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Living with a hiatus hernia

If you're living with a hiatus hernia you already know how uncomfortable it can be. You might be lucky enough not to have symptoms but you may have painful heartburn causing a warm or burning feeling in your chest and throat. Understanding what makes your symptoms better or worse and the treatment options available to you can help you make better decisions about your health. Knowing the possible benefits or side-effects of treatment is also important.

How a sliding hiatus hernia forms
When the junction between the oesophagus and the stomach, as well as a portion of the stomach itself, slides up above the diaphragm

Details

  • Making life easier Making life easier

    If you have a hiatus hernia, it can sometimes prevent the valve at the bottom of your oesophagus from working properly. Your oesophagus is a tube that carries food from your throat to your stomach. If the valve doesn't work as it should, it can cause a problem called gastro-oesophageal reflux disease (GORD). This is when acid or bile in your stomach rises back up into your oesophagus and causes heartburn. The focus of treating a hiatus hernia is mainly on alleviating the symptoms of GORD.

    Not everybody gets symptoms of a hiatus hernia but if you find that you do, here are some tips you can try to ease them.

  • Smoking and alcohol Smoking and alcohol

    Giving up smoking and cutting down on alcohol are two of the most important things you can try as they can both bring on the symptoms of heartburn. 

    There’s plenty of support to help you quit smoking, from local face-to-face services to advice on the phone and online chat rooms. See our Resources section for information on how to access this free support.

    To help reduce the risk of health problems from drinking alcohol, limit the amount you drink. Men shouldn’t regularly drink more than three to four units of alcohol per day and for women its two to three units per day and you should aim to have two alcohol free days each week. ‘Regularly’ means drinking most days or every day. Try to stick within these limits but if alcohol makes your symptoms worse, you may find that you have to stop drinking altogether.

  • A GORD-friendly diet A GORD-friendly diet

    It's important to cut down, or stop eating food or drinks that make your symptoms worse. Some foods and drinks can increase the amount of acid in your stomach or relax the muscle at the bottom of the oesophagus and make heartburn worse. Common culprits include: 
    • chocolate
    • peppermint
    • caffeine
    • fatty and spicy foods

    Try keeping a 'food diary' to help you recognise which foods make your symptoms worse. Write down what you eat every day and any symptoms you get and when you get them. When you know what foods make your symptoms worse, you can eat or drink less of them or avoid these altogether. However, it depends on what type of food it is. While it's fine to cut out something like chocolate, you will need to consider other foods more carefully. Have a chat with your GP or a dietician before you cut out whole food groups, such as fats. You need to ensure you still get all the nutrients your body needs.

    You might also find it helps to eat small meals often rather than one large meal. This is because large meals can put pressure on your abdomen, which can make your symptoms worse.

  • Lose excess weight Lose excess weight

    If you’re overweight or obese, it can make the symptoms of GORD worse. Therefore it's important to lose excess weight. Research has shown that this can improve the symptoms of GORD. 

    The best way to lose weight is to make some changes to both your diet and the amount of exercise that you do.

  • Manage your medicines Manage your medicines

    Some medicines can make the symptoms of GORD worse, such as calcium-channel blockers, nitrates, and beta-blockers

    If you find your symptoms are worse after you take certain medicines, have a chat with your GP to see if there are alternatives.

  • Practical steps Practical steps

    There are some practical things you can do to keep your stomach acids from coming back up. 
    • Raise the head of your bed by putting books or furniture raisers under the legs at the head of your bed. Propping yourself up with pillows, bends you at the waist and doesn’t help.
    • Try not to stoop or bend down after you have just eaten.
    • Don't eat just before you go to bed.
    • Stay upright for three hours after your meals.

    These all help to ensure gravity can do its work and keep your stomach acids from coming back up. It may also help to wear loose comfortable clothes so there’s less pressure on your abdomen. If you wear tight clothing, it can squeeze your stomach area and push acid up into your oesophagus.

    If your hiatus hernia is causing you pain and discomfort, there are medicines to help reduce the symptoms of acid reflux. The most common are antacids, which neutralise the acids in your stomach. The effect antacids have varies from person to person so, unfortunately, there’s no guarantee they will alleviate your discomfort.

    If you try antacids and they don’t work for you, have a chat with your GP or pharmacist to find out if there’s alternative. They may recommend trying a medicine called H2 receptor antagonist or proton pump inhibitors. Both of these medicines reduce the amount of acid your stomach produces.

  • Your options for treatment Your options for treatment

    Deciding about your treatment for a hiatus hernia will largely be driven by your symptoms, and how severe they are. You may find they are manageable and you feel like you can live with some discomfort or your symptoms may be affecting your quality of life. 

    Most people are able to manage their symptoms with self-help measures and medicines. If you’re getting painful heartburn and self-help measures and medicines haven't helped, you may consider surgery. However, this should be a last resort. There’s a range of things you can do to help manage a hiatus hernia so it makes sense to try these first. There might be one that works for you.

    You and your doctor, or surgeon, can work together to make a decision about the treatment that's right for you. This will be based on your doctor or surgeon’s expert opinion and your personal values and preferences.

  • When is surgery necessary? When is surgery necessary?

    If you’ve developed a strangulated rolling hiatus hernia, surgery is your only option. A strangulated rolling hiatus hernia is a medical emergency and you should seek treatment as soon as possible.

    If it’s strangulated, this means the hernia has been trapped by your diaphragm, which can cut off its blood supply. This can rapidly lead to your bowel tissue dying, and your bowel may burst. This will release toxins into your bloodstream, which can be fatal.

  • Bupa On Demand Getting private treatment with Bupa On Demand

    With Bupa On Demand we can help you get treatment for a hiatus hernia.

    Bupa on Demand provides pay as you go access to private healthcare including initial consultations, diagnostics tests and treatment with no insurance needed. We use the Bupa provider network of over 16,000 consultants and 200 hospitals‡‡, which means we can quickly and easily arrange a location convenient for you.

    ‡‡ valid as of October 2017

    • no health insurance needed
    • only pay for the treatment you need
    • your own dedicated healthcare adviser
    • fast access to consultations, tests and treatments
    • access to Bupa’s extensive provider network

    Find out more about Bupa on Demand

    What will you need to get treatment?

    You’ll need a letter from your GP stating that you’ve been referred with symptoms of a hernia. You can then choose to either go to the NHS for your consultation or pay a fixed fee of £250† and get a prompt appointment with a Bupa recognised consultant.

    If you choose to use a Bupa consultant they may recommend further tests and scans. These tests and scans will be at an extra cost although you have no obligation to continue with Bupa and may instead decide to return to the NHS for this or any further treatment that may be required.

    Don't have a referral letter?

    If you don’t have a referral letter you have the option of paying for a 15 or 30 minute private GP appointment in a Bupa centre convenient to you.

    Call us on 0808 163 5136 ^ and talk to one of our healthcare advisers about your options.

    ^Lines are open Monday to Friday 8am to 6pm. Calls may be recorded and may be monitored. 

    Understanding your options

    You’re still entitled to NHS care, free of charge, even if you choose to pay for additional private care. Your position on a NHS waiting list should also not be affected if you choose to have a private consultation.

    People commonly use our Bupa On Demand service:

    • when they have to wait a long time to receive NHS treatment or surgery
    • when they are unable to get an appointment with a consultant or specialist
    • if they’ve been refused NHS treatment but are still suffering from pain and discomfort

    Our pay as you go private healthcare can be used in conjunction with NHS treatment to help you feel better more quickly.

    For more information about NHS treatment, please visit NHS choices.

    What to expect

    When you speak to someone from our Bupa On Demand team, they’ll arrange for you to see a consultant or specialist as soon as they can.

    We understand that waiting for treatment can be a worrying time, so we’ll try our best to make sure everything is explained clearly. During your consultation, you’ll be able to talk about your concerns and ask about your different options.

    Throughout the duration of your treatment, you can expect to pay a fixed price. Prices are available upon request.

    Find consultants and specialists near you with Bupa on Demand.

  • Hiatus hernia surgery Hiatus hernia surgery

    A common type of operation to treat gastro-oesophageal reflux is called a Nissen fundoplication. This operation is usually performed using laparoscopic (keyhole) surgery, which means your surgeon will make a few small incisions in your abdomen rather than one large cut used in open surgery. Your surgeon will use a telescopic camera and small instruments to put your stomach back into the correct position. In a Nissen fundoplication, your surgeon will wrap the top of your stomach around the lower part of your oesophagus and stitch it in place to make a new value.

    Your Surgeon may also repair your hernia with stitches or mesh, depending on the size of your hernia in order to tighten the opening in your diaphragm, through which your oesophagus passes from your chest into your abdomen. This will prevent your stomach contents from going back into your oesophagus.

    There are other ways this type of surgery can be carried out. Ask your surgeon for more details about the different techniques and which is best for you.

    Recovering from hiatus hernia surgery

    If you undergo the procedure with no complications, you will usually be discharged from hospital within two to three days. Depending on how labour intensive your job is, you should be able to return to work within three to six weeks.

    Aftercare

    During your recovery period you’ll be assigned a Bupa healthcare adviser. They’ll be there for you until you’ve finished your treatment and will always be just a phone call away.

    If you ever require support outside of office hours you’ll have access to our 24/7 Bupa Anytime HelpLine where you can speak to a qualified nurse who’ll be able to give you medical advice if something unexpected occurs.

    After surgery your Bupa healthcare adviser will schedule a follow up appointment with a consultant to make sure your surgery was effective. They’ll stay in regular contact, with at least one phone call after your treatment and after your follow up appointment.

    What happens if there are complications? Will I have to pay?

    If there are any complications after your surgery, your treatment package will cover the additional costs. Should you need further treatment, you’ll be able to return to a private hospital within 30 days of the initial procedure. Subject to terms and conditions.

    Risks of surgery

    As with every operation, there are some risks associated with surgery to treat a hiatus hernia. Ask your surgeon to explain what these risks are, and how they apply to you.

  • Useful websites Useful websites

    If you need to lose weight to improve the symptoms of a hiatus hernia, the government’s Change4Life campaign has some healthy eating tips.

    Quitting smoking can help if you have a hiatus hernia. You can sign up to receive free support from the NHS’s smokefree campaign.

  • Related information Related information

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  • Author information Author information

    Produced by Dylan Merkett, Bupa Health Content Team, November 2015.

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