A hiatal hernia occurs when internal tissue or part of an organ pushes through a weakness in the wall of the diaphragm, a muscle that keeps the organs of a person’s abdomen in place.

People with hiatal hernia do not always have symptoms, but the condition can lead to frequent acid reflux, which is known as gastroesophageal reflux disease (GERD).

In this article, we explain the causes and symptoms of a hiatal hernia and the treatment options available.

A man driving a truck while holding his stomach due to a hiatal hernia.Share on Pinterest
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A hiatal hernia develops when tissue or an organ pushes through an opening in the diaphragm. The diaphragm is a dome-shaped muscle that keeps the organs of the abdomen in place, separating them from the heart and lungs in the chest cavity. It also moves up and down to support breathing.

Key structures and blood vessels run through the diaphragm. The largest of these structures is the esophagus, or food pipe, which connects the mouth to the stomach.

An opening in the diaphragm, which is known as the hiatus, usually surrounds the food pipe tightly. This prevents the tissues and contents of the stomach from moving upward. A hiatal hernia occurs when tissues or organs push through the diaphragm at this point.

Types of hiatal hernia

Doctors divide hiatal hernia cases into four categories based on the severity of the condition. The categories are:

  • Type I: Type I hiatal hernias, or sliding hernias, are the most common type, accounting for over 95% of all cases. They occur when the junction between the esophagus and the top of the stomach presses upward through the hiatus. Most people with type I hiatal hernias have no symptoms.
  • Type II: In type II hiatal hernia, part of the stomach migrates upward, into the space next to the esophagus.
  • Type III: Type III is a combination of types I and II. It involves both the junction between the esophagus and stomach, and part of the stomach itself, moving upward through the diaphragm.
  • Type IV: This type occurs when part of the stomach, as well as another organ, protrude upward into the chest. This could include the small intestine, colon, or spleen.

When more than 30% of the stomach is pushing up through the diaphragm, some doctors refer to this as a giant hiatal hernia.

Hiatal hernias can be congenital or acquired. This means some people have them from birth, while others develop them during their lives.

Scientists are still learning about what causes hiatal hernias. However, since they are most common in people over age 50, age is an important risk factor.

One theory is that the diaphragm may weaken over time, allowing tissue to push through it. Another possible risk factor is increased pressure inside the abdomen. A range of situations can cause this, including:

Other risk factors may include:

  • genetics
  • injury to the diaphragm
  • some surgeries involving the esophagus

Most people with hiatal hernias have sliding hernias, which usually do not cause symptoms. Estimates suggest that between 55–60% of those over age 50 have one, but that only 9% experience symptoms.

When people with hiatal hernias experience symptoms, these are usually the result of acid moving up from the stomach. This is known as acid reflux. Acid reflux may cause:

  • heartburn, which is a burning sensation in the chest
  • bloating
  • belching
  • a bad taste in the mouth

Symptoms may get worse in response to certain foods and beverages, or when a person is lying down or bending over, especially after eating. Frequent acid reflux is known as GERD.

Those with types II–IV may also develop symptoms of an obstruction in the esophagus. This may lead to:

  • dysphagia, or difficulty swallowing
  • regurgitation of food
  • nausea or vomiting
  • ulcers, which may bleed and lead to anemia

Because scientists do not fully understand why some people get hiatal hernias and others do not, it is not clear how people can reliably prevent it. Many of the risk factors, such as age, are not within a person’s control.

Obesity is a risk factor, so maintaining a moderate weight may reduce the risk. In addition, seeking help for conditions that cause persistent coughing or straining to have bowel movements may help.

But there is currently no scientific research proving that these can prevent hiatal hernias from occurring.

Sliding hiatal hernias do not always require treatment. For people who have symptoms, the options include:

Diet or lifestyle changes

People with a hiatal hernia may find that making changes to their diet and habits can help reduce heartburn symptoms. It may help people to:

  • eat smaller, more frequent meals
  • sit upright while eating and avoid lying down after meals
  • avoid alcohol or caffeine
  • avoid trigger foods
  • stop smoking, if relevant
  • maintain a moderate weight


Treatments to relieve occasional acid reflux symptoms are available over the counter. These include antacids, which come in the form of liquids or chewy tablets and reduce the acidity of the stomach contents.

Alginate products might also help. These make a foamy gel at the top of the stomach, providing a barrier to its acidic contents.

For more persistent acid reflux, doctors might prescribe other medications, such as proton pump inhibitors or H2 blockers. However, it is worth noting that the prolonged use of medications that reduce acidity in the stomach has some risks.

People need to weigh the benefits and risks of taking these medications with their doctor.


In rare cases, a person with a hiatal hernia may require surgery. This is an option for those with severe and long-term acid reflux that does not respond to lifestyle changes or medication.

Surgery is also necessary for people with types II–IV, particularly if they have symptoms. Some doctors may also recommend surgery even if a person with any of these types does not have symptoms, but there is currently no consensus on the best approach.

Surgery for hiatal hernias is laparoscopic, meaning a surgeon performs them through small keyhole cuts. This is less invasive than surgery that requires a large incision.

A laparoscopic Nissen fundoplication is one of the procedures for treating sliding hiatal hernias. The operation aims to pull the stomach back into place while tightening the diaphragm around the food pipe to prevent further bulging.

Learn more about hiatal hernia surgery.

A hiatal hernia occurs when tissues or organs push through an opening in the diaphragm known as the hiatus. It usually does not cause symptoms, but some people may experience acid reflux and heartburn. Older age contributes to the risk of a hiatal hernia, but the exact causes are unclear.

Adjusting the diet, eating smaller meals, and occasionally taking antacids can help people reduce the discomfort of acid reflux. In severe cases, surgery can help resolve a hiatal hernia.