Symptoms Of A Hiatal Hernia

March 11, 2024

In the human body, a hernia refers to a protrusion of an organ or tissue into an area in which it does not belong. The term Hiatus refers to the opening in the diaphragm which separates the chest cavity from the abdomen. Typically only the esophagus transverses through the hiatus. In the case of a hiatal hernia, the opening now allows some or all of the stomach to protrude. The diaphragm is a primary core stabilizing muscle. A hiatal hernia may be the result of tearing or even genetic predisposition; therefore, not all are painful or symptomatic. Diagnosis is by a medical physician through a combination of patient history, physical examination, and specialized diagnostic tests.

Regurgitation Of Food

A hiatal hernia is diagnosed through specialized x-rays, called a barium swallow, or an endoscopy. A large percentage of hiatal hernias are not diagnosed due to their asymptomatic nature. It is believed asymptomatic hiatal hernias may have been present since birth, potentially occurring in individuals with a naturally widened opening. A strong symptom of a hiatal hernia is the regurgitation of food. Undigested or partially digested food in the stomach can remain in the area that herniates upwards. This forces the food up and into the esophagus, thus causing regurgitation. The risk of the regurgitation of food increases with the size of the hiatal hernia. But, the most likely time food regurgitates is when an individual lays down quickly after eating. The primary complaint is of a bitter taste in the mouth, but a dentist may also see changes in a patient's teeth.

Vomiting Blood

While the direct cause of a hiatal hernia is typically unknown, increased intra-abdominal pressure may contribute. Pregnancy, severe cough, obesity and straining during bowel movements are times during which a hiatal hernia may form due to increased intra-abdominal pressure. Vomiting blood can be a scary indicator for hiatal hernia. Most of the time, the blood is actually a darkened brown or even black, described as coffee-colored. Blood from a hiatal hernia is rarely red. Red or foamy red blood in vomit typically indicates blood from the respiratory tract, not a hiatal hernia. This brown coloring is the chemical reaction of the blood mixed with stomach acids as well as the darkening which occurs as a result of old versus fresh blood. Left untreated, vomiting blood may lead to anemia. By definition, anemia is a medical condition that develops when blood lacks enough healthy red blood cells or hemoglobin. Most commonly, anemia is a result of iron deficiency, which is the type of anemia seen with hiatal hernias.

Heartburn And Acid Reflux

There are four type classifications of hiatal hernias. Type I, a sliding hiatal hernia, is the most common. It accounts for approximately ninety-five percent of all hiatal hernias. Type II, also known as a paraesophageal hiatal hernia, accounts for five percent of all cases, but causes most of the complications. In this type of hiatal hernia, the herniated portion of the stomach can torsion, cutting off its blood supply. This may lead to a serious infection if left untreated. A paraesophageal hiatal hernia is associated with heartburn and acid reflux as the dominant symptoms. These symptoms are greatest immediately after a meal or at night when one lays flat. With a pH probe study, these hiatal hernias will have a higher than normal acid content which accounts for the symptoms. Medications known as proton-pump inhibitors are often utilized to reduce stomach acid and symptoms of reflux. However, with the risks involved in a paraesophageal hiatal hernia, this type is most likely to require surgical correction.

Pain In The Chest Or Abdomen

The structures involved in a hiatal hernia are all extensively innervated, have a good nerve supply, giving the potential for any one or more of them to generate pain. While heartburn is a type of discomfort, the pain in the chest or abdomen from a hiatal hernia is more likely to be severe or intense. The pain is typically located behind the sternum or breast bone. Its location, as well as the burning or heavy pain, may cause concern regarding a cardiac component to the pain. One distinguishing characteristic is that the pain itself increases after eating, or postprandially, and when lying down. Cardiac pain does not typically change in intensity or character based upon any change in activity or function.

Trouble Swallowing

Trouble swallowing, also called dysphagia, occurs when a hiatal hernia causes an obstruction in the lower esophagus or stomach. This results in a delay in the emptying of stomach contents, resulting in dysphagia. Trouble swallowing is very disconcerting, and individuals who struggle with it indicate significant anxiety surrounding the condition. Fear of choking is paramount. In most circumstances, complete obstruction does not occur as a result of a hiatal hernia. However, if difficulty swallowing is persistently problematic, it may prompt a surgical repair. In this case, the hiatal hernia itself is surgically corrected. The surgery may also include a component that stretches the esophagus to improve the propulsion of food. For any suspected hiatal hernia, proper evaluation is imperative. A complete history, physical examination, and specialized diagnostic testing is the first step towards resolving a variety of symptoms stemming from a hiatal hernia.


A hiatal hernia can lead to bloating in the abdomen. Not everyone will experience this symptom, but it tends to occur in individuals whose hernia is causing acid and other stomach contents to flow back into the esophagus. Bloating causes the belly to feel swollen, particularly after eating. Not every case of bloating is a sign of a hiatal hernia. The condition tends to be caused by disturbances in the digestive system or by excessive gas production in the digestive tract. Bloating might make individuals feel uncomfortable, or it might cause pain and a feeling they've eaten too much. Some individuals also notice their stomach looks bigger. Though bloating in the stomach is different from water retention, individuals often use the terms interchangeably. Bloating occurs when gas, liquids, or solids build up excessively in the digestive system. Water retention is a type of bloating, but not all bloating involves water retention.


If individuals have a hiatal hernia, they might find themselves experiencing frequent burping and belching. This might occur even if they haven't made any significant changes to their diet or what they drink. Patients might find foods that don't usually make them burp have led to burping, or they continue burping for much longer than they usually do. Burping occurs when individuals expel air from their stomach by pushing it through their mouth. The condition is generally related to the distending or expansion of the stomach because they've swallowed too much air. When individuals belch, the release of air reduces the distention. A hiatal hernia might lead to burping if there's a backflow of stomach contents. Belching most commonly occurs after individuals eat or drink something too quickly, drink carbonated beverages, or experience anxiety. Some individuals might also belch even if their abdomen doesn't have an excess amount of air in it. This tends to be due to using burping as a tool or habit to reduce discomfort in the abdomen.

Shortness of Breath

Shortness of breath, also known as dyspnea, is another symptom that might occur due to the backflow of acid and stomach contents. It can also be a symptom of many other illnesses. If individuals often experience shortness of breath, they should see a doctor to have the cause evaluated. If shortness of breath is so severe that individuals feel like they cannot breathe at all, they should seek emergency medical treatment.

Some individuals also refer to shortness of breath as a feeling of being unable to get enough air, an intense tightening feeling in the chest, difficulty breathing, feeling as though they're being suffocated, or feeling an intense hunger for air. In healthy individuals, shortness of breath can be brought on by strenuous exercise, high altitudes, and extreme temperatures. But if individuals don't have these factors and experience shortness of breath, they're likely dealing with a medical issue. Patients who experience shortness of breath that comes on suddenly and severely should talk to a doctor right away.

Inability To Pass Gas

A hiatal hernia might be responsible for an individual's inability to pass gas, though several other conditions can also cause this symptom. Adults pass an average of two pints of gas per day. Usually, gas builds up in the digestive tract as a byproduct of the digestion process or due to swallowing air. If individuals don't burp the air up, it will move through the intestinal tract and be released through the rectum. An individual with a healthy and fibrous diet will pass some gas every day. But if individuals find they can't pass gas, this is often the sign of an underlying medical issue. It's sometimes related to a condition called an intestinal blockage, which occurs when the large or small intestine becomes obstructed. This is a medical emergency that must be treated immediately. Some individuals who experience trouble passing gas can treat their problems at home after talking to their doctor. Pain along with the inability to pass gas is a significant reason to talk to a doctor.

Upset Stomach

An upset stomach, sometimes presenting along with indigestion, is an extremely common phenomenon nearly everyone experiences from time to time. For most individuals, bouts of indigestion aren't a cause for concern. However, if individuals notice they're experiencing indigestion and an upset stomach regularly, it could be a sign of an underlying medical condition. This might be a hiatal hernia, or another illness or issue with the digestive tract. Individuals with an upset stomach might experience nausea, bloating, and a feeling of excess gas in the digestive tract. This might be accompanied by belching and farting, and some individuals also experience heartburn or acid reflux. Many cases of an upset stomach can be treated at home without needing a doctor's intervention. If the stomach problems are severe, persistent, or frequent, individuals should talk to a doctor. It's also important to talk to a doctor if an upset stomach is accompanied by an inability to pass gas, bloody vomit or stool, or chronic constipation.

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