A hiatal hernia occurs when part of the stomach moves upward through an opening in the diaphragm, the muscle that separates the chest from the abdomen. Many people have no symptoms, while others experience heartburn, acid reflux, chest discomfort, or difficulty swallowing. Treatment depends on the symptoms and type of hernia and may include lifestyle changes, medicines, or surgery when symptoms are persistent or complications develop.
What symptoms can a hiatal hernia cause?
Small hiatal hernias often cause no noticeable problems and may be discovered during tests for another reason. When symptoms occur, they are frequently related to stomach acid flowing back into the esophagus, the tube that carries food to the stomach. The hernia itself does not always cause symptoms, and similar complaints can occur with other digestive conditions.
Examples of symptoms that may occur include:
- Heartburn: A burning feeling in the chest, often after eating or when lying down.
- Acid reflux: Stomach contents or a sour, bitter fluid coming back into the throat or mouth.
- Chest discomfort: Pressure, burning, or discomfort behind the breastbone.
- Difficulty swallowing: A feeling that food moves slowly or becomes stuck while swallowing.
- Frequent belching or bloating: A feeling of fullness or excess gas after meals.
- Regurgitation: Food or liquid returning to the mouth without the force of vomiting.
- Upper abdominal discomfort: Discomfort or pain in the upper part of the abdomen, sometimes after eating.
According to Mayo Clinic, many hiatal hernias do not cause symptoms, while larger hernias may be associated with reflux and swallowing difficulties. The location and pattern of discomfort can help a healthcare professional decide whether further evaluation is needed.
When do hiatal hernia symptoms need urgent attention?
Chest pain should not automatically be attributed to a hiatal hernia or acid reflux. Seek emergency medical care for new, severe, or unexplained chest pain, particularly if it occurs with shortness of breath, sweating, faintness, or pain spreading to the arm, back, neck, or jaw.
Urgent assessment is also important for sudden, intense chest or upper abdominal pain, repeated vomiting, vomiting blood, black or tarry stools, or an inability to swallow liquids. These symptoms can indicate a serious problem that needs prompt evaluation. Difficulty swallowing that is getting worse, unexplained weight loss, or ongoing vomiting should also be assessed by a healthcare professional without unnecessary delay.
What causes a hiatal hernia?
The diaphragm has a natural opening through which the esophagus passes before joining the stomach. A hiatal hernia develops when part of the stomach pushes through this opening into the chest. The opening or surrounding tissues may become less supportive, allowing the stomach to move upward.
Several factors may contribute to the development of a hiatal hernia or increase the likelihood of one:
- Age-related changes: Hiatal hernias become more common as people get older.
- Increased pressure in the abdomen: Pregnancy, obesity, persistent coughing, repeated straining, or heavy lifting may contribute to pressure on the abdominal area.
- Injury or previous surgery: Damage or changes affecting the diaphragm or nearby tissues may play a role in some cases.
- Individual anatomy: Some people may have a naturally wider opening or weaker supporting tissues.
Having one or more of these factors does not mean a person will develop a hiatal hernia. In many cases, there is no single identifiable cause.
What are the different types of hiatal hernia?
Hiatal hernias are generally grouped according to how the stomach moves through the diaphragm. The type matters because it can affect symptoms, potential complications, and treatment decisions.
Sliding hiatal hernia
A sliding hiatal hernia is the most common type. The junction between the esophagus and stomach, along with part of the stomach, moves upward through the diaphragm. Its position can change with body movement or pressure. This type is often associated with acid reflux, although some people have no symptoms.
Paraesophageal hiatal hernia
In a paraesophageal hernia, part of the stomach moves into the chest beside the esophagus while the junction between the esophagus and stomach may remain in its usual position. Some hernias of this type cause no symptoms, but larger ones can sometimes lead to swallowing problems, discomfort after meals, or complications if the stomach becomes trapped or its blood supply is affected.
According to Cleveland Clinic, treatment decisions depend on the type of hernia, its size, the symptoms it causes, and whether complications are present. A healthcare professional can explain how these factors apply to an individual case.
How is a hiatal hernia diagnosed?
A healthcare professional may ask about heartburn, regurgitation, swallowing difficulties, chest or abdominal discomfort, and when these symptoms occur. Medical history and a physical examination can help guide the next steps, although a hiatal hernia cannot always be confirmed through symptoms or examination alone.
Depending on the situation, tests may include:
- Upper gastrointestinal endoscopy: A thin, flexible tube with a camera is passed through the mouth to examine the esophagus and stomach. It can help identify inflammation, ulcers, or other changes.
- Barium swallow or upper gastrointestinal imaging: The person swallows a contrast liquid, allowing the esophagus and stomach to be seen on X-rays.
- Esophageal function testing: In selected cases, tests such as esophageal manometry measure how well the muscles and movement of the esophagus work.
Not everyone needs every test. The choice depends on the symptoms, the suspected type of hernia, and whether a clinician needs to investigate complications or other possible causes of the symptoms.
How is a hiatal hernia treated?
Many hiatal hernias do not require surgery or any specific treatment if they cause no symptoms. When reflux or discomfort occurs, treatment usually focuses on controlling those symptoms. Surgery may be considered for selected people with persistent problems, certain types of hernia, or complications. Treatment does not follow a single plan for everyone.
1. Lifestyle changes that may help
Changes to eating and daily habits may reduce reflux symptoms, especially when symptoms occur after meals or while lying down. They do not necessarily make the hernia disappear, but they may help reduce discomfort.
- Eat smaller meals: Large meals can make reflux symptoms more noticeable for some people.
- Avoid lying down soon after eating: Allow about three hours between a meal and bedtime if nighttime reflux is a problem.
- Raise the head of the bed: Elevating the upper body with a suitable bed wedge or raised bed head may help with symptoms during sleep.
- Identify personal food triggers: Fatty foods, chocolate, caffeine, spicy foods, acidic foods, or alcohol may worsen symptoms in some people. Avoid restricting foods unnecessarily; focus on items that consistently trigger symptoms.
- Consider weight management if appropriate: For people who are overweight, gradual weight loss may help reduce reflux symptoms.
- Avoid smoking: Smoking can contribute to reflux-related problems, so stopping may be beneficial.
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) recommends measures such as avoiding meals close to bedtime, raising the head of the bed for nighttime symptoms, and losing weight when appropriate to help manage gastroesophageal reflux. The most useful changes depend on a person's symptoms and daily routine.
2. Medicines for heartburn and acid reflux
Medicines can reduce acid-related symptoms, but they do not usually move the stomach back into its normal position or repair the opening in the diaphragm. A clinician or pharmacist can help select an option based on symptom frequency, other health conditions, and medicines already being taken.
- Antacids: These neutralize stomach acid and may provide short-term relief from occasional heartburn. They are not intended to manage every form of persistent reflux.
- H2-receptor blockers: These medicines reduce the amount of acid the stomach produces and may help with heartburn.
- Proton pump inhibitors (PPIs): These reduce stomach acid more strongly and are commonly used when reflux symptoms are frequent or when acid-related irritation needs treatment.
The appropriate medicine and duration depend on the clinical situation. Persistent symptoms despite treatment, symptoms that return when medicine is stopped, or a need to use nonprescription treatments regularly should prompt a review with a healthcare professional rather than repeated self-treatment.
3. When is surgery needed for a hiatal hernia?
Surgery is not necessary for every hiatal hernia. It may be recommended when symptoms remain troublesome despite appropriate treatment, when the hernia is associated with significant complications, or when the anatomy creates a concern that warrants repair. The decision considers the type and size of the hernia, the person's overall health, and the likely benefits and risks of an operation.
According to MedlinePlus, surgery may be used to repair a hiatal hernia when needed, including in situations where reflux symptoms are not adequately controlled or complications arise. The treating team can explain whether surgery is appropriate and what alternatives are available.
What happens during hiatal hernia surgery?
Many repairs are performed using minimally invasive surgery, in which instruments and a camera are inserted through small cuts in the abdomen. The surgeon moves the stomach into its intended position and repairs the opening in the diaphragm. In some cases, an additional procedure called fundoplication is performed, in which the upper part of the stomach is wrapped around the lower esophagus to help reduce reflux.
The exact operation depends on the type of hernia and the reason for surgery. Recovery time, dietary instructions, and follow-up care vary. Possible risks include bleeding, infection, difficulty swallowing, gas-related symptoms, and recurrence of the hernia or reflux. The surgical team should explain the expected benefits and possible complications before the procedure.
Can a hiatal hernia go away on its own?
A hiatal hernia generally does not disappear simply because heartburn improves. Lifestyle changes and medicines can help control symptoms, but they do not usually repair the hernia itself. Some people can manage their symptoms without surgery for years, while others need further assessment or an operation because of persistent symptoms or complications.
Whether treatment is needed depends on the hernia's type, symptoms, and clinical findings. If symptoms change, become more disruptive, or do not respond to the current plan, a healthcare professional can reassess the situation and discuss whether additional testing or a different treatment approach is appropriate.
Living comfortably with a hiatal hernia
For people managing reflux symptoms, keeping track of when symptoms occur may help identify useful adjustments. For example, noting whether symptoms follow large meals, certain foods, or lying down soon after eating can support a more focused discussion with a clinician. There is no need to follow a highly restrictive diet if particular foods do not cause problems.
Follow the treatment plan recommended by your healthcare professional, and review medicines if symptoms continue or side effects occur. New swallowing difficulties, repeated vomiting, unexplained weight loss, or signs of bleeding deserve medical assessment. Emergency symptoms, including concerning chest pain or sudden severe upper abdominal pain, should not be managed at home as though they are routine reflux.