Hiatus hernia living in older adults

Overview

A hiatus hernia (also called hiatal hernia) is when part of your stomach pushes up through the diaphragm (the muscle that separates your chest from your belly) into your chest. It can cause heartburn and other symptoms, but many people have it without any problems.

Yes, hiatus hernia is very common, especially in people over 50. Many people have it and never know.

It affects adults of all ages, but it is most common in older adults. It is more common in people who are overweight, smoke, or have had certain injuries.

Symptoms

Common symptoms

• Heartburn (a burning feeling in the chest, often after eating)
• Regurgitation (food or sour liquid coming back up into the throat)
• Burping or feeling bloated
• A feeling of a lump in the throat
• Difficulty swallowing

Symptoms in children

• Children rarely have a hiatus hernia. If they do, symptoms may include vomiting and poor weight gain.

Symptoms in older adults

• Older adults may have less heartburn but more difficulty swallowing or a feeling of fullness soon after eating.
• Anemia (low iron) can occur if the hernia causes slow bleeding into the stomach.

Causes

Main causes

• A weakening of the diaphragm muscle, which can happen naturally with age.
• Increased pressure in the belly from obesity, pregnancy, heavy lifting, or chronic coughing.
• Injury to the diaphragm from an accident or surgery.

Risk factors

• Being over 50 years old
• Being overweight or obese
• Smoking
• Frequent heavy lifting or straining on the toilet
• Having a family history of hiatus hernia

When to see a doctor

See a doctor urgently if:

• If you have severe chest pain or signs of bleeding (see emergency symptoms).
• If you suddenly cannot swallow liquids or solids.

Book a routine appointment if:

• If you have frequent heartburn that does not get better with over-the-counter remedies.
• If you have trouble swallowing that slowly gets worse.
• If you feel like food is stuck in your chest.

Diagnosis

Your doctor will ask about your symptoms and do a physical exam. They may confirm the diagnosis with a test called an upper endoscopy (a thin tube with a camera that looks into your stomach) or a barium swallow X-ray.

Tests that may be done

• Upper endoscopy (gastroscopy) – a flexible tube with a camera is passed through your mouth to see the hernia.
• Barium swallow – you drink a chalky liquid and have X-rays taken to show the shape of your stomach.
• Manometry – a test that measures how well your esophagus muscles work (sometimes used).

What to expect at your appointment

The tests are usually done as an outpatient. You may be asked to stop eating for a few hours before. Most people find the tests uncomfortable but not painful, and you can go home the same day.

Treatment

Treatment depends on your symptoms. If you have no symptoms, you may not need any treatment. For mild symptoms, lifestyle changes and antacids can help. For more bothersome symptoms, your doctor may recommend medicines that reduce stomach acid.

Self-care at home

• Eat smaller, more frequent meals instead of large ones.
• Avoid lying down for at least 3 hours after eating.
• Elevate the head of your bed by about 6 to 8 inches (use blocks or a wedge pillow).
• Avoid foods that trigger heartburn, such as spicy, fatty, or acidic foods.
• Lose weight if you are overweight.
• Stop smoking.

Medical treatments

Your doctor may suggest medicines that lower stomach acid. These include non-prescription antacids or stronger acid-reducing medications called proton pump inhibitors (PPIs) or H2 blockers. These are usually taken for a few weeks to months as needed. Always discuss the right options with your doctor.

When is surgery considered?

Surgery is rarely needed. It may be considered if symptoms are severe and do not improve with medicines, or if the hernia is very large or causing complications. Surgery involves pulling the stomach back down and tightening the diaphragm opening.

Living with this condition

Most people with a hiatus hernia can live normally. You may need to adjust your eating habits and avoid triggers. Keep a diary of foods and activities that cause symptoms to help manage them.

Lifestyle tips

• Eat slowly and chew well.
• Avoid tight clothing around your belly.
• Lift heavy objects carefully if at all, and avoid straining.
• Stay upright after meals.

Diet and exercise

A balanced, low-fat diet is helpful. Gentle exercise like walking can support weight management and digestion. Avoid intense exercise immediately after eating. Talk to your doctor before starting a new exercise program.

Mental health and emotional wellbeing

Living with chronic heartburn or swallowing problems can be stressful. Some people feel anxious or embarrassed, especially when eating out. It is important to talk to your doctor if symptoms affect your quality of life. Support from family and friends can help.

Prevention

It may not be possible to prevent a hiatus hernia completely, but you can reduce your risk by maintaining a healthy weight, not smoking, and avoiding heavy lifting or straining.

Screening programmes

There is no routine screening for hiatus hernia. It is usually found when you have tests for other symptoms.

Complications

If left untreated

• Long-term acid reflux can damage the esophagus (esophagitis) or cause narrowing (stricture).
• Ulcers in the hernia pouch can lead to bleeding and anemia.
• In rare cases, part of the stomach can get stuck and lose blood supply (strangulation) – this is a medical emergency.

Long-term outlook

For most people, a hiatus hernia is a manageable condition. With simple lifestyle changes and sometimes medication, symptoms can be well controlled. Even if surgery is needed, the outlook is good. Most people return to their normal activities with no long-term problems.

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