for an antacid and hope for the best, but sometimes the cause isn't just "something you ate". It could be a hiatal hernia. This common condition occurs when a part of your stomach migrates upward into your chest. While it sounds alarming, understanding how it works and how to manage it can help you get back to enjoying your life without the constant threat of heartburn.

What is a Hiatal Hernia?

The diaphragm is a large, dome-shaped muscle that separates your chest (thorax) from your abdomen. Normally, your oesophagus (the food pipe) passes through a small opening in the diaphragm called the hiatus to join the stomach.

A hiatal hernia occurs when the upper part of your stomach bulges through this opening and into your chest cavity. Think of it like a persistent "slip" of an organ that should stay below deck but has decided to move upstairs.

What are the Two Main Types of Hiatal Hernia?

Not all hernias are created equal, and they vary significantly in their characteristics and implications for health. Medical professionals typically categorise hernias into two primary types:

• Sliding Hernia: The most common variety (accounting for about 95% of cases). In this instance, the junction where the oesophagus meets the stomach slides up into the chest through the hiatus. It often moves back and forth, appearing and disappearing depending on your posture or pressure.
• Paraesophageal (Rolling) Hernia: This is less common but more significant. The junction stays in its normal place, but a part of the stomach "rolls" up next to the oesophagus. This type carries a higher risk of the blood supply to the stomach being restricted (strangulation).

What are the Symptoms?

Although many individuals with a small hiatal hernia may remain asymptomatic and experience no noticeable issues, larger hernias can give rise to a variety of uncomfortable and sometimes concerning sensations: 

• Gastro-oesophageal Reflux Disease (GORD): The classic "burning" sensation (heartburn) that travels from the stomach toward the throat.
• Regurgitation: Feeling food or sour-tasting acid coming back up into the mouth.
• Dysphagia: A persistent difficulty in swallowing, often feeling like food is "stuck" in the lower chest.
• Shortness of Breath: In severe cases, a large hernia can press against the lungs or diaphragm, making it harder to take a deep breath.
• Chest Pain: Dull aches that can sometimes mimic the symptoms of a heart attack (always consult a doctor if you experience unexplained chest pain).

What are the Causes and the Risk Factors?

If you are thinking, 'Why does this happen?', then let’s decode the answer. The diaphragm can weaken over time, or the hiatus can simply be naturally larger than usual. Here are the common triggers you must know:

• Age: It is significantly more common in those over the age of 50.
• Pressure: Chronic coughing, heavy lifting, or straining during bowel movements increases intra-abdominal pressure.
• Obesity: Carrying extra weight puts constant pressure on the abdominal muscles and the diaphragm.
• Pregnancy: The growing baby exerts upward pressure on the stomach and diaphragm.

How to Diagnose?

If you suspect you have a hiatal hernia, your GP may refer you for a few standard tests. These usually include a barium swallow (an X-ray where you drink a chalky liquid to highlight the digestive tract) or an endoscopy, where a small camera is used to look inside your oesophagus and stomach.

*Do not forget to contact your doctor if you notice any symptoms, even if they are mild. 

How Do Doctors Treat Hiatal Hernias?

Doctors approach the treatment of hiatal hernias based on symptom severity and each patient's specific needs. This type of hernia occurs when a portion of the stomach pushes through the diaphragm into the chest cavity, which can lead to discomfort and complications.

• Lifestyle Modifications: Small, frequent meals are better than three large ones. Avoiding "trigger" foods like caffeine, chocolate, and spicy dishes can also help. Elevating the head of your bed by 15–20cm can prevent acid from rising while you sleep.
• Medication: Antacids and Proton Pump Inhibitors (PPIs) are commonly prescribed to reduce stomach acid production.
• Surgical Intervention: If lifestyle changes and medications fail, or if the hernia is at risk of strangulation, keyhole surgery (laparoscopy) may be required to move the stomach back and tighten the hiatus.

How to Manage the Cost of a Hiatal Hernia?

Managing such a chronic condition often requires long-term medication, consultations with specialists, and potentially costly surgical procedures. This is why it is essential to plan for your healthcare finances. Comprehensive health insurance can be extremely beneficial. Such plans typically cover diagnostic tests, hospitalisation for surgery, and both pre- and post-operative care, ensuring that you don’t have to choose between saving money and taking care of your health. Having a health insurance policy means the financial burden will be one less thing for you to worry about. 

Wrapping Up

A hiatal hernia might feel like a life sentence of bland food and uncomfortable nights, but it doesn't have to be. By identifying the symptoms early and making the necessary lifestyle adjustments, most people live perfectly normal lives. Whether you are managing mild reflux or preparing for a corrective procedure, being proactive about both your medical treatment and your financial protection is the best way to ensure a smooth recovery.

At Niva Bupa, we’re dedicated to offering tailored health insurance plans paired with an extensive hospital network and quick claim settlements, ensuring you receive the coverage and reassurance you truly deserve.

People Also Ask

1. Can I "fix" a hiatal hernia with exercise? 

Exercises cannot physically move the stomach back through the diaphragm once it has shifted. While losing weight through low-impact cardio is highly beneficial for reducing internal pressure, you must avoid heavy lifting or intense abdominal crunches. These specific movements can actually increase the pressure that pushes the stomach further through the hiatus, potentially worsening the condition.

2. Why does my hernia cause chest pain?

Chest pain occurs because stomach acid irritates the sensitive lining of the oesophagus or because the stomach itself becomes pinched within the diaphragm's opening. This discomfort can feel remarkably like a heart issue, often causing significant anxiety for the patient. It is always best to have chest pain evaluated by a professional to distinguish between a hiatal hernia and cardiac concerns.

3. Is caffeine a trigger for hernia symptoms? 

Yes, caffeine is a well-known trigger because it relaxes the lower oesophageal sphincter, the muscular "gate" that should keep acid in your stomach. When this muscle relaxes, acid can easily flow upwards into the chest cavity where the hernia is located. Switching to herbal teas or reducing your intake of strong coffee can significantly decrease your daily discomfort.

4. Can pregnancy cause a permanent hernia? 

Pregnancy significantly increases intra-abdominal pressure, which can push the stomach upward and weaken the diaphragm's hiatus. While many women experience relief after giving birth and the pressure subsides, the structural stretching can sometimes lead to a permanent hernia. Proper postnatal care and maintaining a healthy weight after delivery can help manage any lingering symptoms.

5. Are there any natural remedies for the reflux? 

Natural remedies like ginger tea, slippery elm, or manuka honey are often used to soothe the irritated lining of the oesophagus. While these can provide temporary relief from the burning sensation, they do not address the structural nature of a hiatal hernia. These should be viewed as complementary treatments to be used alongside your doctor's prescribed medical plan.

6. What happens if I leave a hiatal hernia untreated? 

Ignoring a hiatal hernia can lead to chronic acid exposure, which may cause complications like oesophageal strictures (narrowing) or ulcers. In severe cases, it can lead to Barrett’s oesophagus, a condition where the lining of the food pipe changes and increases the risk of cancer. Regular monitoring and symptom management are essential to prevent these long-term health risks.

7. Can a hiatal hernia cause a cough? 

A persistent, dry cough is a common symptom of "silent reflux" associated with a hernia. This happens when tiny amounts of stomach acid or vapours reach the throat and irritate the airways, especially when you are lying flat at night. If your cough is worse after meals or during sleep, it is likely linked to your digestive health rather than a respiratory infection.

8. What is the most common age for diagnosis? 

The condition is most frequently diagnosed in individuals over 50, as the diaphragm's muscles naturally lose elasticity with age. As the hiatus becomes less resilient, it is much easier for the stomach to slip upward. However, lifestyle factors like smoking and obesity mean that a hernia is increasingly being seen in younger adults as well.

9. Is the surgery for this condition dangerous? 

Most modern surgeries for a hiatal hernia are performed laparoscopically, which is a minimally invasive "keyhole" technique. This method involves much smaller incisions, a lower risk of infection, and a significantly faster recovery period than traditional open surgery. Most patients are back to their normal routines within a few weeks, provided they follow post-operative dietary guidelines.

10. How does health insurance help with this condition? 

Managing a hiatal hernia can involve expensive diagnostic tests like endoscopies and long-term medications that add up over time. Having a robust health insurance policy, such as those provided by Niva Bupa, ensures that you can afford the best specialist care and surgical interventions if they become necessary. It provides a financial cushion so you can focus on your recovery without worrying about the cost of treatment.