Hiatal Hernia: Symptoms, Causes, and Treatment Options
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: September 2026
TL;DR: A hiatal hernia occurs when the upper stomach bulges through the diaphragm — the muscle separating the abdomen and chest — into the chest cavity. Small hernias usually cause no symptoms, but large ones can let food and acid back up, causing heartburn. Two risk factors stand out: age 50 or older and obesity. Most people never need treatment; those with symptoms start with lifestyle changes and acid-blocking medicines, and surgery is reserved for cases that do not respond or develop complications.
Quick Answer
A hiatal hernia happens when the upper stomach pushes up through the hiatus — a small opening in the diaphragm — into the chest.
Small hiatal hernias usually cause no symptoms and are often found by accident during tests for other problems.
Larger hiatal hernias can cause heartburn, regurgitation, acid reflux, trouble swallowing, chest or abdominal pain, feeling full quickly, and shortness of breath.
The two main risk factors are being age 50 or older and being obese.
Diagnosis typically involves an X-ray with a chalky liquid, an endoscopy (thin camera tube), or esophageal manometry.
Treatment ranges from lifestyle changes and medicines (antacids, H-2 blockers, PPIs) to surgery that pulls the stomach back down and tightens the diaphragm opening.
Most people with a hiatal hernia never need treatment at all.
What Is a Hiatal Hernia?
A hiatal hernia (pronounced hy-AY-tul HUR-nee-uh) happens when the upper part of the stomach bulges through the large muscle that separates the abdomen and the chest. That muscle is the diaphragm.
The diaphragm has a small opening called a hiatus. The tube used for swallowing food — the esophagus — passes through the hiatus before connecting to the stomach. In a hiatal hernia, the stomach pushes up through that opening and into the chest.
Most of the time, a small hiatal hernia causes no problems. You may never know you have one unless a healthcare team discovers it while checking for something else. A large hiatal hernia, however, can allow food and acid to back up into the esophagus, which can cause heartburn.
The reassuring news: self-care measures or medicines can usually relieve these symptoms. Surgery is needed only when a hiatal hernia is very large or causes complications.
What Does a Hiatal Hernia Feel Like? (Symptoms)
Most small hiatal hernias cause no symptoms. When a hernia is large enough to let stomach contents back up, these are the symptoms to watch for:
Symptom | What it means in plain language |
Heartburn | A burning feeling in the chest, often after eating |
Regurgitation | Swallowed food or liquids flow backward into the mouth |
Acid reflux | Stomach acid backs up into the esophagus |
Trouble swallowing | Food feels stuck or moves slowly down |
Chest or abdominal pain | Pain in the center of the chest or upper belly |
Feeling full soon after eating | The stomach feels crowded by the hernia |
Shortness of breath | The hernia can press on the chest cavity |
Vomiting blood or passing black stools | Could signal bleeding in the digestive tract — seek prompt care |
Vomiting blood or passing black stools is the one symptom that stands apart from the rest. It can mean bleeding somewhere in the digestive tract, and it deserves prompt medical attention rather than self-care.
What Causes a Hiatal Hernia?
A hiatal hernia occurs when weakened muscle tissue allows the stomach to bulge up through the diaphragm. It is not always clear exactly why the tissue weakens. Four possible causes are recognized:
Possible cause | How it contributes |
Age-related changes in the diaphragm | The muscle weakens with age, loosening its grip around the hiatus |
Injury to the area | Trauma or certain types of surgery can damage the region |
Being born with a very large hiatus | A naturally wide opening gives the stomach more room to slide up |
Constant, intense pressure on surrounding muscles | Repeated pressure from coughing, vomiting, straining during bowel movements, exercising, or lifting heavy objects |
Risk Factors
Hiatal hernias are most common in two groups:
People who are age 50 or older
People who are obese
If you fall into either group and notice recurring heartburn, it is worth mentioning the possibility of a hiatal hernia to your healthcare provider.
When Should You See a Doctor?
Make an appointment with a doctor or other healthcare professional if you have any lasting symptoms that worry you. Occasional heartburn is common, but symptoms that persist, worsen, or interfere with daily life deserve a proper evaluation.
Seek prompt medical care if you vomit blood or pass black stools, as these can mean bleeding in the digestive tract.
How Is a Hiatal Hernia Diagnosed?
A hiatal hernia is often discovered during a test or procedure done to find the cause of heartburn or pain in the chest or upper abdomen. Three tests are used:
Diagnostic test | What happens | What it shows |
X-ray of the upper digestive system | You drink a chalky liquid that coats and fills the inside lining of the digestive tract | An outline of the esophagus, stomach, and upper intestine, revealing the stomach's position |
Endoscopy | A long, thin tube with a tiny camera (endoscope) is passed down the throat | The inside of the esophagus and stomach, including any inflammation |
Esophageal manometry | A test measures the rhythmic muscle contractions of the esophagus when you swallow | The coordination and force of the esophageal muscles |
If symptoms persist after lifestyle changes and medicine, you might be referred to a gastroenterologist — a doctor who specializes in digestive diseases.
What Are the Treatment Options?
Most people with a hiatal hernia do not experience any symptoms and will not need treatment. When symptoms such as frequent heartburn and acid reflux do appear, the options follow a stepwise path: lifestyle changes first, then medicines, then surgery if needed.
Medicines
Medicine type | How it works | Examples and notes |
Antacids | Neutralize stomach acid for quick relief | Overuse of some antacids can cause diarrhea or sometimes kidney problems |
H-2-receptor blockers | Reduce acid production | Cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR); stronger prescription versions available |
Proton pump inhibitors (PPIs) | Block acid production and allow the esophagus to heal | Stronger acid blockers than H-2-receptor blockers; OTC versions include lansoprazole (Prevacid 24HR) and omeprazole (Prilosec, Zegerid) |
Surgery
Sometimes a hiatal hernia requires surgery. Surgery may help people who are not helped by medicines, and it may also help people with complications such as serious inflammation or narrowing of the esophagus.
During surgery, the surgeon may pull the stomach down into the abdomen and make the opening in the diaphragm smaller. The operation may also involve reshaping the muscles of the lower esophagus, which helps keep stomach contents from coming back up. In some cases, hiatal hernia surgery is combined with weight-loss surgery, such as a sleeve gastrectomy.
Approach | How it works |
Thoracotomy | A single incision in the chest wall |
Laparoscopy | A tiny camera and special tools are inserted through several small incisions in the abdomen; the surgeon operates while viewing images from inside the body on a video monitor |
What Self-Care Steps Help at Home?
Lifestyle changes may help control the symptoms caused by a hiatal hernia. Try to:
Eat several smaller meals throughout the day rather than a few large meals.
Avoid foods that trigger heartburn, including fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine.
Don't lie down after a meal or eat late in the day.
Maintain a healthy weight.
Stop smoking.
Elevate the head of your bed 8 inches (20 centimeters).
Notice that several of these steps directly address the two main risk factors — weight and age-related strain — which makes lifestyle change a genuine part of the treatment plan, not just a comfort measure.
How to Prepare for Your Appointment
Because appointments can be brief, preparation helps you make the most of the visit. Before the appointment, be aware of any pre-appointment restrictions (such as diet limits), write down your symptoms including any that may seem unrelated, note major stresses or recent life changes, and list all medicines, vitamins, and supplements with doses. Bringing a family member or friend along can help you remember details discussed during the visit.
What's likely causing my symptoms, and what are other possible causes?
What tests do I need, and what's the best course of action?
What are the alternatives to the primary approach?
I have other health conditions — how can I manage them together?
Are there restrictions I need to follow, and should I see a specialist?
Conclusion
A hiatal hernia is one of the more manageable digestive conditions you are likely to hear about. Small hernias often never cause a single symptom, and even the larger ones usually respond well to everyday self-care and widely available acid-blocking medicines. Surgery exists for the minority of cases that medicines cannot help or that develop complications — and even then, minimally invasive laparoscopic techniques are an option.
The practical takeaway: if you are over 50, carrying extra weight, or experiencing recurring heartburn that does not respond to simple changes, bring it up with a healthcare professional. And if you ever vomit blood or pass black stools, seek prompt medical care.
Have lingering heartburn that won't quit? Book an appointment with your healthcare provider to find out whether a hiatal hernia is behind it.
Related Reading on Rinnit
GERD (Acid Reflux Disease): Symptoms, the 8 Lifestyle Triggers, and How to Get Relief — the reflux condition a large hiatal hernia can trigger
Gastritis: Symptoms, the 8 Risk Factors, and How to Calm an Inflamed Stomach Lining — another cause of upper-abdominal discomfort worth ruling out
H. pylori Infection: The Stomach Germ Half the World Carries, Its Warning Signs, and How Antibiotics Clear It — a common contributor to stomach and reflux symptoms
References
Frequently Asked Questions
Is a hiatal hernia the same thing as acid reflux?
No. A hiatal hernia is a physical condition — the stomach bulges up through the diaphragm into the chest. Acid reflux is a symptom (stomach acid flowing back into the esophagus). A large hiatal hernia can cause acid reflux, but many people have acid reflux without any hernia.
Do all hiatal hernias need treatment?
No. Most people with a hiatal hernia experience no symptoms and never need treatment. Treatment is only considered when symptoms like frequent heartburn or acid reflux develop.
What are the main risk factors for a hiatal hernia?
Hiatal hernias are most common in people age 50 or older and in people who are obese. Age-related changes in the diaphragm, prior injury or surgery, a naturally large hiatus, and repeated pressure from coughing or lifting can also contribute.
Can a hiatal hernia go away on its own?
The hernia itself does not reverse on its own, but symptoms can often be controlled completely with lifestyle changes and medicines. Surgery is available when other measures are not enough.
What foods should I avoid with a hiatal hernia?
Avoid foods that trigger heartburn: fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine. Eating several smaller meals and not lying down after eating also helps.
How is a hiatal hernia diagnosed?
Typically through an X-ray of the upper digestive system (after drinking a chalky liquid), an endoscopy using a thin camera tube, or esophageal manometry, which measures the muscle contractions of the esophagus.
Is hiatal hernia surgery common?
No — most people never need it. Surgery is considered for people not helped by medicines, or for those with complications such as serious inflammation or narrowing of the esophagus. It can be done through a single chest incision (thoracotomy) or through small abdominal incisions (laparoscopy).
When should I get emergency care for a hiatal hernia?
Seek prompt medical care if you vomit blood or pass black stools, because these can mean bleeding in the digestive tract.
Rinnit.com provides general health information for educational purposes. This content is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions about your health.
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