What Does a Hiatal Hernia Feel Like? The Symptoms Women Over 50 Shouldn’t Dismiss
Learn how it's treated and why you shouldn't panic if you have a mild case
Groin hernias may get all the attention, but a hiatal hernia—a lesser-known, yet surprisingly common type—affects more women than men. If you’re wondering, “What does a hiatal hernia feel like?” keep reading for everything you need to know, including who’s most at risk and simple ways to ease symptoms.
What is a hiatal hernia?
“It’s basically where part of the stomach will come up from the abdomen or the belly and might move up into the chest,” explains Anish Sheth, MD, gastroenterologist and Chief of Gastroenterology at Penn Medicine Princeton Medical Center. To help you visualize it, the esophagus meets the stomach at an opening in the diaphragm called the hiatus.
“The diaphragm is the muscle we use to breathe, separating our chest from our belly. And when the stomach kind of pops up through this hiatus and moves up into the chest where it doesn’t belong, that’s a hiatal hernia.”
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What causes a hiatal hernia? Why women 50+ are at risk
Women are more prone to developing a hiatal hernia largely due to pregnancy and hormonal changes that occur with age. Here, Dr. Anish explains in more detail the three main risk factors for developing a hiatal hernia:
Pregnancy
“When women—especially those who’ve had multiple pregnancies—carry a baby, their abdomen expands for months, putting pressure on the organs in their stomach,” explains Dr. Sheth. “Over time, that pressure can loosen the connective tissue around the hiatal area, which can lead to a hiatal hernia.”
Obesity
Anything that increases pressure in the abdomen makes a hiatal hernia more likely to develop, which is why excess body fat is another risk factor, says Dr. Sheth.
Age
Hiatal hernias are more common after the age of 50, notes Dr. Sheth. “That’s largely because connective tissues and ligaments get a little bit laxer as we get older.”
What does a hiatal hernia feel like? 4 key symptoms
“The biggest symptom of a hiatal hernia is no symptom at all,” observes Dr. Sheth. “One important thing to note is that it’s surprisingly common. People often hear the word hernia and immediately think of groin hernias or other types that almost always require surgery and cause symptoms.
“But in reality, most hiatal hernias are found incidentally during endoscopies or CT scans, and they tend to be small. So the key takeaway is that small hiatal hernias [1 or 2 centimeters] are very common and usually not clinically significant.”
That said, larger or more significant hiatal hernias [about 5 centimeters or more] may indeed cause a few symptoms, explains Dr. Sheth:
- Acid reflux
- Heartburn, especially after lying down
- Indigestion
- Chest pain
Common hiatal hernia treatments
As Dr. Sheth mentioned above, most hiatal hernias are small and often go unnoticed unless a scan is performed for another reason. A more significant one, however, may require treatment. When it comes to hernia repair, there are a few common types of surgery typically performed.
“In a minimally-invasive fashion, laparoscopically, the stomach is pulled back down into the abdomen where it belongs,” Dr. Sheth explains. “Then sutures or stitches are used—or sometimes they’ll use mesh—to tighten up the opening right at the hiatus, the opening where the stomach was sliding through, so that the stomach can’t bulge back up into the chest.”
But if a patient has severe acid reflux or gastroesophageal reflux disease (GERD), this surgery is sometimes combined with another procedure called a fundoplication to further tighten up that stomach-esophagus junction, he continues.
Worth noting: There’s also an implantable device, called LINX, which can tighten up the hiatal opening and help prevent acid reflux symptoms in the long term.
The bottom line on hiatal hernia symptoms
Most of the time, simple lifestyle tweaks can bring relief for mild hiatal hernia pain and symptoms, notes Dr. Sheth. (The condition does not heal on its own.) “Controlling acid reflux with common acid-blockers, like Prilosec, and making dietary changes—such as avoiding spicy foods, caffeine and alcohol—are usually sufficient.” Eating smaller meals, not lying down soon after eating and weight loss (for individuals with obesity) may also help.
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