A hiatal hernia occurs when a portion of the stomach pushes upward through the diaphragm, the muscular wall separating the chest and abdomen, into the chest cavity. This happens through a small opening in the diaphragm called the hiatus, where the esophagus normally passes to connect to the stomach. While many individuals with a small hiatal hernia experience no symptoms, the question of whether these hernias can enlarge over time is a common concern. This article will explore the progression of hiatal hernias, associated symptoms and potential complications, and various management strategies.
Understanding Hiatal Hernia Progression
Hiatal hernias can indeed enlarge over time, though not all do. Enlargement often results from persistent pressure within the abdominal cavity. Factors contributing to this increased pressure include chronic coughing, repetitive vomiting, straining during bowel movements, and regularly lifting heavy objects. Obesity also places additional pressure, contributing to hernia growth.
Aging is another factor, as diaphragm muscles can weaken, making them more susceptible to enlargement. There are different types of hiatal hernias, with sliding hiatal hernias being the most common, where the stomach and esophagus intermittently slide into and out of the chest. Paraesophageal hernias, less common, involve a portion of the stomach pushing into the chest adjacent to the esophagus and have a higher propensity for complications related to their size.
Symptoms and Potential Complications
Symptoms associated with hiatal hernias often worsen as the hernia enlarges. Common symptoms include heartburn (a painful burning feeling in the chest) and acid reflux (stomach acid flowing back into the esophagus). Regurgitation of food or bitter fluids may also occur.
An enlarging hernia can also lead to dysphagia (difficulty swallowing) and chest pain. Other symptoms include feeling full quickly, belching, or a sour taste. These symptoms arise because the enlarged hernia can disrupt the function of the lower esophageal sphincter, allowing stomach contents to reflux more easily.
More severe complications can arise from an enlarging or incarcerated hernia, particularly with paraesophageal types. These include gastric volvulus (where the stomach twists on itself), a life-threatening condition that can lead to obstruction, ischemia (reduced blood supply), and even perforation. Incarceration (where the herniated portion of the stomach becomes trapped) and strangulation (a cut-off of blood supply) are other serious complications requiring immediate medical attention. Signs of these severe complications include sudden, sharp chest pain, fever, rapid heart rate, bloating, vomiting, or bloody stools.
Managing Hiatal Hernias
Management often begins with lifestyle modifications, especially for mild symptoms. Eating smaller, more frequent meals can reduce stomach pressure and prevent acid reflux. Avoiding meals three to four hours before lying down and elevating the head of the bed by about 8 inches during sleep can also help.
Dietary adjustments are also beneficial, such as limiting fatty foods, acidic foods (like citrus fruits), caffeine, and alcohol, as these can trigger reflux. Maintaining a healthy weight is another important step, as excess abdominal weight can increase hernia pressure.
Medical treatments often manage symptoms, particularly those related to acid reflux. Over-the-counter antacids provide temporary relief, while H2 blockers and proton pump inhibitors (PPIs) are stronger medications that reduce stomach acid production, alleviating discomfort and protecting the esophagus. For cases with severe symptoms, complications, or a large paraesophageal hernia, surgery may be considered. Surgery typically involves pulling the stomach back into the abdomen, making the hiatus opening smaller, and sometimes reconstructing the esophageal valve to prevent reflux. Consulting a healthcare professional is important for accurate diagnosis and a personalized management plan.