A hiatus hernia occurs when part of your stomach pushes up into your chest (the stomach normally sits in your abdomen). It squeezes through an opening in the diaphragm, which is the large, thin sheet of muscle separating your chest from your abdomen.

The opening in your diaphragm is called the hiatus, and your oesophagus (the tube that carries food to your stomach) normally passes through this to reach your stomach.
What happens

At the base of the oesophagus is a ring-like muscle, called a sphincter, which closes the lower oesophagus. This muscle acts as a one-way valve, preventing stomach contents from flowing upwards into the oesophagus.

When part of your stomach pokes through the hiatus, it prevents the muscle from closing the lower end of the oesophagus.

A hiatus hernia can cause highly irritating stomach contents, such as acid, to move up into the oesophagus. This can cause heartburn and other problems, although in many cases a hiatus hernia causes no symptoms (see Symptoms, above).

If there are symptoms, antacid medicines and a change of lifestyle are the preferred treatments (see Treatment, above).
Who is affected?

Hiatus hernia can affect anyone, but it is more common in women and people who are over 50, overweight, pregnant or who smoke. It is estimated that a third of people over 50 have a hiatus hernia (see Causes, above).

There is a rare type of hiatus hernia that affects newborn babies.

A hiatus hernia may be diagnosed using X-rays and diagnostic tests such as endoscopy (looking at the stomach via a fiberoptic tube), esophageal manometry (using a special instrument to measure your sphincter pressure), and tests to measure your esophageal acidity.

During a routine physical examination your doctor may discover an inguinal hernia. Your doctor will usually diagnose it by feeling the area of the internal inguinal ring, deep in the groin. If there’s a bulge in the area, then there’s a good possibility that it’s due to a hernia.
Treating and Preventing Hernia

General hernia prevention strategies include avoiding activities that cause abdominal strain (e.g., lifting heavy weights), and if you’re overweight, losing weight.

In 85% to 95% of hiatus hernia cases, treatment consists of relieving the accompanying heartburn with medication and modifying the diet. Losing weight is also recommended as a way to help relieve pressure. If you experience discomfort at night, it may help to sleep with the upper part of your body propped up on pillows or with the head of your bed raised. It is important not to eat for several hours before lying down, so that the stomach has time to empty. Standing straight rather than slouching is also a good idea. Surgery is uncommon and is reserved as a last resort for severe cases if medical and dietary management hasn’t helped.

If you have an inguinal or umbilical hernia, it is generally repaired by surgery that places the protruding mass back where it belongs and reinforces the weakened area by sewing the muscles together. This is a simple operation that is sometimes performed under local anesthetic.

It’s important to go for regular medical follow-up after surgery because of possible complications. Some surgeons recommend restricting exercise; however, most will encourage a speedy return to activities. Hospital stays of two or three days for surgery have been reduced in the last few years to a same-day discharge.

Laparoscopic hernia repair is done through a tiny incision and avoids the need for invasive open surgery. A television screen enables the surgeon to clearly see inside the person’s body. Studies have shown that this method of treatment promotes faster healing with less likelihood of recurrence.

Wearing a truss was sometimes used in the past to avoid surgery. It is no longer considered an acceptable form of treatment for hernias. In fact, it can even make your hernia worse by weakening tissues.

Paraesophageal hernias are generally treated with surgery.