Hiatal hernia

A hiatal hernia (say "hi-AY-tul HER-nee-uh") happens when part of your stomach bulges up through the diaphragm and into your chest. The diaphragm is a sheet of muscle that separates your belly (abdomen) from your chest.

The hernia bulges through the diaphragm at a place called the hiatus. This is the opening in the diaphragm that the esophagus passes through. The esophagus is the tube that connects the throat to the stomach.

There are three main types of hiatal hernia: sliding, paraesophageal, and mixed. Most people who have a hiatal hernia have a sliding hiatal hernia.

Most people who have a hiatal hernia have no symptoms.

One symptom you may have is heartburn, which is an uncomfortable feeling of burning, warmth, or pain behind the breastbone. It is common to have heartburn at night when you are trying to sleep.

If you often have symptoms or they are severe, you may have gastroesophageal reflux disease (GERD). A hiatal hernia can lead to GERD, and people often have both conditions at the same time.

If you have pain behind your breastbone, it is important to make sure it is not caused by a problem with your heart. The burning sensation caused by GERD usually occurs after you eat. Pain from the heart usually feels like pressure, heaviness, weight, tightness, squeezing, discomfort, or a dull ache. It occurs most often after you are active.

A hiatal hernia often is diagnosed when you see your doctor or have tests for another health problem.

If you have symptoms, your doctor will ask you questions about them. If your symptoms happen often and are severe, you may have gastroesophageal reflux disease (GERD). If this is the case, your doctor may do more tests or give you medicine for GERD.

If you have no symptoms, you don't need treatment.

If you have mild symptoms, your doctor may suggest lifestyle changes and perhaps nonprescription medicines. Here are some things to try:

• Change your eating habits.
  • It's best to eat several small meals instead of two or three large meals.
  • After you eat, wait 2 to 3 hours before you lie down. Late-night snacks aren't a good idea.
  • Avoid foods that make your symptoms worse. These may include chocolate, mint, alcohol, pepper, spicy foods, high-fat foods, or drinks with caffeine in them, such as tea, coffee, colas, or energy drinks. If your symptoms are worse after you eat a certain food, you may want to stop eating it to see if your symptoms get better.
• Do not smoke or chew tobacco.
• If you get heartburn at night, raise the head of your bed 6 in. (15 cm) to 8 in. (20 cm) by putting the frame on blocks or placing a foam wedge under the head of your mattress. (Adding extra pillows does not work.)
• Do not wear tight clothing around your middle.
• Lose weight if you need to. Losing just 5 to 10 pounds can help.

If you often have symptoms or have severe symptoms, you may have GERD. Lifestyle changes may help, and your doctor may prescribe medicine. In severe cases, surgery can be used to pull the hernia back into the belly.

• Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
• Do not take aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) or naproxen (Aleve), unless your doctor says it is okay. Ask your doctor what you can take for pain.
• Your doctor may recommend over-the-counter medicine. For mild or occasional indigestion, antacids such as Tums, Maalox, or Mylanta may help. Your doctor also may recommend over-the-counter acid reducers, such as famotidine (Pepcid AC), cimetidine (Tagamet HB), or omeprazole (Prilosec). Read and follow all instructions on the label. If you use these medicines often, talk with your doctor.
• Change your eating habits.
  • It's best to eat several small meals instead of two or three large meals.
  • After you eat, wait 2 to 3 hours before you lie down. Snacking close to bedtime isn't a good idea.
  • Avoid foods that make your symptoms worse. These may include chocolate, mint, alcohol, pepper, spicy foods, high-fat foods, or drinks with caffeine in them, such as tea, coffee, colas, or energy drinks. If your symptoms are worse after you eat a certain food, you may want to stop eating it to see if your symptoms get better.
• Try to quit smoking or chewing tobacco, or cut back as much as you can. If you need help quitting, talk to your doctor about quit-tobacco programs and medicines. These can increase your chances of quitting for good.
• If you get heartburn at night, raise the head of your bed 6 to 8 inches by putting the frame on blocks or placing a foam wedge under the head of your mattress. (Adding extra pillows does not work.)
• Do not wear tight clothing around your middle.
• Lose weight if you need to. Losing just 5 to 10 pounds can help.