Q: I have a smallish hiatal hernia that so far I have been able to mostly control with medication and changes to my diet. I am trying to avoid having surgery, but is it inevitable that a hiatal hernia will get larger and eventually need to be operated on?
A: A hiatal hernia occurs when part of the stomach protrudes upward through the opening (hiatus) where the esophagus passes through the diaphragm.
Hiatal hernias are more likely to occur in females than males, and are very common during middle age. People who are obese or have had abdominal surgery are at higher risk for hernias. The risk also increases with age. Hiatal hernias can occur in children and adults.
These herniations are caused by a weakness in the muscle tissue at the opening in the diaphragm where the esophagus passes through to the stomach. In some people, this weakness is congenital, which means it is present at birth. In others, it develops over time, as a result of excessive weight gain, physical activity that places pressure on the abdomen, pregnancy, heavy lifting, straining during bowel movements because of constipation, severe vomiting, or chronic and intense coughing. Because the muscle is weak, the hernia occurs during abdominal strain.
Although there is no way to prevent hernias due to a congenital weakness, you can help reduce your risk for a hiatal hernia and control progression. Follow a healthy diet that is high in fiber and drink plenty of fluids to prevent constipation, maintain a healthy weight through diet and exercise, and avoid cigarette smoking, which can cause chronic coughs. If your job requires heavy lifting, learn the proper way to lift and wear a support garment.
The primary symptom is heartburn and acid reflux.
Very rarely is surgery necessary. As you have probably already done, restrict your intake of spicy and acidic foods and beverages, caffeinated beverages, and chocolate. Elevating your head when lying down to prevent gastroesophageal reflux and remain in an upright position after eating. Patients with hiatal hernias find that symptoms are reduced if they eat frequent small meals throughout the day.
Surgery is necessary for a strangulated hiatal hernia (when the opening becomes so tight that blood flow is not getting to parts of the stomach tissue) and very large hiatal hernias that cause severe gastroesophageal reflux. This procedure is usually laparoscopic.
Dr. Brent Ridge is the health expert for Martha Stewart Living Omnimedia. You can call and ask him a question live every Tuesday at 2 p.m. Eastern on Sirius Satellite Radio, Channel 112 (1.866.675.6675). You can also follow along as he learns to grow his own food and raise goats on his farm in upstate New York by visiting www.beekman1802.com.
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