Could Your Acid Reflux Actually Be a Hernia?

Hernia is a general term for an organ or tissue pushing through an opening in the supporting tissue around it. But which organ and which area of the body? Hiatal hernias are the upper portion of the stomach pushing up through the diaphragm. This is one cause of gastric reflux. When the organ is the intestine and the area is somewhere in the abdomen or groin, this is a different hernia altogether.

We’ll start with hiatal hernias, and more broadly, reflux. We all have a ring shaped muscle called a sphincter at the bottom of the esophagus, where it connects to the stomach. This muscle relaxes when you swallow to let food into your stomach. Then it tightens immediately to keep food and stomach acid, in the stomach.

When this muscle fails to do its job, stomach acid backs up into your esophagus, causing heartburn.

Your stomach is designed to handle that much acid, but your esophagus is not. If reflux is not treated, it can lead to other health problems.

Too Much Pressure

Esophagitis happens when the acid damages the tissue of the esophagus, causing it to be inflamed. Left untreated, this can lead to scarring or even cancer. Breathing problems can happen when stomach acid gets all the way up to your windpipe.

What can cause this muscle to fail to do its job? Some medicines can cause the irritation of the lining of the esophagus. Alcohol use and smoking can also cause or worsen these conditions.

Quite often there is simply too much pressure pushing stomach contents upward. Your reflux and the resulting heartburn may be simply because you ate a week’s worth of food in an afternoon. Hello Thanksgiving dinner and the grazing that followed. Hello all-day pizza and nachos and wings during the football marathon.

Also quite possibly there is just too much you. Obesity greatly increases your likelihood of gastric reflux and related complications. This is also why pregnant women tend to have trouble with reflux – increased physical pressure in the abdomen.

Hiatal Hernias

Reflux also could be caused by a hiatal hernia. A hiatal hernia happens when the top portion of the stomach is pushed up through the normal hole in your diaphragm where the esophagus comes down.

This makes a tight band around a portion of the stomach instead of lining up with that band of muscle as it should. Acid can pool in this pouch, causing irritation.

Hernias happen when the muscles of your abdomen pull apart enough for a small bit of your intestines to poke through, causing a bulge under the skin.

If this happens near your belly button you have an umbilical hernia. If it is in your groin (inguinal area) you have an inguinal hernia. If it is in your abdominal wall in general, it is an abdominal hernia. And of course, if the weak spot is the result of an incision from a previous surgery, it would be an incisional hernia.

Often these hernias are no more than a painless swelling that presents no problems and needs no immediate medical attention.

For others, a hernia may cause discomfort and pain, with the pain getting worse when standing, straining, or lifting heavy items. In some cases, a hernia needs immediate surgery because the gut becomes trapped by the surrounding muscle.

Steven Baldridge, RN, is a staff educator at University Hospitals Samaritan Medical Center.

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University Hospitals' experienced team of specialists offers innovative diagnostics for all stages of GERD. Learn more about treatment for gastroesophageal reflux disease at UH.