Hiatal hernia

Originally Published: January 21, 2005
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DEAR ALICE,

WHAT IS A HIATAL HERNIA AND ITS SYMPTOMS? CAN IT CAUSE SHORTNESS OF BREATH??

Dear Reader,

In medicine, the word "hernia" means "something is not where it is supposed to be." A hiatal hernia — sometimes called a diaphragmatic hernia — is movement of the stomach into the chest via a hiatus (a hole) in the diaphragm. Anatomically, the diaphragm muscle is between the stomach and the chest. The hiatus is the opening in the diaphragm where the esophagus or food pipe joins the stomach. A hiatal hernia, then, occurs when the stomach moves into the chest via the diaphragm. There are two types of hiatal hernias: a sliding hernia is when the stomach slides up into the chest and back down; a fixed hernia is when the stomach slides up into the chest and stays there. Both can be quite painful conditions, although some minor hiatal hernias can cause mild to no pain.

Because the stomach assumes space in the chest, leaving less room for the lungs to function at capacity, yes, hiatal hernias can cause shortness of breath. Hiatal hernias can also cause:

  • chest pain
  • heartburn
  • belching
  • difficulty swallowing

Shortness of breath and pain around the breastbone area also can be caused by a hiatal hernia, but can stem from heart problems, as well. If you experience any of these symptoms, it's a good idea to check in with a health care provider to make sure a more severe underlying condition isn't at work. Other warning signs that require medical evaluation include dizziness, irregular heartbeat, and nausea or vomiting.

Hiatal hernias are most often triggered by overeating. Hiatal hernias affect about 25 percent of people older than 50 years — because the diaphragm needs to be weakened in order for the stomach to bulge through, hiatal hernias are more common in older people. Hiatal hernias are also more common in women and people who are overweight.

In order to diagnose a hiatal hernia, a health care provider may perform a simple chest X-ray, possibly with a barium swallow — after drinking a beverage containing the chemical barium, the workings of your stomach will be more visible on X-ray. Other possible tests include an esophagoscopy (where a narrow viewing tube is inserted in the esophagus) and a manometry (where pressure inside the esophagus is measured to look for abnormal muscle movement). Surgery is really the only way to fix a hiatal hernia, which is why most individuals learn to manage living with the condition. There are some treatment strategies, however, to reduce the symptoms:

  • avoid large meals
  • remain upright after a meal
  • reduce body weight
  • abstain from smoking

It's hard to prevent a hiatal hernia, but some lifestyle choices may reduce the risk of developing one, including maintaining a healthy body weight, avoiding smoking, and not lifting heavy objects.

Alice