Specialist in General Surgery
Condition
Upper stomach protrudes through an opening (hiatus) in the diaphragm.
Can cause heartburn, nausea, chest pain, and reflux symptoms.
More common in adults over 50.
May lead to GERD or other complications.
Severe cases can block blood flow, which may be life-threatening.
Treatment: Laparoscopic Nissen Fundoplication surgery.
Recovery: 2–3 days in hospital; avoid strenuous activity for up to 4 weeks.
A hiatal hernia refers to a condition where the upper part of the stomach and oesophagus protrude past the opening (also known as hiatus) in the diaphragm into the chest cavity. This results in the stomach bulging through the diaphragm, which may lead to reflux symptoms, lung complications, and pain.
This condition is observed to occur more frequently in patients over the age of 50.
Hiatal hernias may develop due to a weakening of the diaphragm or increased pressure on the abdomen. Factors that contribute include:
Straining during bowel movements or heavy lifting
Persistent coughing or vomiting
Ageing and weakened muscle tissue
Obesity or smoking
There are two types of Hiatal hernias:
Sliding Hiatal Hernias are the most common type of Hiatal hernias. The condition occurs when the bottom of the oesophagus, also known as the gullet, and the top of the stomach protrude through the hole (hiatus) in the diaphragm. The diaphragm is a muscle that separates the lungs from the abdomen. This results in the hernia sliding into and out of the chest through the hiatus.
Fixed Hiatal Hernia, also known as a paraesophageal hernia, is a different type of hiatal hernia that is less common.
A portion of the stomach pushes past the diaphragm in a fixed hernia and remains fixed in the location, resulting in a bulge. In such cases, the fixed hiatal hernia may obstruct the blood flow to the stomach, causing a possible risk or medical emergency.
Patients with hiatal hernia may not immediately present any symptoms. For those that do, common symptoms may include:
Heartburn or burning sensation in the chest
Chest pain or pressure
Nausea or regurgitation
Difficulty swallowing (dysphagia)
Vomiting or blood in stools (in severe cases)
An obstructed hernia may lead to a blockage in the blood flow to the stomach, which can be a serious issue. You are advised to seek medical attention if you experience long periods of vomiting, pain or observe blood in your stools or black stools.
Hiatal hernias can worsen GERD symptoms, making early diagnosis important.
Patients with a hiatal hernia can experience GERD. Gastroesophageal Reflux Disease (GERD) occurs when the stomach acid contents are regurgitated to the oesophagus, leading to symptoms such as heartburn.
However, it is possible to have developed a hiatal hernia without GERD or GERD without a hiatal hernia.
If you suspect that you may have a hiatal hernia, you are advised to seek medical advice for a proper diagnosis of your condition.
Diet plays a key role in managing hiatal hernia symptoms like heartburn and acid reflux. Making small changes can help reduce discomfort and prevent flare-ups.
Consider avoiding or limiting:
High-fat foods: Greasy, fried, or heavy meals.
Acidic foods and drinks: Citrus, tomato sauce, vinegar, and carbonated drinks.
Spicy foods: Can irritate the oesophagus.
Sugary foods: Soft drinks, sweets, pastries, and desserts.
Alcohol, coffee, and tea: May increase stomach acid.
Smoking: Weakens the lower oesophageal sphincter.
Overeating or late meals: Eat smaller portions and avoid lying down immediately after eating.
Hiatal hernias are usually diagnosed through a gastroscopy. In this procedure, our doctor will insert an endoscope, a long flexible tube fixed with an imaging device to view the walls of your stomach and oesophagus.
This investigation allows our doctor to identify signs of abnormalities in your oesophageal walls and stomach lining and detect possible conditions, and take samples for investigation if necessary.
Our doctor will also be able to see if your stomach is pulled up above your diaphragm, leading to a hiatus.
Hiatal hernias do not resolve without treatment. Lifestyle changes and medications can manage symptoms, but surgery is recommended if symptoms persist or worsen.
Mild symptoms may be managed with:
Antacids, H2-receptor blockers, or proton pump inhibitors (PPIs)
Lifestyle modifications, such as dietary adjustments and weight management
For severe or persistent hiatal hernias, laparoscopic Nissen fundoplication is the preferred treatment. This minimally invasive surgery:
Wraps the upper stomach around the lower oesophagus
Strengthens the lower oesophageal sphincter (LES) to prevent reflux
Has a high long-term success rate and quicker recovery compared with open surgery
This procedure serves to tighten and reinforce the lower oesophageal sphincter (LES) and has a high success rate in helping patients recover and prevent recurrence in the long run.
After surgery, mild discomfort around the incision or shoulder is common. Most patients:
Stay 2–3 days in hospital for monitoring
Avoid strenuous activity or lifting heavy objects for 4–6 weeks
Eat soft foods initially and chew slowly
Follow surgeon instructions carefully to prevent complications
Open surgery typically requires a longer recovery period.
Surgeon fees range from $9,300 – $14,700 (SF701S/5C) , excluding hospital and consumable fees. Final costs depend on hospital choice, complexity of surgery, and insurance coverage. For more details, see our Nissen Fundoplication costing page.
What are the warning signs of hiatal hernia?
While heartburn and nausea are some symptoms of hiatal hernia, more severe signs that may need immediate medical attention are shortness of breath, vomiting of blood and passing of black stools.
Why Do I Feel Moderate Pain That Intensifies Throughout The Day?
Hernias can cause pain for a variety of reasons. A hernia occurs when an organ or tissue protrudes through a weak spot or hole in the muscle or surrounding tissue that holds it in place. The protrusion of the organ or tissue can put pressure on the surrounding tissue and cause discomfort or pain. The pain may be constant or intermittent and may be worse when you are physically active or when you are standing or sitting for long periods of time. Hernia pain may also be exacerbated by coughing, sneezing, or straining during bowel movements.
Does Exercise Aggravate Hiatal Hernia?
Exercise can be beneficial for those that suffer from a hernia but certain activities that put pressure on the abdomen such as weight lifting may cause more pain.
Will The Pain Eventually Subside If I Stop Strenuous Activities?
It is not uncommon for hernia pain to fluctuate or come and go. However, if the hernia is not treated, the pain is likely to persist and may even worsen over time. Hernias can become larger and more uncomfortable as the protrusion of the organ or tissue puts additional pressure on the surrounding tissue.
What Is The Difference Between GERD And A Hiatal Hernia?
GERD is a severe form of acid reflux where stomach acid flows backwards into the oesophagus. Long-lasting GERD can cause hiatal hernia as it weakens the muscles in the abdomen, resulting in the upper stomach bulging out (hiatal hernia).
Dr Ganesh at G & L Surgical Clinic strives to prioritise his patients’ recovery and comfort. Having had adequate experience in performing hernia removal surgeries for numerous patients for many years in Singapore.
Furthermore, the staff at G & L Surgical Clinic have been thoroughly and adequately trained to make your experience a comfortable and hassle-free one. Whether you intend to undergo our hernia treatments, procedures or other medical services in Singapore, you can rest assured that you will be properly and sufficiently cared for by trained professionals.
Organise a consultation with our surgeons for further assistance on hernia treatments in Singapore.
