You might not think about your diaphragm very often, but it plays a crucial role in your body. This large muscle separates your chest from your abdomen. It has a small opening, called a hiatus, which allows your esophagus (your swallowing tube) to pass through and connect to your stomach. Sometimes, the upper part of the stomach can push up through this opening and into the chest cavity. This condition is known as a hiatal hernia.
If you recently discovered you have a hiatal hernia, you are not alone. These hernias are quite common, especially as we age. For many people, a hiatal hernia does not cause any noticeable issues. However, for others, it can lead to uncomfortable daily symptoms that disrupt eating and digestion.
We want to provide you with clear, accurate information about what happens when a hiatal hernia forms. By learning about the different types, the common risk factors, and the ways doctors evaluate this condition, you can better understand your digestive health. This guide will explore the structural changes involved and the steps you can take to identify the problem.
A hiatal hernia occurs when the muscle tissue around the esophageal opening weakens. This allows the upper portion of your stomach to bulge up through the diaphragm. Doctors generally categorize these hernias into two main types: sliding hernias and paraesophageal (or "rolling") hernias. Medical professionals also classify them into Types I through IV depending on their exact position and severity. Sliding hernias are by far the most common type. In a sliding hernia, the stomach and the section of the esophagus that joins the stomach slide up into the chest.
Several risk factors make you more likely to develop this condition. Established risk factors include your age and your weight. As you get older, your muscle tissues naturally lose some of their strength and elasticity. Additionally, obesity places extra pressure on your abdomen, which can force the stomach upward through the hiatus over time.
Many people with a hiatal hernia never experience any symptoms at all. You might live with one for years without knowing it is there. When symptoms do occur, they depend heavily on the type and size of the hernia. Because sliding hernias affect the barrier between the stomach and the esophagus, they frequently cause heartburn and acid reflux-type symptoms. You might also experience chest discomfort or notice issues with swallowing your food. In some cases, a hiatal hernia can cause hidden bleeding in the digestive tract, which can eventually lead to anemia.
If you experience these symptoms, a healthcare provider can use several methods to evaluate your esophagus and stomach. A common diagnostic tool is an endoscopy, where a doctor uses a long, thin tube with a camera to look directly inside your digestive tract. They might also use imaging tests to get a clear picture of your anatomy. A barium swallow involves drinking a special liquid that coats your digestive tract, making the hernia clearly visible on an X-ray. A CT scan can also provide detailed images to help classify the hernia and guide your care.
Doctors classify hiatal hernias based on how the stomach moves through the diaphragm. A sliding hernia is the most common type. It happens when the junction between your stomach and esophagus slides up into your chest cavity. A paraesophageal, or "rolling," hernia occurs when a portion of the stomach pushes through the hiatus and rests next to the esophagus.
No, you will not always feel symptoms. In fact, many people have a hiatal hernia and are completely asymptomatic. They often only find out about the condition when a doctor performs a scan or test for an entirely different reason. When symptoms do show up, they usually include heartburn, chest discomfort, or difficulty swallowing.
Because the symptoms of a hiatal hernia can mimic other digestive issues, doctors rely on specific medical tests to confirm a diagnosis. They frequently use an endoscopy to look inside your esophagus and stomach with a tiny camera. They might also order imaging tests, such as a CT scan or a barium swallow X-ray, to see exactly how your stomach and diaphragm are positioned.