A hiatal hernia, or a hiatus hernia, occurs when the upper part of your stomach pushes up into your chest through an opening in your diaphragm, the muscle that separates your abdomen from your chest. The area where this happens is where your stomach and esophagus join, known as the hiatus. This is where the end of your esophagus normally goes through an opening in your diaphragm.
At times, a hiatal hernia will not cause any problems or require treatment. However, in other cases the narrow opening in your diaphragm can squeeze the part of the stomach that it surrounds, causing retention of stomach acid and other contents. The contents can back up into the esophagus, causing heartburn and other symptoms.
Self-care and medication can help treat and ease the symptoms of a hiatal hernia, but if the symptoms are severe, surgery may be needed.
Types of Hiatal Hernias
There are two main types of hiatal hernias. A sliding hiatal hernia is the most common type of a hernia and occurs when part of your stomach pushes through the opening in your diaphragm next to the esophagus, thus squeezing both the esophagus and part of the stomach together. This hernia is also referred to as a type 1 hernia.
A paraesophageal hiatal hernia is relatively rare and is divided into types 2, 3, and 4. It is more severe than a sliding hiatal hernia. This hernia occurs when part of your stomach pushed through the opening in your diaphragm next to the esophagus so that both the esophagus and stomach are squeezed together. This hernia may require an operation by a thoracic surgeon to repair.
Causes and Risk Factors
Hiatal hernias appear due to the weakening of the muscle tissue in the diaphragm, which allows the stomach to push up through the opening of your esophagus. Although there are a number of reasons as to why a diaphragm can become weakened, the following factors can play a big role:
- Age-related changes to your diaphragm
- Injury from trauma or surgery
- Being born with a large hiatus (opening in the diaphragm)
A diaphragm usually isn’t enough to cause a hiatal hernia, since there is also a need for increased pressure in your abdomen to push the stomach up the through the diaphragm. Increased abdominal pressure can come from the following factors:
- Straining during bowel movements
- Strenuous exercise
- Lifting heavy objects
Hiatal hernias can happen at any age and affect both women and men. The following factors can put you at an increased risk if you experience any of them:
- Being 50 or older
- Being overweight or obese