Hiatal hernia (diaphragmatic hernia) in adults and children

What is a hiatal hernia?

Hernias are common, but there are various types that you can develop or be born with. A hiatal hernia happens when part of your stomach protrudes through your diaphragm (the large muscle separating your abdomen and chest) via the natural opening for the oesophagus (swallowing tube). 

Generally, small hiatal hernias do not cause significant problems, and you may not know you even have one without having investigative tests. However, some hiatal hernias can be painful and cause significant symptoms and complications. 

Our specialists at St Thomas’ and Evelina London Children’s hospitals treat hiatal hernias in adults and children and offer personalised advice on how to prevent them.

Who is at risk of a hiatal hernia?

Anyone can develop a hiatal hernia, but they’re more common in the over 50s or people that are overweight or obese. 

 Children can develop hiatal hernias too and, occasionally, babies can be born with a congenital hiatal hernia. Doctors will often detect this very soon after birth or during a routine ultrasound scan. 

 No one knows exactly why some babies are born with a congenital hiatal hernia. However, surgery can be performed after birth.

Types of hiatal hernia 

There are two main types of a hiatal hernia – type 1 and type 2.  

A type 1 hiatal hernia is the most common, and is sometimes called a sliding hiatal hernia. This occurs when part of your stomach slides up through the gap in your diaphragm that your oesophagus passes through (the tube of muscle that carries food and liquid to your stomach). 

A type 2 hiatal hernia, also known as a para-oesophageal or rolling hiatal hernia, is where the upper part of your stomach pushes through the hiatus opening next the oesophagus and sits in the chest. 

Sometimes, you can have a combination of type 1 and type 2, known as a type 3 hiatal hernia. Rarely, another type can occur where another abdominal organ pushes through the hiatus opening and into the chest. 

Hiatal hernia symptoms

Unlike some other types of hernias, hiatal hernias often don’t cause symptoms. Hernias typically cause a lump or bump that protrudes and may disappear when lying down or pushing it back. However, hiatal hernias do not cause a noticeable lump as they are internal to the body. 

Sometimes, hiatal hernias can cause problems, the most common of which is gastro-oesophageal reflux disease (GORD).  

Symptoms of GORD can include:  

• a sore throat 
• chest pain not related to your heart 
• difficulty swallowing 
• heartburn 
• indigestion 
• regurgitation of food or drink 

Not everyone with a hiatal hernia will have GORD and may instead develop symptoms such as:  

• nausea 
• pain or pressure high up in your abdomen or chest 
• shortness of breath 

These symptoms are more common in type 2 hiatal hernias.

Symptoms of hiatal hernia in children 

Many children who develop a hiatal hernia will not experience severe symptoms. However, they may complain of a burning sensation in their chest or feeling acid in the back of their throat. These could be GORD-related symptoms. Children and babies with hiatal hernias can also experience vomiting or regurgitation of food and drink.  

If you think you or your child are experiencing symptoms of hiatal hernias, please don’t hesitate to contact our customer service team to make an appointment with one of our consultants.

What causes hiatal hernia? 

Hernias are usually caused by a weakness in your tissues that allows an organ to protrude through. However, in a hiatal hernia, the organ pushes through an existing, natural opening. Your hiatus opening only needs to widen slightly for an organ to go through.  

In some cases, hiatal hernias can be caused by:  

• injuries
• surgery 

However, the most common causes of a hiatal hernia include:  

• chronic straining due to constipation 
• frequent vomiting 
• heavy lifting 
• intense exercising 
• obesity 
• pregnancy and childbirth 
• strain from coughing or sneezing

Complications of hiatal hernia 

Generally, hiatal hernias are not serious and you may never know you have one. However, a large hiatal hernia may become problematic and cause symptoms like chronic acid reflux or GORD.  

It is rare for a hiatal hernia to get stuck or block the hiatus. However, if it does get stuck, it can cause:  

• a gastrointestinal obstruction (blockage) 
• gastritis (a condition that causes inflammation and stomach ulcers) 
• ischemia (where your hernia becomes tightly compressed and loses blood supply – a medical emergency) 

If you’re concerned about your or your child’s hiatal hernia symptoms, fill in our online form to book an appointment with one of our specialists.

We are experts in diagnosing and treating hiatal hernias in adults and children, so you can feel confident that we’ll manage the condition effectively. 

Hiatal hernia treatment

If you’re diagnosed with a hiatal hernia and are experiencing mild or no symptoms, we may recommend lifestyle changes.  

How to prevent a hernia

Lifestyle changes may help prevent a hiatal hernia, or alleviate mild hiatal hernia symptoms – these changes include:  

• avoiding food and drinks that trigger your GORD, like fatty, fried or spicy foods and caffeine 
• eating smaller meals throughout the day, instead of a few substantial meals 
• keeping your head elevated slightly at night (this may require placing something like books under the feet at the top of your bed) 
• lifting heavy objects with proper form 
• losing weight if you’re overweight 
• quitting smoking 
• stopping lying down after eating

Some cases hiatal hernia won’t require treatment, especially if you don’t have any symptoms. For people who are experiencing symptoms, medical treatment may be advised to alleviate these for example medication to reduce stomach acid.

Hernia repair surgery

Hernia repair surgery may be recommended to stop persistent symptoms and reduce the risk of complications.

To find out more about surgical options to treat hernias, we’ve listed some information below or you can visit the hernia repair surgery page for full details.

Surgeons can perform surgery for a hiatal hernia laparoscopically (keyhole surgery) and under general anaesthetic. This will involve making tiny incisions in your abdomen before inserting a camera and surgical tools to treat the area.  

Hiatal hernia repair surgery involves:  

• pulling your stomach and lower oesophagus back underneath the diaphragm 
• closing the hole in your diaphragm 
• wrapping the upper part of your stomach around your lower oesophagus and fixing it in place with surgical staples or stitches to recreate the normal valve that stops reflux (fundoplication) 

Open hernia repair surgery is sometimes necessary, but we’ll discuss your options beforehand so you know what to expect. 

We offer adult gastrointestinal (GI) surgery services to treat your hiatal hernia effectively. Our gastroenterologists and gastrointestinal surgeons are experts in diagnosing, managing and treating hiatal hernias, so you can feel confident that we will prioritise your health.  

Hiatal hernia surgery is usually a very effective treatment method, and most patients experience no further hiatal hernia symptoms once they have recovered from their operation.

Hiatal hernia treatment recovery

Once your surgery is completed, you may need to remain in the hospital for up to 2 days while we monitor your condition. If our surgeons perform your procedure as keyhole surgery, your recovery time may be shorter as it’s a less invasive technique.  

It can take up to 6 weeks to fully recover and you may experience temporary symptoms, such as bloating and difficulty swallowing.

Treating hiatal hernia in children

As part of our paediatric general surgery service, our specialists effectively manage and treat your child’s hiatal hernia. If symptoms are only mild, we may recommend lifestyle changes, such as avoiding GORD triggers and giving smaller meals more often.  

However, if your child has a congenital hiatal hernia or significant symptoms, we will recommend surgery. We perform children’s hiatal hernia repairs under general anaesthetic, so your child will be asleep and safe throughout. 

We’ll use laparoscopic techniques to enhance your child’s recovery and repair their hiatal hernia effectively. 

We’ll also provide all the aftercare advice you need to support your child’s recovery at home.