Should I get my hiatus hernia fixed?

Mar 4, 2021

We are going to be talking about this one very commonly asked question that, should I get my hiatus hernia fixed?

Before we address this question, I want to highlight that in one of the previous blogs I’ve exactly explained how the valve, which is there at the point where the food pipe joins the stomach, is so critical in maintaining the acid in the stomach and preventing it from coming and staying in the food pipe, which is where we experience symptoms of heartburn and reflux.

So, this condition called as hiatus hernia is nothing else but when the valve which is there between the food pipe and the stomach starts to malfunction because the gap which is there between those two parts, or you know two areas of the muscle which is called the diaphragm where it stretches out, that is what leads to a hiatus hernia. It’s a hernia which is internal and a part of the stomach begins to come up.

In this image below (insert image referenced in video) I’m showing you two images of two types of common types of hiatus hernia. One is called a sliding hiatus hernia and the other is called a rolling hiatus hernia. The sliding is a situation where the top half of the stomach or top part of the stomach will go from the abdomen into the chest through that diaphragmatic opening. Whereas in the rolling hernia, there is a wall of the stomach rolls up, you can see it’s like a bubble of stomach which has gone up into the chest on one side only, and that creates a different kind of symptoms.

So let’s have a closer look at sliding hiatus hernia. Individuals will mostly experience symptoms of reflux which is heartburn regurgitation which means the feeling of you food, saliva and liquid coming up and the sensation of choking and coughing especially at nighttime. That is what is called “volume reflux” in medical terms, but let’s do a quick test right now. Friends if you have had your meal (you don’t have to do it right now) but after you’ve had a meal try this bending forward test. What it means is that if you bend forward, because the valve is incompetent and there’s a portion of stomach which is already sitting in the chest, if you bend forward you have the sensation that food is almost going to come back up and you might regurgitate or vomit it and that is a test which gives us an initial clue that you may have a hiatus hernia and it may be of a nature that is creating significant symptoms for you.

While the other kind of hernia, which is a rolling hiatus hernia, creates mostly symptoms of chest pain, some gurgling sensations in these sounds coming up in the chest, chest pains can be mimicked or it can be mistaken for pain coming from your heart but that is generally not the case if someone’s got a rolling hiatus hernia. These people can also have anemia which is low blood count, low iron level count and very importantly there is difficulty in swallowing the food – they have swallowing issues. So, all of these hernias lead to a few common conditions which we discussed last time but some of the key ones are that esophagitis, which means the whole burning of the inner lining of the food pipe it is called reflux esophagitis, it also leads to an ulcer formation, creates issues with swallowing and choking which puts individuals at risk of developing asthma, and most importantly and most, unfortunately, the long-standing complication of this is the development of Barrett’s esophagus or esophageal cancer. So, the answer to the question of should I get my hardest hernia fixed really hinges on these four key things.

Number one, what is the severity of your symptoms? Are they really bad or are they fairly manageable? It’s like some people have a hiatus hernia and they don’t have any symptoms they’re getting along pretty well in which case you don’t really need to do much about it but I always recommend getting it checked to get it investigated at least and the investigations that we mostly do is by way of an endoscopy which is a camera down the throat.

The second point is, have you been on medications for the symptoms that you’re getting? Some people have been getting relief from medications but they’re just sick and tired of taking medications or they’re developing side effects of medications, in which case we recommend considering a repair, a surgical repair.

The third thing is what is your fitness for surgery? Some people may be old, frail, they have a big hiatus hernia which is giving them symptoms but they are just not fit enough to have surgery, because this type of surgery, as I mentioned in one of my previous blogs, is done using keyhole techniques where we put gas into the abdomen and we inflate it which puts a strain on the heart. So fitness is another thing.

The fourth and the most important thing is; have you tried lifestyle measures such as diet, improving your water intake, taking care of truncal obesity (fat around the middle part of the body) and more importantly, have you quit smoking? If you continue to smoke your symptoms of reflux regurgitation will never get better. And most importantly, constipation. People who are not regular in using their bowels will develop some form of reflux, regurgitation or bowel issues, so it’s important to fix those aspects and very importantly, constipation leads to more straining and straining is not good for any form of hernia in the body. I would always say this: please take expert medical advice before you decide on the need for surgery but if you are experiencing any of those symptoms which are really intense and you are at the point where you have to depend on medications all through, you may need to consider getting your hiatus hernia fixed.

I hope this helps! Please subscribe to my blog and share this if you think it will benefit anyone else in your family or circle. Thank you.

Learn. Grow. Serve.

Dr Arun Dhir
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Dr Arun Dhir
Surgeon, Health & Wellness Advocate.
Author of “Happy Gut, Healthy Weight” and “Create a New You Health Journal
Founder of Radical Wellness Programme