Patient education: Hiatal hernia – Discharge instructions (The Basics)

What are discharge instructions? — Discharge instructions are information about how to take care of yourself after getting medical care for a health problem.

What is a hiatal hernia? — A hiatal hernia is when a part of the stomach moves up into the chest area. Normally, the stomach sits below the diaphragm. The diaphragm is the layer of muscle that separates the organs in the chest from the organs in the belly. The esophagus, the tube that carries food from the mouth to the stomach, passes through a hole in the diaphragm. In people with a hiatal hernia, the stomach pushes up through that hole, too.

There are 2 types of hiatal hernia (figure 1):

●Sliding hernia – This happens when the top of the stomach and the lower part of the esophagus squeeze up into the space above the diaphragm. This is the most common type of hiatal hernia.

●Paraesophageal hernia – This happens when the top of the stomach squeezes up into the space above the diaphragm. This is not very common, but it can be serious if the stomach folds up on itself. It can also cause bleeding from the stomach or trouble breathing. People with this type of hernia sometimes need surgery to fix it.

Sometimes, a hiatal hernia can cause acid reflux. This is when stomach acid backs up into the esophagus.

How do I care for myself at home? — Ask the doctor or nurse what you should do when you go home. Make sure that you understand exactly what you need to do to care for yourself. Ask questions if there is anything you do not understand.

If you have symptoms of acid reflux, like heartburn, you should also:

●Take all of your medicines as instructed.

●Raise the head of your bed by 6 to 8 inches – This might help if you have symptoms of acid reflux, like heartburn. You can put blocks of wood or rubber under 2 legs of the bed or a foam wedge under the mattress. You can buy blocks made for this. Just sleeping with your head raised on pillows is not enough.

●Avoid foods that make your symptoms worse – Write down what you had to eat or drink before you had reflux. This will help you learn which foods cause you problems. For some people, these include coffee, chocolate, citrus fruits and juices, tomato products, spicy foods, hot peppers, alcohol, peppermint, and fatty foods.

●Try to lose weight, if you have excess body weight. Your doctor or nurse can help you do this in a healthy way.

●Quit smoking, if you smoke. Your doctor or nurse can help.

●Avoid overeating. Eat smaller meals. Try not to drink too much liquid with meals.

●Avoid late meals – Lying down with a full stomach can make your symptoms worse. Try to plan meals for at least 2 to 3 hours before bedtime.

●Wait at least 2 to 3 hours after eating before lying down or bending over.

●Avoid tight clothing – Some people feel better if they wear comfortable clothing that does not squeeze the stomach area.

What follow-up care do I need? — Your doctor or nurse will tell you if you need to make a follow-up appointment. If so, make sure that you know when and where to go.

When should I call the doctor? — Call for advice if you:

●Have heartburn that is worse when bending over or lying down

●Have trouble swallowing, or feel like food gets "stuck" on the way down

●Lose weight without trying to

●Choke when you eat

●Vomit blood, or have bowel movements that are red, black, or look like tar

●Have reflux that is very bad, very frequent, or not helped by over-the-counter medicines

●Keep vomiting

More on this topic

Patient education: Hiatal hernia (The Basics)
Patient education: Acid reflux and GERD in adults (The Basics)

Patient education: Gastroesophageal reflux disease in adults (Beyond the Basics)