Hiatal Hernia Treatments and Medications

Over 200,000 people in the United States are diagnosed or treated for hiatal hernias every year. This type of hernia occurs in the upper portion of the stomach and interferes with the diaphragm. Many people may not even know they have a hiatal hernia—some don't need treatment with medication or surgery. Learn more about what a hiatal hernia is and what can be done to treat it in the following sections.

Additionally, if you are born with a larger than usual hiatus may naturally be prone to hernias. A variety of symptoms can indicate if a hiatal hernia has developed.

When the stomach pushes through the diaphragm, an individual may be able to feel the bulge or a hard lump in the abdomen. The pressure of a hernia can also cause stomach acids to flow back into the esophagus, also referred to as acid reflux. The lower esophageal sphincter (LES), the group of muscles that prevent stomach acid from rising up back into the esophagus, can be compromised if a hiatal hernia forms. Persistent acid reflux, also known as gastroesophageal reflux disease or GERD, can develop as a result of a hiatal hernia.

Additional symptoms of a hiatal hernia include throat irritation, mild to severe chest pains, difficulty swallowing, and shortness of breath. A more complicated hernia can cause gastrointestinal stress and irritation which can lead to internal bleeding, vomiting of blood, and anemia.

Consult a healthcare provider if you are experiencing any of these hiatal hernia symptoms. Getting a proper diagnosis to determine if you have a hiatal hernia is important before more damage occurs.

Be sure to write down your symptoms so you don’t forget anything. Some patients find keeping a log or journal of the severity of the symptoms is helpful. A food and activity log can provide insightful information to your ailment.

Once symptoms have been reviewed, there are several ways to determine if a patient is experiencing a hiatal hernia. A pH test can measure the presence of acid in the esophagus. If there is enough evidence of a hernia, further examination may be necessary. Your regular physician or healthcare provider may refer you to a gastroenterologist, a doctor that specializes in digestive disorders.

One of the first methods to gain a deeper perspective on your internal workings is through barium swallow which utilizes a special type of X-rays. X-rays of the upper part of the stomach can provide a visual image of any herniated muscles near the diaphragm. Before the procedure, the patient must drink a barium solution that coats the stomach’s lining. The barium swallow will allow a specialist to analyze the silhouette of the digestive system to diagnose a hernia and determine the severity of the condition.

An endoscopy is another option to diagnose a hiatal hernia. During the procedure, a small flexible tube with a camera and light (the endoscope) is inserted through the patient's mouth, down the esophagus, and into the stomach to view the problem area. The doctor will then be able to see if there is any inflammation, or herniation of muscle near the diaphragm. In preparation for an upper endoscopy, the patient is often given a sedative to relax or be sedated. The process takes approximately 20 to 30 minutes to complete, then the endoscope is removed.

While medication and lifestyle changes can greatly aid in reducing symptoms and promote healing, surgery is sometimes necessary to correct a hiatal hernia. A hiatal hernia can become recurrent or a medical emergency. In those cases, the patient may need an operation referred to as Nissen fundoplication.

During the surgical process, the herniated stomach is pulled down from the opening in the diaphragm and reset in the proper position. The top of the stomach is wrapped around the lower esophagus to restore normal function. In addition, the hiatus is made smaller to prevent future bulging. The esophageal sphincter may need to be reconstructed to aid in reducing acid reflux symptoms associated with hiatal hernia and any hernia sacs that may have developed will be removed during the process.

Small incisions on the abdominal cavity allow the surgeon to perform the operation laparoscopically. The doctor will be able to view the location of the hernia with a small camera (laparoscope) inserted through the opening made on the abdomen. The image will be displayed on a screen to complete the surgery.

Recovery from hiatal hernia surgery may take two to four weeks. Patients should refrain from lifting heavy objects and strenuous activity for several months following the operation. Hernias can reappear, thus being mindful and participating in recommended lifestyle changes can help ensure the success of the surgery. Consult a doctor if you are experiencing signs of a hiatal hernia.

By using over-the-counter drugs that decrease stomach acid, the damaged muscles and tissue are given an opportunity to heal. Commonly used antacid medications include Maalox and Tums.

Histamine agonists are another type of medicine available without a prescription that aids in reducing acids that worsen hiatal hernia symptoms. Two of the most commonly used OTC h-2 blocker medicines in this category include Zantac and Pepcid. Recently, the FDA has recalled Zantac from the market due to an increased risk of cancer.

Some OTC drugs are also available in prescription form. Proton pump inhibitors (PPI) are the most commonly used prescription medications for hiatal hernias. PPIs reduce stomach acid production. Prescription-strength PPIs are the most effective in reducing acid secretion. Prilosec, Nexium, and Prevacid are among the most commonly prescribed prescription drugs for a hiatal hernia.

Medications used to treat hiatal hernias are often time-released. It is important not to crush the medication up for consumption causing too much medication to be absorbed into the system potentially increasing the risk and severity of side effects. Always read prescription medication information and warnings. Some medications react with other medications. For optimal results, be sure to tell your healthcare provider and pharmacist about all medication you are taking and use medicine as directed.

Instead of eating three meals a day, many gastroenterologists suggest that eating smaller portions of food or smaller meals more often throughout the day can help reduce the flare-up of a hernia. Allowing the body to digest thoroughly prior to going to bed (eating two to three hours before going to sleep) is also suggested for people with hernias.

Listen to your body. Learn what foods and activities trigger your hernia discomfort. Avoid eating spicy or fried foods or other foods such as tomatoes, onions, and citrus fruits that could aggravate a hernia. Reduce caffeine and chocolate intake. Peppermint can also irritate a hiatal hernia. Eliminating alcohol and smoking can also help prevent or allow for the healing of a hiatal hernia. Drinking plenty of water, exercising, and eating foods that keep bowel movements regular can reduce the stress and straining that can lead to a hiatal hernia.

If you are experiencing acid reflux as a symptom of your hiatal hernia, elevating your head or the head of the bed when lying down can also reduce flare-up symptoms. A foam wedge or wooden blocks placed under the legs of the head of the bed can be helpful solutions.

Controlling symptoms naturally with lifestyle changes is one of the many ways you can take charge of your health, though many individuals will also need some form of medication to treat their hernia symptoms.

Frequently asked questions about hiatal hernia