Hiatus hernia symptoms
Many hiatus hernias don’t cause any problems. In fact, many people with small hiatus hernias have no symptoms at all and may never know they have the condition unless it is discovered by accident as part of a test for another problem. However, moderately-sized or large hiatus hernias are more likely to cause symptoms and discomfort.
What are the common symptoms?
The most common symptoms of hiatus hernia are those arising from gastro-oesophageal reflux, which can occur as a result of the hernia. These symptoms include heartburn, which is a painful burning sensation felt in the lower front chest area behind the breastbone and upper abdomen, often after eating or when lying down. Regurgitation of sour or bitter-tasting acid fluid into the mouth, particularly at night, occurs with more severe reflux.
Other symptoms
Depending on the type of hiatus hernia, other symptoms can include:
- difficulty in swallowing, due to swelling of the oesophageal lining;
- pain on swallowing hot liquids;
- a sense of pressure in the lower chest;
- feeling as if food is sticking in the oesophagus (gullet);
- belching or burping; and
- occasionally, an irregular heartbeat.
These symptoms are often worse when you bend over, lie down or strain to lift heavy objects. Symptoms often occur in pregnant women as this is a common time to develop a hiatus hernia.
Complications of hiatus hernia
Strangulation
A rolling or para-oesophageal hiatus hernia is one in which the top part of the stomach (fundus) bulges into the chest through the oesophageal opening in the diaphragm. A rare complication of rolling hiatus hernias is a condition known as strangulation. This is where the protruding part of the stomach becomes twisted or pinched by the diaphragm. This can cause bloating, blockage of the oesophagus or problems swallowing. Very rarely, the blood supply to the stomach can become blocked, and this can cause severe chest pain and breathing difficulties. This is a medical emergency and surgical treatment is needed immediately.
Difficulty breathing
Sometimes with large hiatus hernias there is so much of the stomach protruding up through the oesophageal gap in the diaphragm that it presses on your lungs and can make breathing more difficult. See your doctor if you are having difficulty breathing.
Complications of reflux
In some people with hiatus hernia, the acidic stomach contents regurgitate regularly into the oesophagus (reflux). This may cause damage to the oesophagus and even bleeding that may lead to anaemia in some cases. Ongoing reflux may cause injury to the oesophagus and a narrowing of the oesophagus (called a stricture) that can cause swallowing difficulties.
The outlook
In most cases, hiatus hernia can be kept in control by medications, lifestyle and dietary changes and your doctor can help you with these. Other treatment, such as surgery, is normally only required if your symptoms become worse and more constant.
Last Reviewed: 19 July 2001
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