Hiatal Hernia and Pregnancy

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Many women get indigestion during their pregnancies, especially in the last trimester. They may experience heartburn or get an acidy taste in their mouth and throat, and burp more often. It isn’t pleasant, but for most women, it isn’t serious.

In some pregnancies, indigestion can be caused by a hiatal hernia.  A hiatal hernia is also called a hiatus hernia or, sometimes, a diaphragmatic hernia. For the large majority of women, a hiatal hernia during pregnancy is not serious. However, in rare cases it can cause severe, continuing indigestion and other problems.

An anatomy lesson helps give more understanding of what a hiatal hernia is. The abdomen is separated from the chest by a thin wall of muscle called the diaphragm. The esophagus, or food pipe, runs up from the stomach to the throat and mouth. and passes through a small gap in the diaphragm called the esophageal hiatus. Right about where the esophagus passes through the diaphragm is the lower esophageal sphincter, a ring of muscle in the esophagus that helps prevent stomach contents from coming up into the esophagus.

Normally, the stomach always stays below that small gap in the diaphragm. In a hiatal hernia, the upper part of the stomach pushes up into the chest through the gap. There are basically two kinds of hiatal hernia, and both are caused by a weakness in the diaphragm. One is called a sliding hiatal hernia, where the esophagus and the top part of the stomach slide upward into the chest cavity. The other is a paraesophageal hernia, where part of the stomach has pushed up into the chest cavity forming a separate pouch alongside the esophagus.

Hiatal hernias are relatively common and are more common in older people. They can be caused by any activity that forces the abdominal organs upward. This includes activities like weightlifting, straining to empty the bowels, or frequently coughing or vomiting extremely hard. Some people may have a congenital weakness of the diaphragm or a larger gap, but this is rare.

Most hiatal hernias are minor and have few if any symptoms. A large hiatal hernia, with more of the stomach pushing up into the chest cavity can cause more severe digestion problems and even start to push on the lungs.

A hiatal hernia can be one cause of gastroesophageal reflux disease (GERD), where acid from the stomach keeps rising up into the esophagus. GERD is a risk factor for esophageal cancer.

Pregnancy is also a leading cause of hiatal hernias because the expanding uterus pushes the other abdominal organs upward.

Most hiatal hernias are very minor and cause no symptoms. When symptoms do occur, they can usually  be controlled by lifestyle changes like not going to bed too soon after dinner, sitting up straight while eating, not lying down with a full stomach, or eating several small meals a day rather than one or two big ones. Some foods—anything very spicy or greasy or carbonated beverages—can make indigestion from a hiatal hernia worse. If indigestion is worse at night, sleep with your upper body elevated by using two or three pillows under your head and shoulders.

Mild indigestion from a hiatal hernia during pregnancy can be treated with over-the-counter antacids that contain calcium carbonate, such as Tums. If your indigestion is still making you uncomfortable no matter what you do, talk to your doctor or midwife.

More serious symptoms from hiatal hernias include difficulty swallowing and a feeling that what you swallowed is having trouble getting all the way into the stomach, or shortness of breath right after you eat. You may also experience regurgitation of stomach contents into your esophagus or into your mouth. Backflow of stomach acid into your esophagus can cause severe acid indigestion and chest or abdominal pain.

The most serious, but very rare, complication of a hiatal hernia can occur if the portion of esophagus or stomach become twisted. This twisting can cut off the blood supply to those sections of esophagus or stomach that are affected. This is an emergency. If you experience sudden severe chest and abdominal pain and difficulty swallowing, call your doctor immediately and go to the emergency department.

If indigestion and other problems due to a hiatal hernia can’t be relieved, there are surgical procedures that can be done to correct it.  One type of surgery is done laparoscopically through a small incision. Another type is an open surgery that is done through a larger incision on the abdomen.

If surgery for a hiatal hernia is needed, it will usually be scheduled for after you give birth.

Valerie DeBenedette
Valerie DeBenedette is an experienced health and medical writer who lives about an hour north of New York City with a dog that is smaller than her cat. Her work has appeared in magazines, newspapers, newsletters, and on websites. She is a member of the National Association of Science Writers.

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