Two types of hiatal hernias exist, which are the fixed and the sliding hernia. The sliding hernia accounts for 95% of all cases. It is believed that 60% of people over the age of 60 have it. However, because there is very little hiatal hernia pain and symptoms, most people aren't even aware of it being present, and that 60% figure could be much higher.
A hiatal hernia happens when the stomach pushes through the hiatus (opening) in the diaphragm, entering the mediastinum, which is the cavity that holds the heart. When you inhale, the hernia becomes more prominent, because the diaphragm contracts. It is also more prominent when swallowing, when the esophagus shortens. That said, these symptoms are minimal so, while they would be noticeable during a medical examination, most people are never aware of the hernia being there at all.
Understanding Hiatal Hernia Pain and Symptoms:
As stated, a hiatal hernia is usually asymptomatic and it tends to be found only when someone has to have an x-ray or other scan of the abdominal or chest area for other reasons. Sometimes, they are found during an endoscopy as well. If people do experience hiatal hernia pain and symptoms, it tends to be because of heartburn, with stomach acids moving up into the esophagus.
Within the stomach, foods, liquids, and digestive juices mix together to start the process of digestion. The stomach is lined with a protective material so the acid doesn't eat away at the muscle. However, the esophagus does not have this lining, relying instead on the LES (lower esophageal sphincter) and on the diaphragm muscle to stop acid from moving back up. In someone without a hiatus hernia, the pressure in the abdominal cavity is higher than in the chest cavity, further increase during an intake of breath. When there is a hiatus hernia, however, the junction where this happens moves into the chest, which means the zone of high pressure is lost. As a result, acid can enter the esophagus, causing acid reflux.
Common symptoms include:
– Heartburn, which feels like pain or burning in the chest
– Retching, vomiting, or nausea
– Burping
– So-called "waterbrash", which happens when a huge influx of saliva suddenly appears in the mouth, stimulated by the acid refluxing
Usually, the symptoms are at their worst just after a meal, and particularly if you lie down or bend over. This is why walking off a meal is highly recommended.
Some people with a hiatus hernia develop a type of asthma as a result. This usually happens if some of the acid reflux reaches all the way into the throat, where it can be inhaled. Cough spasms and frequent lung infections, including bronchitis and pneumonia, can happen then. This is irrelevant of age.
It is important to note, however, that most people with a hiatus hernia do not experience reflux. At the same time, there are rare cases where the symptoms progress into volvulus, which is a medical emergency. Symptoms include vomiting, chest pain, and painful, difficult swallowing.