Hiatus hernia living patient overview

Overview

A hiatus hernia is a condition where a part of your stomach pushes upward through the diaphragm — the large muscle that helps you breathe — into your chest. This can cause stomach acid to flow back into the tube that connects your mouth to your stomach (the esophagus), leading to heartburn and discomfort.

Yes, hiatus hernia is a common condition, especially as people get older. Many people have a small one without even knowing it.

It can affect anyone, but it is most common in adults over 50. It is also more common in people who are overweight, pregnant women, and those who have a chronic cough or strain frequently.

Symptoms

Common symptoms

• Heartburn (a burning feeling in the chest, often after eating or at night)
• Acid reflux (stomach acid coming up into your throat or mouth)
• Chest pain or discomfort
• Difficulty swallowing
• Feeling full quickly after eating

Symptoms in children

• Reflux symptoms like spitting up frequently, irritability during or after feeds, arching the back, or poor weight gain.

Symptoms in older adults

• Heartburn, regurgitation, chest pain, and sometimes a chronic cough or hoarseness. Older adults may also experience anemia from slow blood loss.

Causes

Main causes

• Weakening of the diaphragm muscle, often due to age
• Increased pressure in the abdomen from obesity, pregnancy, straining, heavy lifting, or chronic coughing

Risk factors

• Being over 50
• Being overweight or obese
• Pregnancy
• Chronic coughing or constipation
• Frequent heavy lifting or straining

When to see a doctor

See a doctor urgently if:

• If you have severe chest pain or difficulty breathing — call emergency services right away
• If you vomit blood or have black stools
• If you have trouble swallowing with pain

Book a routine appointment if:

• If you have frequent heartburn or acid reflux that bothers you
• If you feel a lump in your throat or food gets stuck
• If over-the-counter remedies do not help after a week or two

Diagnosis

A doctor will ask about your symptoms and medical history. They may do a physical exam and then order tests to look at your esophagus and stomach.

Tests that may be done

• Barium swallow X-ray (you drink a chalky liquid that shows up on X-rays)
• Endoscopy (a thin, flexible tube with a camera is passed down your throat to look inside)
• Esophageal manometry (measures muscle contractions in your esophagus)
• pH monitoring (measures how much acid comes up into your esophagus)

What to expect at your appointment

Most tests are done as an outpatient — you go home the same day. For an endoscopy, you will be given medicine to help you relax. The doctor will explain the results and talk with you about next steps.

Treatment

Treatment for a hiatus hernia focuses on managing symptoms and preventing complications. Most people start with lifestyle changes and, if needed, medications to reduce stomach acid. Surgery is only considered when symptoms are severe or do not improve with other treatments.

Self-care at home

• Eat smaller, more frequent meals instead of large ones
• Avoid lying down for at least 2 to 3 hours after eating
• Raise the head of your bed by 6 to 8 inches (using blocks or a wedge pillow)
• Avoid foods that trigger heartburn, such as spicy, fatty, or acidic foods, and caffeine
• Maintain a healthy weight
• Quit smoking and limit alcohol

Medical treatments

A doctor may recommend medications that reduce stomach acid, such as over-the-counter antacids, acid reducers, or prescription-strength acid blockers. These help control symptoms but do not fix the hernia itself. Always follow your doctor’s advice — do not take any medication without speaking to a healthcare professional first.

When is surgery considered?

Surgery may be an option if symptoms are severe, do not improve with lifestyle and medicines, or if there are complications like breathing problems, bleeding, or a strangulated hernia (where the stomach is trapped). The most common surgery is called fundoplication, where the top of the stomach is wrapped around the esophagus to tighten the valve. Talk to a surgeon about the risks and benefits.

Living with this condition

Living with a hiatus hernia often means making simple adjustments to your daily habits. Most people manage well with small changes and do not find it limits their activities.

Lifestyle tips

• Eat slowly and avoid rushing through meals
• Chew your food well
• Stay upright after eating — avoid bending or straining
• Wear loose-fitting clothes around your waist
• Manage stress, as it can make heartburn worse

Diet and exercise

A balanced diet is important. Avoid trigger foods (like citrus, tomatoes, onion, garlic, chocolate, mint, and spicy or fatty foods). Gentle exercise like walking is good, but avoid high-impact activities or heavy lifting that could increase abdominal pressure. If you want to start a new exercise routine, talk to your doctor first.

Mental health and emotional wellbeing

Dealing with ongoing symptoms like heartburn can be stressful and affect your quality of life. It is okay to feel frustrated or worried. Talk to your doctor or a mental health professional if you are feeling depressed or anxious. If you need immediate support, reach out to a crisis helpline in your area — you are not alone.

Prevention

It is not always possible to prevent a hiatus hernia, but maintaining a healthy weight, avoiding heavy lifting and straining, and not smoking can help reduce your risk.

Screening programmes

There is no routine screening for hiatus hernia. Talk to your doctor if you have reflux symptoms — they can help decide if you need any tests.

Complications

If left untreated

• Chronic acid reflux (GERD) that can damage the esophagus
• Esophagitis (inflammation of the esophagus)
• Esophageal ulcers or strictures (narrowing)
• Anemia from slow blood loss
• In rare cases, a strangulated hernia requiring emergency surgery

Long-term outlook

The outlook for most people with a hiatus hernia is very good. With simple lifestyle changes and medical care, symptoms can be well controlled. Most people continue to live full, active lives. If surgery is needed, it is often successful and provides long-term relief. Always work closely with your healthcare team to manage your condition.

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