Hiatal Hernia Symptoms, Causes, Treatment And Prevention

You have a hiatal hernia when a portion of your stomach pushes through the diaphragm. The esophagus passes through the chest and crosses over to the diaphragm before entering the abdomen through an opening known as the esophageal hiatus. In those suffering from a hiatal hernia, the hiatal openings are larger than in the average person.

These openings herniate the hiatus and to the chest, which may or may not cause more severe health problems. In fact many people have small hiatal hernias and have no clue unless it is found by accident when searching for another problem. Bigger hiatal hernias can present with many symptoms to alert you.

Take a look at the photo below so you understand where hiatal hernias occur so you know where to be alert for hiatal hernia symptoms

Hiatal Hernia

Hiatal Hernia

Hiatal Hernia Symptoms

When learning about the symptoms of hiatal hernias it is important to understand the two types of hiatal hernias. The small hiatal hernias, also known as sliding hernias, most often present with no symptoms. In those instances where the small hiatal hernia does present with symptoms, they are most often associated with gastroesophageal reflux disease (GERD). But it is important to note these symptoms because those suffering from GERD are more likely to have a hiatal hernia.

These symptoms include heartburn, nausea and vomiting.

The large hiatal hernia presents with many different symptoms. You may have a larger hiatal hernia if you have experienced any of the following symptoms:

  • Heartburn
  • Vomiting
  • Shortness of breath
  • Chest pain or pressure in the chest originating in the sternum (below your breastbone)
  • Fatigue
  • Belching & Hiccups
  • Coughing
  • Upper abdominal pain

If you experience ongoing symptoms associated with GERD you should see your physician to see if you have a small hiatal hernia. But if you experience one or more of the symptoms of a large hiatal hernia, be sure to see your physician right away. You may be suffering from a less problematic illness, but it is better to be safe rather than sorry.


There are several different causes of hiatal hernias. In the most general sense a hiatal hernia is caused by weak muscle tissue that allows your stomach to protrude through the diaphragm. It isn’t quite clear why this happens, however there are several different factors that can lead to the formation of a hiatal hernia.

Some factors that contribute to a hiatal hernia include an unusually loose esophageal attachment to the diaphragm and this lets the esophagus to herniate. The other medical cause is a shortening of the esophagus that pulls the stomach upward, often caused by reflux, inflammation or scarring.

Hiatal Hernia And a Healthy Esophagus And Diaphragm

This photo shows the difference between a hiatal hernia and a healthy esophagus and diaphragm

There are many other contributing factors that can increase your risk for hiatal hernias, many of which are simple lifestyle habits. The following factors may contribute or cause hiatal hernias;

  • Smoking
  • Poor posture
  • Obesity
  • Persistent heavy lifting or bending
  • Heredity and congenital defects
  • Frequent and persistent coughing
  • Straining due to constipation
  • Direct injury to the stomach and diaphragm area

When To Seek Medical Care

One of the reasons that illnesses such as a hiatal hernia worsen is that we ignore the symptoms or assume they are due to a less threatening health problem. If you experience symptoms of a hiatal hernia for more than several days or those symptoms worsen you should seek medical care. Furthermore, if those symptoms persist more than a few days and you are in a high risk category (smoking, obesity etc…) then you should seek medical care.

When to call the doctor

You should call your doctor for an appointment if you experience any of the symptoms above and there is no reason for them. You should also call the doctor of you have symptoms that last longer than they should, get worse over time or if you get more symptoms from the list.

When to go to the hospital

You should forget trying to make a doctor’s appointment and go to the hospital if your pain is increasing in severity and you have trouble breathing. These problems can become extremely dangerous very quickly and you will need immediate medical assistance.

If you experience symptoms like chest pain and you have heart disease or high risk factors for heart disease including high blood pressure, diabetes or history of heart attacks you should get someone to take you to the hospital right away. Do not dismiss these symptoms or put them off for another day.

Other symptoms that require immediate medical assistance include:

  • Vomiting up blood
  • Cough accompanied by fever
  • Inability to swallow with ease
  • Stools that are tarry and dark
  • Heart palpitations
  • Feeling faint
  • Chronic heartburn

These are quite serious symptoms so it is best to overreact than to risk more severe problems.


A hiatal hernia diagnosis is often discovered during a procedure to determine why a patient is experience chest pain and pressure or heartburn. Frequently the diagnosis is incidental as the physician attempts to rule out other illnesses such as heart disease. First your complete medical history will have to be examined to look for other signs of heart disease or hiatal hernia. Be sure to be completely honest during this history and tell your doctor everything, including what foods or events make your symptoms worse.

You may have to undergo a physical exam that includes checking your lungs, heart and rectum. This will allow the doctor to feel for inflammation as well as tenderness in affected areas. Most often however, a hiatal hernia diagnosis is made by a barium x-ray or endoscopy. The x-ray lets the doctor see a silhouette of your esophagus to check for swelling, while the endoscope has a camera that lets the doctor see for himself any signs of hiatal hernia on your stomach or esophagus.


Since most people with a hiatal hernia experience no symptoms, those people will unlikely need no treatment. However if you experience any known signs or symptoms of hiatal hernia you may be required to commit to lifestyle changes or undergo medical treatment for hiatal hernia. These treatments may treat your hernia or the symptoms associated with the hernia.

Self-Care at Home often includes making significant changes to your current lifestyle. This self-care at home can help you avoid symptoms and reduce your risk of getting a hiatal hernia. First you should reduce any activities that may cause pressure to the areas impacted by a hiatal hernia, which means you need to minimize heavy lifting, avoid straining and long periods of bending over. Other things you can do as part of a hiatal hernia treatment plan are:

  • Lose weight to relieve the pressure.
  • Exercise regularly for less straining and pressure, especially those associated with constipation.
  • Improve your posture and avoid slouching or hunching over.
  • Sleep with your head inclined about 4 to 6 inches
  • Try standing for a while after a meal and avoid prolonged sitting after you eat.
  • Avoid eating within 3 hours of your regular bedtime
  • Consume smaller meals more often instead of fewer large meals.
  • Avoid caffeine and alcohol
  • Take up a low fat diet

Medical Treatment for hiatal hernia often includes different medications for heartburn and acid reflux. Some of these are over-the-counter medicines but depending on the severity of your heartburn or reflux, you may need prescription strength drugs. In other instances patients may be given medicine to prohibit acid production to allow the esophagus to heal.

In instances where medication and at home care don’t work to treat a hiatal hernia, surgery may be warranted. However these cases are usually quite severe and only conducted in emergency situations. Hiatal hernia surgery may reconstruct your esophageal sphincter, decreasing the size of the opening of your diaphragm or to remove the hernia sac altogether.

Does Hiatal Hernia Get Bigger When You Eat?

While the hiatal hernia does not expand after meals, it is suggested that patients suffering from a hiatal hernia eat frequent small meals throughout the day to avoid putting unnecessary pressure on your stomach. Smaller meals will relieve that pressure, compared to large meals that cause greater pressure which usually translates into greater pain.

Can A Hiatal Hernia Cause Pain Under Breastbone?

Yes. One of the main symptoms of a hiatal hernia is chest pain under the breastbone, which is the sternum. If you experience this symptom there is a good chance that you have a hiatal hernia and should see your physician right away.

Can Hiatal Hernia Cause Burning Skin?

In general the burning skin sensation is caused by GERD, which is a precursor for many patients to hiatal hernia. Heartburn however, is a symptom of a hiatal hernia and it does cause a burning or warm sensation behind the breastbone.

Can Hiatal Hernia Cause Heart Palpitations?

Yes. If you experience heart palpitations you should go to the hospital, especially if you are at risk for heart disease or have already been diagnosed with heart disease. These palpitations could be signs of a more serious illness, but even if not this does require immediate medical assistance.


Your best bet for preventing a hiatal hernia diagnosis is to maintain a healthy lifestyle, which means a low fat diet that does not include fatty or deep fried foods. Regular exercise should also be part of prevention as weight loss can greatly reduce your risk for a hiatal hernia.

The other aspect of prevention you should focus on includes improving your posture to relieve any pressure put on your stomach, chest or esophagus. This also means avoid excessive straining (adding high fiber foods can help alleviate constipation) and bending. This kind of prolonged pressure can increase your risk of getting a hiatal hernia.


The prognosis for most patients suffering from a hiatal hernia is quite good. With treatment that includes lifestyle changes and medications to manage the symptoms, you can reduce the pain and discomfort associated with any symptoms of this illness. The prognosis depends on the size and severity of the hernia, but if you follow through with your treatment plan you should experience no further problems.

If you do not receive treatment for a hiatal hernia you put yourself at risk for many complications that may require hospitalization and surgery to correct. Be mindful of the symptoms as you experience them and implement lifestyle changes immediately to improve your prognosis.

Written By Miranda Stephens

Miranda Stephens, MD is certified by the American Board of Family Medicine. Dr. Stephens earned her undergraduate degree from the University of Colorado.She completed a residency in Family Medicine at the University of Michigan at Ann Arbor. In 2006 Dr. Stephens was chosen for Alpha Omega Alpha Honor Medical Society.


Leave a Reply