Should I get my hiatus hernia fixed?
Should you get your hiatus hernia fixed? Before we consider that question, let us first discuss what a hiatus hernia is.
WHAT IS A HIATUS HERNIA?
Hiatus hernia is the term used to describe a condition where part of the stomach pushes up into the lower chest through a weakness in the diaphragm. The diaphragm is the large flat muscle that separates the lungs from the tummy (abdomen) and helps us breathe.
At the junction where the food pipe joins the stomach, there is a thickened area of muscle that acts as a valve. This area is critical in containing the acid in the stomach, preventing it from coming up into and remaining in the food pipe. This is the condition of heartburn and reflux. Hiatus hernia develops when that critical valve between the food pipe and stomach starts to malfunction, allowing part of the stomach to move through the diaphragm.
TYPES OF HIATUS HERNIA
There are two common types of hiatus hernia; sliding hiatus and rolling hiatus.
Image reference: https://cdn.ps.emap.com/wp-content/uploads/sites/3/2003/07/030708-Hiatus-hernia.pdf
Sliding hiatus hernia comes about when the top half of the stomach, or top section of the stomach, protrudes into the chest from the abdomen through a diaphragmatic opening. Rolling hiatus hernia, by contrast, occurs when the wall of the stomach (in bubble form) rolls up through a diaphragmatic space into the chest on one side only. Each result in different kinds of symptoms.
WHAT ARE THE SYMPTOMS?
Those with a sliding hiatus hernia will mainly experience symptoms of reflux. This heartburn regurgitation is the feeling of food, saliva, and liquid coming up into the oesophagus accompanied by a sensation of choking and coughing, especially at night-time (volume reflux).
A quick test can be carried to check for sliding hiatus hernia. After a meal, in the seating position bend forward, bringing your chest to your legs. Do you feel the sensation of food coming up or the need to vomit or regurgitate your food? This could be an indication that the valve between your stomach and oesophagus is malfunctioning, and a portion of your stomach is sitting in your chest.
Rolling hiatus hernia mainly creates symptoms of chest pain and gurgling sensations accompanied by sounds coming up in the chest. Chest pains can be mistaken for heart pain, but that is generally not the case for someone suffering from a rolling hiatus hernia.
Sufferers of rolling hiatus hernia are also prone to anaemia, which is a deficiency in the number or quality of red blood cells in your body, and low blood iron levels.
Sufferers of both hernias will also experience difficulties with swallowing their food. In addition, constipation and irregular bowel movements can develop some form of reflux regurgitation or bowel issues. Constipation leads to more straining, and straining is not good for any form of hernia in the body.
WHAT CAN IT LEAD TO?
Left untreated, hiatus hernias can lead to esophagitis, which is the inflammation or ‘burning’ of the inner lining of the food pipe resulting from reflux. This can lead to ulcer formation, which creates problems with swallowing and choking. This can put individuals at risk of developing asthma, and most unfortunately, the development of Barrett’s Oesophagus or oesophageal cancer.
SHOULD YOU FIX YOUR HIATUS HERNIA?
As repairing a hiatus hernia requires surgery, the decision to do so hinges upon four key factors.
Severity – Are the severity of your symptoms unbearable, or are they fairly manageable? Some sufferers can manage their symptoms and remain comfortable, in which case, there is no need for further intervention. It is recommended to have a doctor investigate the extent of the hernia by way of an endoscopy (camera placed into the throat).
Medications – Many gain relief from hiatus hernias through the use of medicines. However, when the burden of taking constant medication becomes too much, or medications start causing unmanageable side-effects, then a surgical repair may be appropriate.
Fitness – Fitness for surgery is an important factor, particularly for the old and frail. Surgery is conducted using keyhole techniques. These involve using gas to inflate the abdomen which puts strain on the heart. Fitness for surgery must be carefully assessed.
Lifestyle – The fourth and arguably most important factor is lifestyle. Have changes to diet and lifestyle been put in place to mitigate the symptoms? Lifestyle changes are a reliable non-surgical method to mitigate the condition. Measures such as improving your water intake, managing truncal obesity (fat around the abdomen), and avoiding smoking can all help. Smoking, in particular, will prevent symptoms of reflux regurgitation from improving.
If you are experiencing intense symptoms of hiatus hernia or are depending upon medications to manage them, it may be time to consider surgery. Of course, always seek an expert medical opinion before making any decision.
Dr Arun Dhir is a gastrointestinal surgeon, author and health and wellness mentor. He has been carrying out gastro intestinal and weight loss surgery for over two decades and has authored several books in this space. His life mission is to educate and empower individuals to create lasting transformations.
Please subscribe to Dr Arun’s YouTube channel to stay connected