Hiatus Hernia Explained
At WeCovr, an FCA-authorised broker that has helped arrange over 800,000 policies, we believe in empowering you with clear information. This guide explains hiatus hernia and how private medical insurance can provide a swift route to treatment for UK residents, helping you regain control of your health and well-being.
Learn about hiatus hernia, symptoms, and treatment via private healthcare
A hiatus hernia is a common condition, yet it often goes undiagnosed or is misunderstood. It can cause persistent discomfort that significantly impacts your daily life, from what you eat to how you sleep. While the NHS provides excellent care, long waiting times for diagnosis and treatment can be a source of frustration.
This is where private medical insurance (PMI) comes in. It offers a parallel path, giving you faster access to specialists, diagnostic tests, and treatment, putting you on the road to recovery sooner. In this comprehensive guide, we'll break down everything you need to know about hiatus hernias and how private health cover can make all the difference.
What Exactly is a Hiatus Hernia?
Think of your body as having two main compartments: your chest (thorax) and your abdomen. These are separated by a large, dome-shaped muscle called the diaphragm. Your oesophagus (the tube that carries food from your mouth to your stomach) passes through a small opening in the diaphragm called the hiatus.
A hiatus hernia occurs when the upper part of your stomach bulges or pushes up through this opening into your chest.
It’s a bit like pushing a small balloon through a hole in a sheet of paper. The balloon is your stomach, and the paper is your diaphragm. This misplacement can interfere with the normal functioning of the valve at the bottom of the oesophagus, leading to a host of uncomfortable symptoms.
While the term "hernia" might sound alarming, most hiatus hernias are not life-threatening. However, they can cause chronic discomfort that requires management or treatment.
The Two Main Types of Hiatus Hernia
Hiatus hernias are generally classified into two types, with one being far more common than the other.
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Sliding Hiatus Hernia (Type 1): This is the most common type, accounting for over 95% of all cases. In a sliding hernia, the part of the stomach connected to the oesophagus, along with the stomach itself, slides up into the chest through the hiatus. It can slide back and forth, which is why symptoms can come and go.
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Para-oesophageal Hernia (Type 2): This type is less common but can be more serious. The top part of the stomach squeezes through the hiatus and sits next to the oesophagus. The junction between the oesophagus and stomach remains in its correct place. The main risk here is that the herniated part of the stomach can become "strangulated," meaning its blood supply is cut off. This is a medical emergency.
Understanding the type of hernia you have is crucial as it dictates the urgency and type of treatment required.
Common Symptoms of a Hiatus Hernia
Many small hiatus hernias cause no problems at all. You could have one for years and never know it. When symptoms do occur, they are most often related to gastro-oesophageal reflux disease (GORD), where stomach acid flows back up into the oesophagus.
Common signs and symptoms include:
- Heartburn: A burning sensation in your chest, often after eating, which can be worse when lying down or bending over.
- Acid Reflux: Regurgitating food or sour liquid back into your mouth.
- Belching (Burping): Frequent and sometimes uncomfortable belching.
- Difficulty Swallowing (Dysphagia): A feeling that food is stuck in your chest or throat.
- Chest or Abdominal Pain: Pain that can be mistaken for a heart attack. It's vital to seek immediate medical attention for any new, severe chest pain.
- Feeling Full Quickly: A sense of fullness after eating only a small amount of food.
- Bad Breath: Caused by the reflux of stomach contents.
- Shortness of Breath: A large hernia can press on the lungs, making breathing feel difficult.
- Vomiting Blood or Passing Black Stools: These are rare but serious symptoms that require urgent medical care, as they can indicate internal bleeding.
The severity of these symptoms doesn't always correlate with the size of the hernia. Some people with large hernias have few symptoms, while others with small ones experience significant discomfort.
What Causes a Hiatus Hernia?
The exact cause isn't always clear, but hiatus hernias typically result from a weakening of the diaphragm muscle. This allows the stomach to push through more easily. Several factors can increase the pressure in your abdomen and contribute to this weakening:
- Age: The condition is most common in people over 50. Muscle tissue can lose elasticity and weaken with age. The National Institute for Health and Care Excellence (NICE) notes that prevalence increases significantly with age.
- Obesity: Excess weight puts sustained pressure on the abdomen and diaphragm.
- Pregnancy: The growing uterus increases intra-abdominal pressure.
- Persistent, Heavy Coughing: Conditions like chronic bronchitis can strain the diaphragm.
- Straining During Bowel Movements: Chronic constipation is a known risk factor.
- Heavy Lifting or Straining: Jobs or hobbies that involve frequent heavy lifting can contribute.
- Genetics: Some people may be born with a larger hiatal opening than usual.
It’s often a combination of these factors over time that leads to the development of a hiatus hernia.
Diagnosing a Hiatus Hernia: The NHS vs. The Private Pathway
If you're experiencing persistent symptoms, the first step is to get an accurate diagnosis. The journey to diagnosis can vary significantly depending on whether you use the NHS or private healthcare.
The NHS Pathway
- GP Appointment: You'll start by visiting your GP to discuss your symptoms. They may prescribe initial medication like antacids or PPIs to see if your symptoms improve.
- Referral: If symptoms persist or are severe, your GP will refer you to a gastroenterologist or an upper gastrointestinal (GI) surgeon.
- Waiting List: This is often the longest part of the process. According to NHS England data, the median wait time for a referral to treatment can be several months. As of early 2025, waiting lists remain a significant challenge for the health service.
- Diagnostic Tests: Once you see a specialist, they will arrange for diagnostic tests.
- Follow-up and Treatment Plan: After the tests, you'll have another appointment to discuss the results and formulate a treatment plan, which could involve more waiting for surgery if required.
The Private Pathway with PMI
- GP Referral (Often Flexible): Most private medical insurance policies require a GP referral to ensure the specialist you see is appropriate. However, some modern plans offer direct access to specialist services.
- Fast-Track Specialist Appointment: You can typically book an appointment with a private consultant within days or a week. You get to choose the specialist and the hospital from your insurer's approved list.
- Rapid Diagnostics: Tests like endoscopies are usually performed very quickly, often within a week or two of the consultation. There are no long waiting lists.
- Prompt Treatment: If surgery is recommended, it can be scheduled at your convenience, often within a few weeks.
Here’s a simplified comparison:
| Stage of Journey | Typical NHS Timeline | Typical Private/PMI Timeline |
|---|---|---|
| GP to Specialist | 8 - 18 weeks | 1 - 2 weeks |
| Specialist to Diagnostics | 4 - 8 weeks | 1 - 2 weeks |
| Diagnosis to Surgery | 18 - 52+ weeks | 2 - 6 weeks |
| Total Time (Approx.) | 6 months to 1.5+ years | 4 - 10 weeks |
Note: Timelines are estimates and can vary based on location, urgency, and the specific NHS Trust or private provider.
Key Diagnostic Tests for a Hiatus Hernia
To confirm a diagnosis and rule out other conditions, a specialist will likely recommend one or more of the following tests:
- Upper GI Endoscopy (or Gastroscopy): This is the gold-standard test. A thin, flexible tube with a camera on the end (an endoscope) is passed down your throat to view your oesophagus, stomach, and the top part of your small intestine. It allows the doctor to see the hernia directly.
- Barium Swallow (or Barium Meal): You drink a chalky liquid containing barium, which coats the inside of your upper digestive tract. A series of X-rays are then taken. The barium highlights the organs, making the hernia visible on the X-ray images.
- Oesophageal Manometry: This test measures the rhythmic muscle contractions in your oesophagus when you swallow. It also measures the force and coordination of the muscles and the valve at the bottom of the oesophagus. It's often done before surgery to ensure the oesophagus is functioning properly.
With private health cover, these tests can be arranged swiftly, providing you with a clear diagnosis and peace of mind without the lengthy wait.
Treatment Options: From Lifestyle Tweaks to Surgery
Treatment for a hiatus hernia is tailored to the severity of your symptoms. For many, simple lifestyle changes and medication are enough to manage the condition effectively.
1. Lifestyle and Dietary Changes
This is the first line of defence and can make a huge difference.
- Eat Smaller, More Frequent Meals: Large meals expand your stomach and increase pressure, making reflux more likely.
- Avoid Trigger Foods: Common culprits include spicy foods, fatty or fried foods, citrus fruits, tomatoes, chocolate, mint, onions, garlic, and caffeine. Keep a food diary to identify your personal triggers.
- Maintain a Healthy Weight: Losing even a small amount of excess weight can significantly reduce pressure on your abdomen. For WeCovr members, our complimentary CalorieHero AI-powered app can be a fantastic tool to help track your nutrition and support your weight management goals.
- Don't Lie Down After Eating: Wait at least 3 hours after a meal before lying down or going to bed.
- Elevate the Head of Your Bed: Use blocks or a wedge pillow to raise the head of your bed by 6-8 inches. This uses gravity to help keep stomach acid down. Piling up pillows is less effective as it can bend your waist and increase pressure.
- Avoid Tight Clothing: Belts and waistbands that are too tight can squeeze your stomach and worsen reflux.
- Stop Smoking: Nicotine relaxes the valve at the bottom of the oesophagus, making reflux worse.
2. Medication
If lifestyle changes aren't enough, your doctor may recommend medication.
- Antacids: Over-the-counter liquids or tablets (e.g., Gaviscon, Rennie) that neutralise stomach acid for short-term relief.
- H2-Receptor Blockers: These reduce acid production. They are available over-the-counter (e.g., ranitidine, famotidine) or on prescription.
- Proton Pump Inhibitors (PPIs): These are the most powerful drugs for reducing acid production and are highly effective for healing an inflamed oesophagus. Examples include omeprazole, lansoprazole, and esomeprazole. They are typically prescribed by a doctor.
3. Surgical Treatment
Surgery is usually reserved for cases where:
- Medication and lifestyle changes fail to control severe reflux symptoms.
- There are complications, such as severe inflammation, bleeding, or narrowing of the oesophagus (a stricture).
- You have a large para-oesophageal hernia, which carries a risk of strangulation.
The most common surgical procedure is called laparoscopic Nissen fundoplication.
- What is it? It's a keyhole surgery. The surgeon makes several small incisions in the abdomen and uses special instruments to repair the hernia. They pull the stomach back down into the abdomen and wrap the top part of the stomach (the fundus) around the lower oesophagus.
- How does it work? This wrap tightens the valve between the oesophagus and stomach, preventing acid from refluxing. The surgeon also makes the opening in the diaphragm (the hiatus) smaller to prevent the stomach from bulging through again.
- Benefits of Laparoscopic Surgery: Compared to open surgery, keyhole surgery means less pain, smaller scars, a shorter hospital stay (usually 1-2 days), and a quicker recovery.
Accessing this surgery through the private sector via PMI means you can avoid the long NHS waiting lists and have the procedure done by a surgeon of your choice at a time that suits you.
How Private Medical Insurance Covers Hiatus Hernia
This is where understanding the fundamentals of private medical insurance UK policies is crucial. PMI is designed to cover the diagnosis and treatment of acute conditions that arise after your policy has started.
An acute condition is a disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. A newly symptomatic hiatus hernia that requires treatment would typically fall into this category.
The Critical Rule: Pre-existing and Chronic Conditions
Standard UK PMI policies do not cover pre-existing conditions. This is the single most important rule to understand.
- What is a pre-existing condition? It's any illness or symptom you have had, sought advice for, or received treatment for before your policy start date. If you've been to your GP with heartburn and acid reflux before taking out insurance, any subsequent diagnosis of a hiatus hernia will likely be excluded from your cover.
- What is a chronic condition? It's a condition that cannot be cured but can be managed, such as diabetes or asthma. While the initial diagnosis and treatment of a hiatus hernia are acute, the long-term management of mild, ongoing reflux could be considered chronic by some insurers and may not be covered indefinitely.
An expert PMI broker like WeCovr can help you understand the different types of underwriting (e.g., 'moratorium' vs. 'full medical underwriting') which determine how pre-existing conditions are handled.
How WeCovr Can Help You Find the Right Cover
Navigating the world of private health cover can be complex. As an independent broker, WeCovr works for you, not the insurance companies.
- Market Comparison: We compare policies from all the leading UK insurers to find a plan that fits your needs and budget.
- Expert Advice: We explain the jargon and the fine print, ensuring you understand exactly what is and isn't covered. Our advice comes at no extra cost to you.
- Tailored Policies: We help you choose the right level of cover, from outpatient limits to hospital lists, so you're not paying for benefits you don't need.
- Ongoing Support: We are here to help if you need to make a claim, and we can also help you find discounts on other policies, such as life insurance, when you purchase PMI with us. WeCovr's high customer satisfaction ratings reflect our commitment to our clients.
Living Well and Staying Active with a Hiatus Hernia
Managing a hiatus hernia is not just about medical treatment; it's about adopting a lifestyle that minimises symptoms and improves your quality of life.
| Area of Life | Do's | Don'ts |
|---|---|---|
| Diet | Eat small, regular meals. Chew food thoroughly. Stay hydrated with water. | Avoid large, heavy meals. Steer clear of your known trigger foods (spicy, fatty, acidic). Don't eat late at night. |
| Exercise | Focus on low-impact activities like walking, swimming, cycling, and light yoga. | Avoid exercises that strain the abdomen, such as heavy weightlifting, crunches, or sit-ups. |
| Sleep | Elevate the head of your bed. Sleep on your left side, which can help reduce acid reflux. | Don't sleep on a flat surface if you suffer from night-time reflux. Avoid eating for 3 hours before bed. |
| Travel | Pack your medications. Stick to your dietary routine as much as possible. Stay active with walking tours. | Don't overindulge in unfamiliar or rich foods and alcohol. Avoid long periods of sitting immediately after a big meal. |
By being mindful of these factors, you can often keep symptoms under control and live a full, active life.
Is a hiatus hernia considered a pre-existing condition for private health insurance?
Can I still get private medical insurance if I already have a hiatus hernia?
How much does private hiatus hernia surgery cost in the UK?
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Take the Next Step Towards Peace of Mind
Waiting for a diagnosis or treatment can be stressful and debilitating. Private medical insurance offers a path to faster, more flexible healthcare, putting you in control.
If you're ready to explore your options, the team at WeCovr is here to help. We provide friendly, expert advice to help you navigate the market and find the perfect policy.
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What is Private Medical Insurance?
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Private medical insurance works by paying for your private healthcare costs. When you need treatment, you can choose to go private and your insurance will cover the costs, subject to your policy terms and conditions. This can include:• Private consultations with specialists
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Choice of Consultant and Hospital
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Private medical insurance is particularly valuable for those who want to take control of their healthcare journey and ensure they receive the best possible treatment when they need it most.
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