What Are Hiatal Hernias?

A hiatal hernia is a weakness or stretching of the digestive tract where it passes through the diaphragm. The diaphragm is the muscle separating the chest from the abdomen (belly). Because of this stretching, acid from the stomach may flow back into the esophagus (the tube that connects the mouth and stomach). This acid causes irritation. Part of the stomach may also come up through the opening into the lower chest. Hiatal hernias can affect people of all ages, but they are more common in people older than 50.

What Causes Hiatal Hernias?

The cause is unknown. Obesity, pregnancy, straining or lifting with tightened abdominal muscles, coughing, abdominal trauma, and long-lasting constipation or straining with bowel movements may slightly increase the chance of having a hiatal hernia.

What Are the Symptoms of Hiatal Hernias?

People often have no symptoms, but when they do occur, they are usually about an hour after meals. They include heartburn, chest pain, belching, and rarely swallowing problems. Bending over or lying down can make heartburn worse. A complication is bleeding, caused by irritation of the esophagus.

How Are Hiatal Hernias Diagnosed?

The health care provider uses endoscopy or barium swallow x-rays to diagnose hiatal hernias. In endoscopy, a small lighted tube with a tiny camera on the end is passed into the esophagus to see the hernia. Pressure measurements (manometry) may be done to prove that there is lower pressure where the esophagus and stomach meet.

How Are Hiatal Hernias Treated?

The goals of treatment are to control symptoms and prevent complications. The main approach is changing lifestyle and diet. If you have heartburn during the night, raising the head of the bed 4 to 6 inches (with wooden blocks or bricks, not pillows) will keep stomach acid from backing up and reaching the esophagus during sleep. Avoid foods and drinks that make symptoms worse.

Medicines can be used when these changes aren’t enough. Antacids neutralize stomach acid, and drugs to reduce stomach acid include ranitidine, famotidine, and proton pump inhibitors such as omeprazole.

If symptoms cannot be controlled or complications such as scarring, ulceration, or bleeding occur, surgery may be needed to correct the hernia.

DOs and DON’Ts in Managing Hiatal Hernias:
  • DO lose weight if you’re overweight.
  • DO eat slowly. Eat four or five small daily meals instead of one or two large meals.
  • DO call your health care provider if you feel that food stops beneath the breastbone.
  • DO call your health care provider if you have pain with shortness of breath, sweating, or nausea.
  • DO call your health care provider if you vomit blood or vomit often.
  • DO call your health care provider if symptoms don’t improve after 1 month of treatment.
  • DON’T drink alcohol and caffeine products (coffee, tea, cocoa, cola).
  • DON’T eat fried, spicy, and fatty foods; citrus juices; peppermint; and spices that may irritate the hernia.
  • DON’T eat large meals.
  • DON’T eat anything for at least 2 hours before bedtime.
  • DON’T bend over or lie down right after eating.
  • DON’T smoke.
  • DON’T wear tight-fitting pants, belts, and undergarments.

Contact the following sources:

  • American College of Gastroenterology
    Tel: (703) 820-7400
    Website: http://www.acg.gi.org

Copyright © 2016 by Saunders, an imprint of Elsevier, Inc.

Ferri’s Netter Patient Advisor

What Are Femoral Hernias?

A femoral hernia is a bulge of intestine (bowel) or fatty tissue pushing through a weak muscle in the groin. It occurs near the thigh, usually on the right side. More women than men tend to have them. It can’t be entirely prevented.

What Causes Femoral Hernias?

Contributing factors include being overweight, pregnancy, coughing a lot, constipation, straining to have a bowel movement (stool), and heavy lifting. Getting older, smoking, being born prematurely or having a low birth weight, illness, and using steroid medicines tend to increase chances of having a femoral hernia.

What Are the Symptoms of Femoral Hernias?

Very small hernias may cause no symptoms. The main symptom is a bulge in the groin. It gets bigger on standing and smaller when lying down. It may cause an aching pain that might be felt in the inner part of the thigh.

A bulge that gets bigger and starts to hurt more can mean an incarcerated or strangulated hernia. With an incarcerated hernia, bowel or fat became stuck in the hernia. With a strangulated hernia, blood flow is blocked. Other symptoms of incarcerated or strangulated hernias include nausea, vomiting, and severe constipation. Also, the hernia won’t get smaller when lying down.

How Are Femoral Hernias Diagnosed?

The health care provider will make a diagnosis by doing a physical examination. If surgery is suggested, blood and urine tests, and electrocardiography (ECG) (a record of the heart’s electrical activity) will be done before the surgery.

How Are Femoral Hernias Treated?

First, the health care provider will try to push the hernia back, to prevent incarceration and strangulation.

However, femoral hernias can be fixed by outpatient surgery. The operation used depends on the hernia size and general health. The surgeon may fix it through a small cut in the skin (laparoscopy). The surgeon repairs the hernia by using a lighted tube that is put through a very small hole in the skin. A mesh material may be put over the hernia to add strength, so that the hernia won’t occur again.

The health care provider will prescribe pain pills and may suggest using a mild laxative to avoid straining when moving the bowels. After surgery, sudden and severe twisting and turning and driving a car should be avoided to prevent loosening the stitches or incision.

DOs and DON’Ts in Managing Femoral Hernias:
  • DO follow your doctors instructions about taking pain pills, returning to work, and resuming sex after surgery.
  • DO eat a high-fiber diet and drink eight glasses of water a day to prevent constipation and straining to have a bowel movement.
  • DO call your surgeon if the incision gets red or swells or fluid seeps from it. Also call your surgeon if your temperature gets higher than 100° F.
  • DO reduce your chance of getting femoral hernias by keeping your weight down, eating a high-fiber diet, drinking enough water, and following safety instructions about lifting heavy objects.
  • DON’T forget follow-up appointments.
  • DON’T lift heavy objects or drive until your surgeon says you can.

Contact the following sources:

  • American Gastroenterological Association
    Tel: (301) 654-2055
    Website: http://www.gastro.org
  • Society for Surgery of the Alimentary Tract
    Tel: (978) 526-8330
    Website: http://www.ssat.com

Copyright © 2016 by Saunders, an imprint of Elsevier, Inc.

Ferri’s Netter Patient Advisor