A hernia happens when an internal component of the body, usually an organ, thrusts through a weakness in the surrounding muscle or tissue wall.
A hiatus hernia occurs when the stomach pushes up into the chest by squeezing through an opening in the diaphragm, the large sheet of muscle separating the chest from the abdomen.
The opening in the diaphragm is known as the hiatus.
The oesophagus, a tube carrying food to the stomach, passes through the diaphragm to reach your stomach.
A hiatus hernia happens like this.
At the base of the oesophagus is a ring-like muscle, the sphincter, a one-way valve which closes the lower oesophagus.
When the stomach thrusts through the hiatus, it prevents the sphincter from closing the lower portion of the oesophagus.
A hiatus hernia allows stomach contents, particularly stomach acid, to move up into the oesophagus.
This normally causes heartburn and other problems, although occasionally a hiatus hernia will cause no symptoms.
This condition can affect anyone, but it is more common in the over-fifties, smokers, and people who are overweight or pregnant.
Of the over-fifties, about a third are affected to a greater or lesser extent.
The symptoms can include severe heartburn, gastro-oesophageal reflux disease (GORD), where stomach acid flows back into the oesophagus, and a deep burning chest pain, which may even affect the shoulder blades.
Bending forward, straining or lying down worsens the pain, which can be so severe it disturbs sleep and can be mistaken for a heart attack.
Minor symptoms can include a croaky voice or symptoms of asthma.
There are many factors which can cause a hiatus hernia to develop, including pressure on the abdomen caused by excessive coughing, vomiting, straining, or sudden physical exertion.
Obesity can also cause hiatus hernia due to increased pressure on the abdomen.
Also as the diaphragm weakens with age, the stomach can push through it.
The various methods of treatment aim to prevent stomach acid from flowing back into the oesophagus by either preventing reflux into the oesophagus or by reducing the amount of stomach acid produced.
Antacid medicines can relieve some of the symptoms.
They come in liquid or tablet form and can be swallowed or chewed.
When they reach the oesophagus and stomach, they help to neutralise the acid.
They do not work for everyone and are not a long-term solution.
Many doctors prefer alginates, which contain a foaming agent, which forms a layer that floats on top of the stomach contents.
This prevents stomach acid from flowing back into the oesophagus.
Also acid-suppressing medicines such as Ranitidine, and/or histamine receptor blockers, are available to reduce the amount of acid produced in the stomach.
If these treatments fail, surgery can be performed.
During the procedure, the stomach is placed into the correct position and the diaphragm is tightened.
Surgery usually uses laparoscopy, the least invasive technique, where only a tiny incision is made in the abdomen.
The procedure is not complicated so patients usually go home the same day.
So remember the good news: a hiatus hernia, although often painful and irritating, is curable, and you do not need to suffer in silence!