THE HIDDEN HERNIA
They say a well-trained doctor doesn't need all the mod-cons of modern medicine to reach a diagnosis. All they need is a good history, and some basic examinations. It's fortunate then, that all these can be done there-and-then, during a private GP consultation at London Doctors Clinic! Our highly experienced doctors know the human body upside-down and inside-out, which is very useful in diagnosing conditions such as hiatus hernias - the topic of this article!
Where Do You Find A Hiatus Hernia?
Despite most other types of hernia being found outside the body, hiatus hernias are actually inside! A hiatus hernia is when a part of the stomach moves up through the opening in the diaphragm for the oesophagus, and into the chest.
The diaphragm is a thin sheet of muscle that separates the lungs from the abdomen and helps during breathing; it naturally has some holes for things to pass through, but the stomach should not be one of them! Normally, the hole for the oesophagus is covered by a thin membrane, but as the oesophagus moves up and down during swallowing, a hole can develop and this can allow the stomach through and into the chest.
Risk Factors For Hiatus Hernias
The main risk factors for developing a hiatus hernia are those that increase the pressure in the abdomen or decrease the muscle tone of the diaphragm. These factors will increase the likelihood that the stomach will herniate (push through) into the chest.
Risk factors include:
- Being pregnant or obese - as this increases pressure in the abdomen
- Heavy lifting - again, this will increase pressure
- People who strain to pass stool - for example, those experiencing constipation
- Recurrent vomiting - the pressure in the stomach has to be increased in order to vomit
Those who are pregnant are more at risk of hiatus hernias, since there is increased pressure in the abdomen
Increasing the pressure in the abdomen can also lead the muscles around the diaphragm to weaken. These muscles may also weaken naturally with age - hence why older people are more at risk of hernias in general.
Therefore, hiatal hernias are most common in people who:
- Are pregnant
- Over the age of 50
- Are overweight
- Have ascites (abdominal fluid collection) as a result of liver failure
Newborn babies can also have hiatal hernias but these are present from birth (they are congenital).
Types of Hiatal Hernia
There are two types of hiatal hernias; sliding and rolling hiatus hernias.
Sliding hernias move up and down and thus in and out of the chest area, with the junction between the oesophagus and stomach moving above the diaphragm. They make up around 80% of hiatus hernias. This type of hernia by itself tends not to cause any symptoms and can sometimes be found as an incidental finding on a chest X-ray.
Rolling hiatal hernias are more unusual and are also known as para-oesophageal hernias. They develop when the hole in the diaphragm is larger and part of the stomach rolls into the chest next to the oesophagus. The junction between the stomach and the oesophagus remains below the diaphragm.
Hiatal Hernia Symptoms
Most hiatal hernias are asymptomatic, but some can cause a condition called GORD - gastro-oesophageal reflux disease - otherwise known as 'acid reflux'. This is when stomach acid leaks from the stomach into the oesophagus as the junction at the bottom of the oesophagus doesn’t work properly. The oesophagus may then become irritated causing:
- Pain that may feel like heartburn
- General chest pain
- Difficulty with swallowing.
It may also cause nausea, vomiting or the feeling of acid or an unpleasant taste at the back of the mouth.
These symptoms may be worse after meals and when lying flat, but helped by sitting up or by walking around. More severe symptoms can involve coughing, asthma and chest infections if the acid is coughed up and then inhaled.
Hiatal Hernia Diagnosis
Hiatal hernias can be diagnosed by a barium swallow or by endoscopy.
On a barium swallow, the swallowed barium coats the oesophagus as it passes, allowing a radiologist to determine the anatomy of the structures the barium passes. An endoscopy involves passing a slim tube with a camera attached down the oesophagus and into the stomach.
Hiatal Hernia Treatment
Treatment of a hiatus hernia is primarily around managing the symptoms of GORD, and this can be coordinated by your GP. This may include:
- Eating smaller meals
- Eating earlier in the evening
- Not eating any food or drink that makes symptoms worse
- Elevating the head and upper body when sleeping
Surgery to repair the hernia is normally only recommended if long term medication doesn’t help relieve symptoms. There are not many long term complications of hiatal hernias but GORD can increase your risk of oesophageal cancer.
If you are experiencing symptoms of GORD, your doctor might recommend you elevate your head and upper body when sleeping
If you have experienced any of these symptoms, or are concerned about hernias, why not speak to a doctor by booking in a consultation at any of our 12 London clinics. If you're in search of a "GP near me", LDC is here!
By Katie Hodgkinson