A hiatal hernia occurs when a portion of the stomach pushes through the diaphragm into the chest cavity. This condition can lead to discomfort and various complications if not properly managed.
This comprehensive guide explores the causes, symptoms, dietary recommendations, lifestyle adjustments, and treatment options to help you effectively manage a hiatal hernia.
What Is a Hiatal Hernia?
The diaphragm is a large muscle that separates the chest and abdominal cavity and plays a crucial role in breathing. Its opening is called the hiatus, through which the esophagus passes to connect with the stomach.
A hiatal hernia occurs when part of the stomach protrudes through this opening into the chest area. There are two primary types of hiatal hernias:
- Sliding Hiatal Hernia: This is the more common type, where the stomach and the lower part of the esophagus slide into the chest through the hiatus.
- Paraesophageal Hiatal Hernia: Less common but more concerning, this type occurs when a portion of the stomach squeezes through the hiatus and sits beside the esophagus.
Causes and Risk Factors of Hiatal Hernia
Hiatal hernias don’t usually develop overnight. They are often the result of a combination of anatomical, lifestyle, and age-related factors that weaken the diaphragm over time.
Understanding these causes and risk factors is crucial. It not only aids in diagnosis but also empowers individuals to take preventive action where possible.
Let’s break down the most common causes and contributing risk factors in greater detail:
1. Age: A Natural but Critical Factor
One of the most well-documented risk factors for a hiatal hernia is age, particularly in individuals over 50. This is a critical factor to consider.
As we age, the muscles and connective tissues that support our internal organs weaken naturally. The diaphragm, a muscular wall between the chest and abdomen, is no exception.
With this weakening, the hiatus (the opening where the esophagus passes through the diaphragm) can become more extensive or flexible, allowing the esophagus to push through.
2. Obesity: Extra Weight, Extra Pressure
Obesity is a significant modifiable risk factor. Excess fat in the abdominal region puts direct pressure on the stomach, pushing it upward toward the chest, especially when a person bends over, lies down, or engages in heavy exertion.
Moreover, obesity can exacerbate conditions like acid reflux or GERD (Gastroesophageal Reflux Disease), which often occur hand-in-hand with hiatal hernias. This understanding can motivate individuals to maintain a healthy weight and reduce their risk of developing a hiatal hernia.
3. Injury or Surgery: Structural Disruption
Trauma—whether from an accident, blunt force, or surgical intervention—can weaken or disrupt the diaphragm’s structure. This weakening may make it easier for part of the stomach to push through the hiatus.
Examples include:
- Abdominal surgeries (especially around the esophagus or stomach)
- Severe abdominal injury from sports, accidents, or falls
- Post-operative complications or infections affecting the diaphragm muscles
While rare, these instances are essential, especially for patients undergoing previous abdominal procedures.
4. Congenital Factors: Born with a Predisposition
Some people are simply born with a larger-than-normal hiatus. This anatomical anomaly can make it easier for the stomach to push into the chest cavity, even without other contributing factors like obesity or trauma.
Children or young adults with congenital hiatal hernias may be asymptomatic for years, with the hernia only being discovered during unrelated imaging or endoscopic exams. In some rare cases, this condition is diagnosed in infancy.
5. Increased Abdominal Pressure: The Silent Culprit
Any activity that chronically increases intra-abdominal pressure can stretch and weaken the hiatus over time. These include:
- Heavy lifting: Especially without proper posture or core engagement
- Chronic coughing: Often seen in smokers, individuals with asthma, or untreated allergies
- Persistent vomiting: From gastrointestinal illnesses or eating disorders
- Constipation and straining: Regularly straining during bowel movements increases internal pressure
- Pregnancy: The growing uterus can press upward on the stomach, temporarily increasing the risk of herniation
This is the most underrated cause because many of these pressures are part of daily life. However, when these stressors become repetitive or chronic, they significantly raise the risk of a hiatal hernia developing.
Recognizing the Symptoms of a Hiatal Hernia
One of the most perplexing aspects of hiatal hernias is that many people may not experience symptoms, especially in the early stages or if the hernia is small. For others, the symptoms can be subtle, intermittent, or mistaken for common digestive issues like indigestion or acid reflux. This underscores the importance of recognizing the symptoms of a hiatal hernia.
In fact, the symptoms of a hiatal hernia often closely resemble those of gastroesophageal reflux disease (GERD), which occurs when stomach acid frequently flows back into the esophagus.
This overlap can make diagnosis challenging, so knowing the specific signs to watch for and how they affect your quality of life is essential.
Let’s dive into the most commonly reported symptoms and what they feel like.
1. Heartburn: That Annoying Burn in Your Chest
Arguably the most frequent and familiar symptom, heartburn is a burning sensation behind the breastbone (sternum). It typically occurs after eating a meal, especially one heavy, spicy, or fatty, and is worse when lying down or bending over.
Why does it happen? With a hiatal hernia, the lower esophageal sphincter (LES)—a ring of muscle that usually keeps stomach contents from flowing back up—can become displaced or weakened.
As a result, stomach acid leaks into the esophagus, causing that characteristic burning sensation.
2. Regurgitation: When Food or Acid Comes Back Up
Regurgitation is more than just a bad taste in your mouth. It’s the unpleasant return of partially digested food or acidic fluid into the throat or mouth, often without warning. Unlike vomiting, there’s no nausea or retching—just a sudden backflow.
This symptom can feel alarming and may:
- Happens shortly after eating
- Be triggered by lying down too soon after meals
- Leave a sour, bitter taste in your mouth
- Cause you to wake up coughing or choking in the middle of the night
Repeated regurgitation isn’t just uncomfortable—it can lead to complications like:
- Dental erosion from acid exposure
- Bad breath (halitosis)
- Increased risk of esophageal inflammation (esophagitis)
3. Difficulty Swallowing (Dysphagia): The Feeling of Food Getting Stuck
Some individuals with a hiatal hernia experience dysphagia, or difficulty swallowing. This may feel like:
- A sensation that food is “stuck” behind your breastbone
- The need to take smaller bites or drink water to help food go down
- A delayed passage of solids, and occasionally even liquids
This symptom arises when acid reflux causes inflammation or narrowing of the esophagus, known as esophageal stricture.
4. Chest or Abdominal Pain: Mimicking a Heart Problem
A hiatal hernia can sometimes cause sharp or pressure-like pain in the chest or upper abdomen. This symptom can be scary because it closely mimics the pain associated with heart attacks.
This discomfort may:
- Appear after eating large meals
- Radiate toward the neck or back
- Be accompanied by bloating or belching
- Feel worse when lying flat
Importantly, chest pain should never be self-diagnosed. If you are unsure whether it’s heartburn or a heart condition, it’s always better to seek immediate medical evaluation.
Your physician may perform tests, such as an EKG, chest X-ray, or endoscopy, to determine the exact cause.
Dietary Recommendations for Hiatal Hernia
Your diet determines how you feel if you have a hiatal hernia. Since this condition is closely associated with acid reflux and GERD, consuming foods can soothe your digestive system or aggravate your symptoms.
The goal of a hiatal hernia-friendly diet is to:
- Reduce stomach acid production
- Prevent reflux of acid into the esophagus
- Avoid unnecessary pressure on the stomach
Let’s examine this further, identifying what to avoid, what to include, and how to customize your eating habits for relief.
Foods to Avoid
Certain foods tend to relax the lower esophageal sphincter (LES)—the valve between the stomach and esophagus—or stimulate acid production, making reflux and discomfort more likely.
1. Citrus Fruits and Juices
Oranges, grapefruits, lemons, and even limes might seem healthy, but highly acidic. That acidity can irritate the sensitive lining of your esophagus, especially if it’s already inflamed from reflux.
- Even a small glass of orange juice can trigger a burning sensation in the morning.
- Lemon water, although popular for “detox,” can make symptoms worse for those with hernias.
Better alternatives: Switch to non-citrus fruits like bananas or melons, and opt for herbal teas or plain water infused with cucumber or mint.
2. Tomato-Based Products
Tomatoes are another acidic trigger food, and they are used in everything—pizza sauce, pasta sauce, ketchup, and salsa.
- The acidity can cause immediate heartburn for some individuals.
- Even “low-acid” tomato sauces can be problematic if consumed in large portions or with fatty foods.
3. Spicy Foods
That fiery vindaloo or hot wings may taste amazing, but spicy dishes can inflame the stomach lining and increase acid production, leading to a more intense burning sensation.
- Chili peppers, cayenne, black pepper, and other spices, such as paprika or hot sauce, can all trigger symptoms.
- Spices can also slow gastric emptying, leaving you feeling uncomfortably full.
4. Chocolate and Caffeinated Beverages
Chocolate is a double whammy—it contains methylxanthine (a muscle relaxant) and caffeine, which relax the LES.
Caffeinated drinks like coffee, tea, and energy drinks can:
- Stimulate acid production
- Weaken the LES
- Cause jitteriness, which may heighten sensitivity to symptoms
5. Alcohol
Alcohol, especially in excess, irritates the stomach lining and relaxes the LES, making reflux more frequent and severe.
- Red wine is particularly acidic, though all types of alcohol can cause symptoms.
- Alcohol can also dehydrate the body and worsen digestion over time.
Foods to Include
Now that we’ve covered what to avoid, let’s explore the variety of delicious, satisfying, and symptom-soothing foods you can include to effectively manage hiatal hernia discomfort.
1. Non-Citrus Fruits
These fruits are generally low in acid and easy on the digestive system. Examples include:
- Bananas
- Apples (especially sweet, red varieties)
- Pears
- Cantaloupe and honeydew
2. Vegetables
Non-gassy, low-acid vegetables help neutralize stomach acid and provide necessary nutrients.
Best choices:
- Green beans
- Carrots
- Broccoli (steamed to reduce gas)
- Peas
- Zucchini and squash
3. Whole Grains
Complex carbs like:
- Oatmeal
- Brown rice
- Quinoa
- Whole-grain breads and pasta
These grains absorb stomach acid, reduce hunger without bloating, and keep the digestive tract moving.
4. Lean Proteins
Proteins are essential, but choosing the right kind matters.
Best options include:
- Skinless chicken or turkey (grilled or baked)
- White fish (like cod or tilapia)
- Eggs (boiled or poached)
- Lentils and chickpeas (well-cooked)
Lifestyle Modifications for Hiatal Hernia Relief
While dietary adjustments are key to managing a hiatal hernia, your daily habits can be equally important—if not more. How you eat, sleep, move, and even what you wear can affect the pressure inside your abdomen and the frequency of reflux.
Making a few intentional changes to your lifestyle can go a long way in easing discomfort and preventing the hernia from worsening. Here’s a breakdown of impactful, evidence-based lifestyle modifications you can start today:
1. Eat Smaller, More Frequent Meals
Why it matters:
When you eat large meals, your stomach expands to accommodate the food. This increases pressure on the diaphragm and the hiatus, making it easier for stomach contents to push upward into the esophagus, especially if you have a hernia.
Instead of three large meals, aim for five to six smaller meals throughout the day.
How to do it:
- Use smaller plates to help with portion control
- Avoid “all-you-can-eat” style meals or skipping meals, which leads to overeating later
- Chew food slowly and thoroughly to aid digestion
2. Avoid Lying Down After Eating
Why it matters:
Gravity plays a huge role in digestion. When you lie flat right after a meal, gravity is no longer helping keep stomach contents where they belong—in your stomach. This increases the chances of acid reflux and discomfort.
How long to wait?
Give yourself at least 2 to 3 hours after eating before lying down, reclining on a couch, or going to bed.
Helpful habits:
- Go for a light walk after meals instead of heading straight to the sofa
- Do household chores that keep you upright and moving
- If you must recline (e.g., due to fatigue or illness), use a wedge pillow or sit in a reclined but elevated position
3. Elevate the Head of Your Bed
Why it matters:
Lying flat while sleeping can cause nighttime reflux, especially if you’ve eaten close to bedtime. Elevating the head of your bed by 6–8 inches allows gravity to help keep stomach acid from rising up into the esophagus.
Options to elevate your head:
- Use a wedge pillow (avoid stacking regular pillows—it can strain your neck)
- Place sturdy risers or blocks under the legs of your bed at the head side
- Use an adjustable bed frame, if available
4. Quit Smoking
Why it matters:
Nicotine—found in cigarettes and many vaping products—relaxes the lower esophageal sphincter, making it more likely for stomach acid to escape into the esophagus.
Additionally, smoking:
- Increases acid production in the stomach
- Reduces saliva production, which usually helps neutralize acid
- Delays the healing of the esophagus if it has been irritated
Quitting smoking may not reverse a hernia, but it can drastically reduce symptoms and lower the risk of serious complications like esophageal ulcers or cancer.
Tips to quit:
- Seek support from a physician, counselor, or support group
- Use nicotine patches or prescription medications to ease withdrawal
- Replace the smoking habit with healthy alternatives like chewing gum or deep breathing exercises
Medical Treatments for Hiatal Hernia
While lifestyle and dietary changes are the first line of defense against symptoms of hiatal hernia, they might not be enough for everyone, especially for those with moderate to severe symptoms or if the hernia is large.
In such cases, medical treatment is necessary to relieve symptoms, heal inflammation, and prevent complications.
There are two main categories of medical intervention:
- Medications – to control acid and reduce symptoms
- Surgical procedures – to correct the anatomical problem when needed
Let’s dive into both in more detail.
Medications: Managing Symptoms Effectively
The primary goal of medications in hiatal hernia management is to reduce stomach acid and minimize the damage it can cause to the esophagus. These medications don’t fix the hernia itself, but they are often highly effective at controlling symptoms like heartburn, regurgitation, and chest pain.
1. Antacids – For Quick Relief
Antacids are typically the first medications people reach for when heartburn strikes.
How they work:
They neutralize existing stomach acid, providing fast relief—usually within minutes.
2. H2 Receptor Blockers – For Ongoing Control
These medications block histamine, which stimulates acid production in the stomach lining.
How they work:
They prevent acid reflux by reducing the amount of acid your stomach produces.
3. Proton Pump Inhibitors (PPIs) – For Severe Symptoms and Healing
PPIs are the most effective class of acid-reducing medications. They don’t just reduce acid—they block its production almost entirely.
How they work:
They inhibit the “proton pump” in the stomach’s lining, which secretes hydrochloric acid.
Surgical Options: When Is Surgery Necessary?
While most cases of hiatal hernia can be managed with non-surgical approaches, surgery may be recommended in certain situations:
When to Consider Surgery:
- The hernia is significant and poses a risk of strangulation (when the stomach becomes trapped and its blood supply is cut off
- Medications and lifestyle changes no longer control symptoms
- You experience frequent regurgitation, severe esophagitis, or esophageal narrowing
- Breathing difficulties due to the stomach pressing on the lungs
- There’s a risk of Barrett’s esophagus or cancer
Conclusion:
Living with a hiatal hernia can be challenging, especially when symptoms like heartburn, regurgitation, or chest discomfort interfere with your daily life. But the good news is that with the right combination of lifestyle, dietary habits, medical care, and—when necessary—surgery, most people can manage their symptoms effectively and enjoy an everyday, active life.
At CGA Weight Loss, every health journey begins with knowledge and proactive choices. Whether you’re managing weight, digestive conditions, or overall wellness, we’re here to support you with personalized care and expert guidance.
