DEAR DOCTOR K:
I had heartburn, and my doctor told me I have a “hiatal hernia.” I thought hernias caused pain and swelling in the groin. Could my doctor be wrong?
Any doctor’s diagnosis can be wrong, present company included. Of course, I can’t know for sure if your doctor’s diagnosis is right, but I’ll bet it is.
There is a common condition called “inguinal hernia” (or just “hernia”) in which the intestine bulges out through a hole in the muscle of the groin. That’s the kind of hernia you’re describing.
A hiatal hernia is different. It’s a condition that affects your stomach and esophagus. Hook the tips of your fingers underneath the lowest rib. At about that spot is the diaphragm, a flat muscle that separates your chest from your abdomen. By moving down and up, the diaphragm helps your lungs take in and blow out air.
The diaphragm has a small hole in it. (The word “hiatal” is an ancient word for such holes in body tissue.) The esophagus, the tube that connects your mouth to your stomach, runs through the hole. Normally, the stomach starts just below the diaphragm. In fact, tough tissue around the hole normally tethers the top of the stomach to the diaphragm, keeping the stomach below it. (See illustration.)
In people with a hiatal hernia (like you, if your doctor is right), the tissue holding the stomach below the hole in the diaphragm weakens. This allows part of the stomach to slide up into your chest. That’s most likely to happen when you do something that raises the pressure in your abdomen, like persistent or heavy coughing, vomiting, or straining while having a bowel movement.
Fortunately, many people with a hiatal hernia do not get symptoms from it. But some do, and you may be one. The symptoms usually are heartburn, belching, bloating, a sense of fullness in the upper part of the abdomen after a meal, or even nausea and vomiting. Usually the heartburn is felt in the abdomen, but sometimes it’s felt below the breastbone, in the chest. The symptoms are caused by gastroesophageal reflux disease, commonly called GERD. GERD often occurs in people with hiatal hernia, although many people with GERD do not have hiatal hernia.
The diagnosis of a hiatal hernia sometimes can be made by a simple chest X-ray that shows part of the stomach where it shouldn’t be: in your chest. Another type of X-ray, called a barium swallow, also can pinpoint the problem. Maybe your doctor has ordered one of these studies.
If your hiatal hernia causes reflux symptoms, such as heartburn, it may help to eat smaller, more frequent meals. Avoid eating for at least two hours before going to bed, and sit up for at least one hour after eating. If these changes don’t help, antacids or acid blockers usually will.
Rarely, surgery may be necessary if you have persistent reflux or inflammation of the esophagus that does not heal with medication. Most of the time, however, simple measures can fix your symptoms.