A hiatal hernia occurs when the upper part of the stomach pushes up into the chest cavity through a small opening in the diaphragm, the large muscle separating the abdomen and chest. This condition is common, especially in individuals over 50, and many people are unaware they have one because it often causes no symptoms. The short answer to whether you can feel a hiatal hernia with your fingers is generally no, due to its deep, protected internal location. The physical sensations associated with a hernia are typically internal discomfort from acid reflux, not an external lump that can be felt.
The Anatomy of a Hiatal Hernia
The diaphragm is a dome-shaped muscle that forms a barrier between the chest and abdominal cavities and plays a primary role in breathing. The esophagus, which carries food from the throat to the stomach, passes through an opening in this muscle called the esophageal hiatus. A hiatal hernia develops when the hiatus enlarges or weakens, allowing a portion of the stomach to slide or bulge upward into the chest cavity.
The vast majority of cases are sliding hiatal hernias, where the junction between the esophagus and stomach moves up and down through the opening. The stomach is located deep within the torso, positioned beneath the rib cage and layers of abdominal muscle. This anatomical positioning means the herniated portion of the stomach is not accessible for external touch.
Even when the hernia is large, the surrounding bony and muscular structures prevent it from creating a noticeable protrusion on the skin’s surface. Unlike an inguinal hernia, which can cause a visible bulge in the groin area, a hiatal hernia is contained within the body’s core. The depth and protection afforded by the lower ribs and the diaphragm muscle make manual detection virtually impossible.
Recognizable Symptoms, Not Physical Lumps
While the hernia itself cannot be felt externally, the condition often manifests through distinct internal sensations and digestive issues. The most common symptoms are directly related to the movement of the stomach and the subsequent disruption of the lower esophageal sphincter. This disruption allows stomach acid and contents to flow backward into the esophagus, a condition known as gastroesophageal reflux disease (GERD).
The backflow of stomach acid causes the painful burning feeling in the chest or throat known as heartburn, which is the most frequent complaint. Other common indicators include the regurgitation of food or sour-tasting fluids into the mouth, a persistent bad taste, and difficulty swallowing. Difficulty swallowing can feel like food is catching in the throat or chest.
The pain from a hiatal hernia is felt internally in the chest or upper abdomen, sometimes mimicking non-cardiac chest pain. This discomfort may be exacerbated by bending over, lifting, or lying down, as these actions increase abdominal pressure and encourage acid reflux. The internal nature of these symptoms, such as belching, chronic cough, and hoarseness, serves as the primary clue for the presence of a hiatal hernia.
How Doctors Confirm a Hiatal Hernia
Because a hiatal hernia is an internal condition, medical professionals rely on specific imaging and procedural tests for an accurate diagnosis. One common diagnostic tool is an X-ray of the upper digestive system, often performed using a barium swallow. The patient drinks a liquid containing barium, which temporarily coats the lining of the esophagus and stomach.
The barium allows the organs to appear clearly on the X-ray, letting the doctor visualize the position of the stomach relative to the diaphragm and confirm the hernia. Another procedure used is an upper endoscopy, or esophagogastroduodenoscopy (EGD). During an EGD, a thin, flexible tube equipped with a light and camera is passed down the throat into the esophagus and stomach.
This method allows for direct visualization of the gastroesophageal junction, enabling the doctor to see if the stomach has pushed through the hiatus and to check the esophageal lining for inflammation caused by acid reflux. In some cases, a pH monitoring test may be used to measure the amount of stomach acid entering the esophagus over a period of time.