Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
The esophagus connects the mouth and throat to the stomach. It passes through
the chest cavity and enters the abdominal cavity through a hole in the diaphragm
called the esophageal hiatus. The term hiatal hernia describes a
condition where a part of the stomach that normally is located in the abdominal
cavity pushes or protrudes through the esophageal hiatus to rest within the
What causes a hiatal hernia?
Normally, the space where the esophagus passes through the diaphragm is sealed by the phrenoesophageal membrane, a thin
membrane of tissue connecting the esophagus with the diaphragm where the
esophagus passes through the diaphragm, so that the chest cavity and abdominal
cavity are separated from each other. Because the esophagus shortens and
lengthens with each swallow, essentially squeezing food into the stomach, this
membrane needs to be elastic to allow the esophagus to move up and down. Normal
physiology allows the gastroesophageal (GE) junction, where the esophagus and
stomach meet, to move back and forth from just below to just above the
diaphragm. However, at rest the GE junction should be located below the
diaphragm and in the abdominal cavity. It is important to remember that these
distances are very short.
Over time, the phrenoesophageal membrane may weaken, and a part of the
stomach may herniate through the membrane and remain above the diaphragm
Decreased abdominal muscle tone and
increased pressure within the abdominal cavity may lead to the development of a
hiatal hernia. Thus, peopole who are
women who are
pregnant are at an
increased risk for developing a hiatal hernia.
People who have
or those who have constipation and strain to have a bowel movement, increase the
intra-abdominal pressure when they strain, and this may weaken the
The membrane also may weaken and lose
its elasticity as a part of aging.
Ascites, an abnormal collection of
fluid in the abdominal cavity often seen in people with liver failure, also is
associated with the development of a hiatal hernia.
A Viewer Asks: I am wondering if exercise will help with a hiatal hernia?
Dr. Marks Answers: Exercise has no effect on hiatal hernias.
Exercise, however, can increase
acid reflux in people who are prone to acid reflux, presumably those individuals with weak lower esophageal sphincter muscles.