Patient Education1 min read

Hiatal Hernia

Overview

A hiatal hernia occurs when part of the stomach slides upward through the opening in the diaphragm (the hiatus) into the chest. It is common, especially with age, and many people have no symptoms. When symptoms occur, they are often related to acid reflux.

Symptoms

Heartburn and acid regurgitation

Chest or upper abdominal discomfort

Difficulty or discomfort when swallowing

Belching and bloating

Feeling full quickly after eating

Fatigue or pallor from slow blood loss in some cases

Common Causes

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Age-related weakening of the diaphragm muscle

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Increased pressure in the abdomen from obesity or pregnancy

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Chronic coughing, straining or heavy lifting

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Previous surgery or injury near the diaphragm

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Being born with a larger hiatus

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Family tendency

Self-Care Tips

Eat smaller meals and avoid lying down for 2 to 3 hours after eating

Raise the head of your bed rather than just adding pillows

Limit foods that trigger your reflux, such as fatty or spicy meals, and caffeine

Aim for a healthy weight if you are overweight

Avoid smoking and tight clothing around the waist

Follow your doctor's advice about reflux medicines and review

When to See a Doctor

Book a visit if you have frequent heartburn, trouble swallowing, regurgitation, or symptoms that do not improve with lifestyle changes. Seek emergency care immediately for severe chest pain (which can also be a heart problem), sudden severe abdominal pain, persistent vomiting, inability to swallow, vomiting blood, or black stools.

How doctors investigate it

Your doctor will start with your symptoms and examination. An upper endoscopy lets the doctor look directly at the esophagus and stomach, see the hernia, and check for inflammation or complications. A barium swallow X-ray can outline the hernia and its size, and esophageal pressure and acid tests may be used if surgery is being considered. Blood tests may check for anemia.

Treatment options

Small hernias without symptoms usually need no treatment. When reflux symptoms are present, lifestyle changes and acid-reducing medicines prescribed by your doctor are the first step. Surgical repair may be considered for large hernias, persistent symptoms despite treatment, or complications such as bleeding, narrowing or a hernia that becomes twisted or trapped. Your doctor will explain the benefits and risks that apply to you.

Frequently Asked Questions

Does every hiatal hernia need surgery?

No. Most hiatal hernias are small and cause no problems or can be controlled with lifestyle changes and medicines. Surgery is usually considered only for certain larger hernias or when symptoms or complications persist despite treatment.

Is a hiatal hernia the same as acid reflux?

No, but they are related. A hiatal hernia can weaken the barrier at the junction of the esophagus and stomach and make reflux more likely. You can have reflux without a hernia, and a hernia without reflux.

Can chest pain from a hiatal hernia be confused with a heart problem?

Yes. Reflux-related chest pain can feel similar to heart pain. If you have new, severe or exertional chest pain, shortness of breath, or pain spreading to the arm or jaw, seek emergency care right away rather than assuming it is the hernia.