A hiatal hernia occurs when the upper part of your stomach pushes up through your diaphragm and into your chest region. This can cause symptoms like heartburn, acid reflux, and chest pain.

The diaphragm is a large muscle that lies between your abdomen and chest. You use this muscle to help you breathe.

Normally, your stomach is below the diaphragm. However, in people with a hiatal hernia, a portion of the stomach pushes up through the muscle. The opening it moves through is called a hiatus.

While surgery is sometimes needed, you can also manage the condition with medication and dietary changes.

Read on to learn more about hiatal hernias.

There are generally four types of hiatal hernia.

  • Type I: Called a sliding hernia, this is the more common type. It occurs when your stomach and esophagus slide into and out of your chest through the hiatus.
  • Type II: This less common form is called a paraesophageal hernia. It happens when part of your stomach pushes through your diaphragm and stays there.
  • Type III: This form is a combination of sliding and paraesophageal hernias.
  • Type IV: This happens when the stomach and another organ like the colon or spleen push into the chest.

It’s rare for even fixed hiatal hernias to cause symptoms. If you do experience any symptoms, they’re usually caused by stomach acid, bile, or air entering your esophagus.

Common symptoms include:

Surgical treatment is sometimes required to repair larger hiatal hernias and treat heartburn symptoms. If your reflux symptoms can’t be managed with medication, your doctor may recommend surgery. They might also suggest it if you have a type of hernia called a giant esophageal hernia (intrathoracic stomach).

Types of surgery

While hiatal hernias can often be treated with lifestyle changes or medication, some people may need surgery to repair them. This involves tightening your diaphragm and pulling the stomach down from the chest cavity back into the abdomen.

A surgeon will recommend surgery based on your symptoms and whether or not medical treatment hasn’t helped.

Common surgical options include:

  • Hiatus hernia surgery: A surgeon will repair the diaphragm opening and pull the hernia back into your abdomen. Then, they’ll repair the hiatus to make it more narrow.
  • Nissen fundoplication: This procedure involves using stitches to wrap the upper part of the stomach, called the fundus, around the bottom portion of the esophagus in order to hold the stomach in place. The stitches create pressure at the end of your esophagus, preventing stomach acid and food from flowing up from the stomach.
  • Collis-Nissen gastroplasty: This surgery is used to lengthen the esophagus in patients with more complex hernias. A surgeon will use tissue from the upper part of your stomach to extend your esophagus.

What to expect

Surgery to repair a hiatal hernia typically takes a few hours and is done while you’re under general anesthesia. Your surgeon may choose one of the following techniques:

  • Open repair: In an open repair surgery, your surgeon will make a large surgical cut in your belly in order to perform surgery.
  • Laparoscopic repair: In laparoscopic surgery, your surgeon will make several small cuts in your belly and insert a thin tube with a small camera through one of the cuts. Surgical tools will be inserted through the other cuts, and the surgeon will use a monitor hooked up to the camera in order to view the inside of your stomach.

Recovery

You can expect to stay in the hospital for a day or two after surgery. Some surgeries may require you to follow a soft or liquid diet and avoid carbonated beverages for a couple of weeks after surgery. After surgery, you might lose your appetite and experience diarrhea.

There are generally no significant restrictions after hiatal hernia repair surgery, which means it’s ok to walk, climb stairs, have sexual intercourse, or exercise as long as it doesn’t hurt. It’s generally advised to avoid lifting heavy objects for at least a couple of weeks.

Your surgeon or doctor will provide more specific guidelines and instructions for your recovery.

Most cases of hiatal hernia don’t require treatment. If you have acid reflux and heartburn, you may be treated with medications or, if those don’t work, surgery.

Medications

Your doctor may recommend over-the-counter (OTC) or prescription medications such as:

Diet

Hiatal hernia causes acid reflux symptoms. Changing your diet can reduce your symptoms.

It may help to eat smaller meals several times a day instead of three large meals. You should also avoid eating meals or snacks within a few hours of going to bed.

There are also certain foods that may increase your risk of heartburn. Consider avoiding:

  • spicy foods
  • chocolate
  • foods made with tomatoes
  • caffeine
  • onions
  • citrus fruits
  • alcohol

Other ways to reduce your symptoms include:

  • stopping smoking
  • raising the head of your bed by at least 6 inches
  • avoiding bending over or lying down after eating

The exact cause of many hiatal hernias is not known. In some people, injury or other damage may weaken muscle tissue. This makes it possible for your stomach to push through your diaphragm.

Another cause is putting too much pressure (repeatedly) on the muscles around your stomach. This can happen when:

  • coughing
  • vomiting
  • straining during bowel movements
  • lifting heavy objects

Some people are also born with an abnormally large hiatus which makes it easier for the stomach to move through it. Factors that can increase your risk of a hiatal hernia include:

You may not be able to avoid a hiatal hernia entirely, but you can avoid making a hernia worse by:

  • maintaining a moderate weight
  • not straining during bowel movements
  • getting help when lifting heavy objects
  • avoiding tight belts and certain abdominal exercises

Several tests can diagnose a hiatal hernia.

Barium swallow

Your doctor may have you drink a liquid with barium in it before taking an X-ray. This X-ray provides a clear image of your upper digestive tract, allowing your doctor to see the location of your stomach. If it’s protruding through your diaphragm, you have a hiatal hernia.

Endoscopy

Your doctor may perform an endoscopy. They’ll slide a thin tube in your throat and pass it down to your esophagus and stomach so that they can see stomach is pushing through your diaphragm. Any strangulation or obstruction will also be visible.

Doctors don’t know exactly what causes hiatal hernias or how to prevent them from happening.

However, certain factors like living with obesity and smoking may increase your risk of a hiatial hernia, so maintaining a moderate weight and quitting smoking may help decrease your risk of developing one.

An obstruction or a strangulated hernia may block blood flow to your stomach. This is considered a medical emergency. Call your doctor right away if:

Don’t assume that a hiatal hernia is causing your chest pain or discomfort. It could also be a sign of heart problems or peptic ulcers. It’s important to see your doctor. Only testing can find out what’s causing your symptom

Gastroesophageal reflux disease (GERD) occurs when the food, liquids, and acid in your stomach end up in your esophagus. This can lead to heartburn or nausea after meals.

It’s common for people with a hiatal hernia to have GERD. However, that doesn’t mean either condition always causes the other. You can have a hiatal hernia without GERD or GERD without a hernia.

A hiatal hernia occurs when the upper part of your stomach pushes through your diaphragm and into your chest region. While you may have no symptoms, you might experience heartburn, acid reflux, and chest pain.

Many people with hiatal hernias have no symptoms and do not need medical care. But for people with more severe hernias, treatment with medication, lifestyle changes, and, in some cases, surgery may be needed to repair the hernia and provide relief from uncomfortable symptoms like heartburn and chest pain.