A hiatal hernia occurs when part of your stomach pushes through the opening of your diaphragm and into your esophagus. If your hiatal hernia is small, you will be asymptomatic and require no treatment. However, if the protrusion is quite large, food and acid will back up into your esophagus, causing symptoms like chest pains and heartburn. Although medication usually is enough to treat large hiatal hernias, a severe protrusion may require surgery.
Before recommending medicine or surgery, your doctor will probably recommend lifestyle changes to fix your hiatal hernia. Most of these changes will revolve around your diet and exercise habits. Your doctor may recommend you eat smaller meals, since big portions can distend your stomach. You will also want to recognize which foods cause problems for you, such as spicy, fried and fatty foods, and avoid eating them. Losing weight can always help your hiatal hernia, because slimming down will reduce the pressure on your stomach. Reducing stress is another way to stop symptoms such as heartburn and excessive stomach acid.
If lifestyle changes don't work for you, your doctor will next try to put you on medication. Antacids like Maalox or Mylanta will cut down the amount of acid in your esophagus and relieve heartburn. However, your symptoms will probably return if you discontinue use. Your doctor may also recommend an H-2 blocker or proton pump inhibitor. H-2 blockers, such as Pepcid and Tagamet, reduce the amount of acid produced by your stomach. It is important to talk to your doctor about the use of these drugs, especially if you are on other medication. Proton pump inhibitors also prevent the stomach from producing acid and give the esophagus time to heal itself. These drugs are quite effective but are very expensive if you are not insured.
Your doctor will only recommend surgery for your hiatal hernia if lifestyle changes and medication fail to work. It will also be necessary if you experience chronic bleeding or your esophagus is obstructed. The surgery to repair a hiatal hernia involves pulling your stomach lower in the abdomen and making the opening of the diaphragm smaller. Sometimes the muscle of the esophageal sphincter is rebuilt or the hernia sac is removed. The surgeon will enter through either an incision in the chest wall or the abdomen. It is also possible to have laparoscopic surgery, where your doctor will enter through a very small incision and use a fiber-optic camera. This procedure is less invasive than other surgeries.