Hiatus hernia living in adults

Overview

A hiatus hernia happens when part of your stomach pushes up through the diaphragm (the large muscle that helps you breathe) into your chest. This can sometimes cause stomach acid to flow back into your gullet (food pipe), leading to discomfort.

Yes, hiatus hernias are very common, especially in adults over 50. Many people have one without knowing it.

It can affect anyone, but it is more common in older adults, people who are overweight, and those who have increased pressure in the abdomen (for example, during pregnancy or from heavy lifting).

Symptoms

Common symptoms

• Heartburn (a burning feeling in your chest or throat)
• Regurgitation (stomach acid or food coming back up into your mouth)
• Chest pain or discomfort
• Difficulty swallowing or a feeling of a lump in your throat
• Frequent burping or hiccups

Symptoms in older adults

• In older adults, symptoms may be milder, such as unexpected weight loss, anemia (low red blood cells), or persistent cough.
• They may not have obvious heartburn, so the condition can be missed.

Causes

Main causes

• Weakening of the diaphragm muscle with age
• Increased pressure in the abdomen from obesity, pregnancy, heavy lifting, or straining during bowel movements

Risk factors

• Being over 50
• Excess body weight or obesity
• Smoking
• Chronic coughing or constipation
• Repeated heavy lifting

When to see a doctor

See a doctor urgently if:

• If you have sudden, severe chest pain
• If you vomit blood or have black, tarry stools
• If you have trouble swallowing or feel like food gets stuck

Book a routine appointment if:

• If you have frequent heartburn, acid reflux, or regurgitation that bothers you
• If you have unexplained weight loss or persistent cough
• If you have difficulty swallowing that comes and goes

Diagnosis

Your doctor will start by asking about your symptoms and doing a physical exam. They may then recommend one or more tests to look at your oesophagus and stomach.

Tests that may be done

• Endoscopy (a thin, flexible tube with a camera is passed down your throat to see the hernia)
• Barium swallow X-ray (you drink a chalky liquid and X-rays are taken to show the hernia)
• Oesophageal manometry (a small tube measures the pressure in your oesophagus)

What to expect at your appointment

These tests are usually done as outpatient procedures. You may be asked to stop eating or drinking for a few hours beforehand. The tests are generally safe and not painful, though you might feel some discomfort.

Treatment

Treatment for hiatus hernia focuses on controlling symptoms and preventing complications. Many people manage well with lifestyle changes and medications. Surgery is only considered if symptoms are severe or do not improve.

Self-care at home

• Eat smaller, more frequent meals rather than large meals.
• Avoid foods and drinks that trigger heartburn, such as spicy foods, fatty foods, chocolate, caffeine, and alcohol.
• Try not to lie down or go to bed for at least 3 hours after eating.
• Raise the head of your bed by about 6 to 8 inches (using blocks or a wedge pillow).
• If you are overweight, losing even a small amount can help reduce symptoms.
• Stop smoking, as smoking can weaken the valve between your stomach and oesophagus.

Medical treatments

Medications can help reduce stomach acid and relieve heartburn and regurgitation. These include antacids, acid reducers (H2 blockers), and proton pump inhibitors (PPIs). Always talk to your doctor or pharmacist before using any medication, and do not take them for longer than recommended without medical advice.

When is surgery considered?

Surgery may be an option if your symptoms are severe, if medications do not help, or if you develop complications like a strangulated hernia or severe oesophagitis. The most common procedure is called fundoplication, where the top of the stomach is wrapped around the lower oesophagus to strengthen the valve.

Living with this condition

Living with a hiatus hernia often requires small adjustments to your daily habits, especially around eating and sleeping. Most people find that with the right changes, symptoms are well controlled and they can enjoy a normal life.

Lifestyle tips

• Eat slowly and chew your food well.
• Avoid bending over or straining after meals.
• Wear loose-fitting clothing that does not put pressure on your stomach.
• Manage stress through relaxation techniques like deep breathing or gentle exercise.
• Stay active with low-impact activities like walking, but avoid heavy lifting or exercises that strain your abdomen.

Diet and exercise

A diet low in acidic, spicy, and fatty foods can help reduce symptoms. Include plenty of vegetables, lean proteins, and whole grains. Eat smaller portions more often. Gentle exercise like walking, yoga, or swimming is beneficial. Avoid exercises that require lying flat or bending forward, as they can worsen reflux.

Mental health and emotional wellbeing

Coping with a chronic condition like hiatus hernia can sometimes cause worry or anxiety, especially if symptoms interfere with eating or sleeping. It is important to talk to your doctor about any distress you may feel. Relaxation techniques and support from loved ones can help.

Prevention

It is not always possible to prevent a hiatus hernia, especially as it is linked to ageing. However, you can lower your risk by maintaining a healthy weight, avoiding heavy lifting or straining, not smoking, and treating chronic cough or constipation promptly.

Complications

If left untreated

• Oesophagitis (inflammation and damage to the oesophagus lining from acid)
• Barrett's oesophagus (a change in the lining of the oesophagus that can increase the risk of oesophageal cancer)
• Oesophageal stricture (narrowing of the oesophagus from scarring, making swallowing difficult)
• Strangulated hernia (a rare emergency where the herniated stomach becomes twisted and loses blood supply)

Long-term outlook

With proper management, most people with hiatus hernia have a good quality of life. Symptoms can often be controlled with lifestyle changes and medication. Serious complications are uncommon, and surgery is very effective for those who need it. Regular check-ups with your doctor can help catch any problems early.

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