10 Common Hiatal Hernia Symptoms You Should Know About

A hiatal hernia occurs when part of your stomach pushes upward through the diaphragm, the muscle that separates your chest from your abdomen. The diaphragm has a small opening called the hiatus through which your esophagus passes before connecting to your stomach. In a hiatal hernia, the stomach bulges up through this opening into your chest cavity.

While many people with a small hiatal hernia may not experience any symptoms at all, others can develop uncomfortable and sometimes concerning signs. Understanding these symptoms is crucial for early detection and proper management of the condition. This comprehensive guide will walk you through the most common symptoms associated with hiatal hernias, helping you identify when it might be time to consult with a healthcare professional.

1. Heartburn and Acid Reflux

Heartburn is by far the most common symptom of a hiatal hernia, affecting the majority of people who experience symptoms from this condition. This burning sensation typically occurs in the chest, behind the breastbone, and can extend upward toward the throat.

The reason heartburn is so prevalent with hiatal hernias is that the displacement of the stomach compromises the lower esophageal sphincter (LES), the muscular valve that normally prevents stomach acid from flowing back into the esophagus. When this valve doesn’t function properly, stomach acid can easily reflux into the esophagus, causing that familiar burning sensation.

Key characteristics of heartburn related to hiatal hernia include:

• Worsening after eating, especially large meals
• Intensification when lying down or bending over
• Relief when sitting upright or standing
• A burning sensation that may last from a few minutes to several hours
• Sometimes accompanied by a sour or bitter taste in the mouth

2. Regurgitation of Food or Liquids

Regurgitation is the backflow of stomach contents into the mouth or throat without the forceful contractions associated with vomiting. This is another hallmark symptom of hiatal hernia and can be particularly distressing for those who experience it.

With a hiatal hernia, the weakened barrier between the stomach and esophagus allows partially digested food and stomach acid to flow back up more easily. This typically happens when the stomach is full or when you’re in certain positions that put additional pressure on the stomach.

People experiencing regurgitation often describe:

• A sensation of food coming back up into the throat or mouth
• Sour or bitter liquid in the back of the throat
• The need to re-swallow food or liquid
• Increased occurrence at night when lying flat
• Sometimes accompanied by a gurgling sound in the throat

3. Chest Pain

Chest pain associated with a hiatal hernia can be alarming because it may mimic the symptoms of a heart attack. This pain typically originates from the irritation of the esophagus by stomach acid or from the pressure created by the herniated portion of the stomach.

The chest pain from a hiatal hernia is usually located in the center of the chest, behind the breastbone, though it can sometimes radiate to other areas. It’s important to note that any chest pain should be evaluated by a medical professional to rule out cardiac issues, especially if it’s severe or accompanied by shortness of breath, arm pain, or sweating.

Characteristics of hiatal hernia-related chest pain include:

• A sharp, burning, or pressure-like sensation
• Pain that worsens after eating or when lying down
• Relief with antacids or sitting upright
• Duration that can last from minutes to hours
• May be mistaken for angina or heart-related pain

4. Difficulty Swallowing (Dysphagia)

Difficulty swallowing, medically known as dysphagia, occurs when the herniated stomach portion interferes with the normal passage of food through the esophagus. This symptom can range from mild discomfort to a significant challenge in consuming solid foods.

The swallowing difficulties arise because the hiatal hernia can create a narrowing at the junction where the esophagus meets the stomach, or it can disrupt the normal coordinated contractions that move food downward. Additionally, inflammation from chronic acid reflux can cause scarring and narrowing of the esophagus over time.

People with dysphagia from hiatal hernia may experience:

• A sensation of food getting stuck in the chest or throat
• Greater difficulty swallowing solid foods compared to liquids
• The need to drink water frequently during meals to help food go down
• Sometimes pain when swallowing
• Gradual worsening over time if left untreated

5. Belching and Bloating

Excessive belching and persistent bloating are common yet often overlooked symptoms of a hiatal hernia. These symptoms occur because the abnormal positioning of the stomach can trap air and gas, leading to increased pressure and discomfort.

The hiatal hernia disrupts the normal anatomy of the upper digestive system, making it harder for gas to be released naturally. Additionally, people with hiatal hernias often swallow more air while eating due to the discomfort, which further contributes to bloating and belching.

Notable features include:

• Frequent burping, especially after meals
• A feeling of fullness or tightness in the upper abdomen
• Visible distension of the abdomen
• Discomfort that may be temporarily relieved by belching
• Bloating that worsens throughout the day

6. Nausea and Vomiting

While less common than heartburn or regurgitation, nausea and vomiting can occur with hiatal hernias, particularly when the hernia is larger or when there are complications. These symptoms result from the disruption of normal stomach function and the backup of stomach contents.

The displaced stomach may not empty properly, leading to feelings of nausea. In some cases, the pressure and discomfort from the hernia, combined with severe acid reflux, can trigger the vomiting reflex. This is more likely to occur after eating large meals or foods that are difficult to digest.

Characteristics of nausea and vomiting with hiatal hernia:

• Persistent nausea, especially after eating
• Occasional vomiting, particularly when symptoms are severe
• Relief of symptoms after vomiting
• Association with other symptoms like heartburn or chest pain
• May indicate a larger hernia or complications if frequent

7. Shortness of Breath

Shortness of breath is one of the more unusual and concerning symptoms that can occur with a hiatal hernia. This symptom develops when a large hiatal hernia extends significantly into the chest cavity, potentially putting pressure on the lungs or heart.

The herniated stomach portion occupies space in the chest that would normally be available for lung expansion. This mechanical interference can make it difficult to take deep breaths, especially when lying flat or after eating a large meal when the stomach is distended. Additionally, aspiration of stomach contents into the airways can cause respiratory symptoms.

Breathing difficulties may manifest as:

• Feeling unable to take a full, deep breath
• Worsening when lying down, especially on the back
• Improvement when sitting upright or standing
• Sometimes accompanied by chest pressure or discomfort
• May be more noticeable during physical exertion

8. Chronic Cough and Hoarseness

A persistent cough and hoarseness that don’t seem to be related to a respiratory infection can be manifestations of a hiatal hernia. These symptoms occur when stomach acid repeatedly irritates the throat and vocal cords, a condition known as laryngopharyngeal reflux.

The acid that refluxes from the stomach doesn’t necessarily need to reach the mouth to cause problems. Even small amounts of acid vapor can irritate the delicate tissues of the throat and larynx. This chronic irritation leads to inflammation, causing voice changes and triggering a cough reflex as the body attempts to clear the irritation.

These respiratory symptoms typically present as:

• A dry, persistent cough, especially at night or upon waking
• Hoarseness or voice changes, particularly in the morning
• Frequent throat clearing
• A sensation of a lump in the throat
• Symptoms that don’t respond to typical cough or cold remedies

9. Upper Abdominal Pain

Pain in the upper abdomen or just below the breastbone is another symptom that can be associated with a hiatal hernia. This discomfort stems from the pressure exerted by the herniated stomach and the inflammation caused by acid reflux in the lower esophagus.

The pain can vary in intensity and character, ranging from a dull ache to sharp, stabbing sensations. It’s often located in the epigastric region, which is the area at the top of the abdomen, directly below the ribcage. This pain is distinct from the chest pain described earlier and is felt lower in the body.

Upper abdominal pain characteristics include:

• Discomfort in the area just below the breastbone
• Pain that may worsen after eating or when lying down
• Sometimes described as a gnawing or burning sensation
• May be accompanied by feelings of fullness or pressure
• Can radiate to the back in some cases

10. Early Satiety and Loss of Appetite

Early satiety refers to feeling full after eating only a small amount of food, and it’s a symptom that can significantly impact quality of life for those with a hiatal hernia. This occurs because the herniated portion of the stomach reduces the effective capacity of the stomach and can slow down the emptying process.

When part of the stomach is pushed through the diaphragm, it can’t expand normally to accommodate food. Additionally, the discomfort associated with eating—such as heartburn, pain, and bloating—can lead to decreased appetite. Over time, some people may begin to avoid eating to prevent these unpleasant symptoms, which can lead to unintended weight loss.

This symptom manifests as:

• Feeling uncomfortably full after eating small portions
• Reduced interest in food or meals
• Unintentional weight loss in some cases
• Avoidance of meals due to anticipation of discomfort
• Need to eat smaller, more frequent meals

What Causes a Hiatal Hernia?

Understanding the causes of hiatal hernias can help identify risk factors and potentially prevent their development. While the exact cause isn’t always clear, several factors are known to contribute to the formation of hiatal hernias:

Age-related weakening of tissues: As we age, the diaphragm muscle can weaken, and the hiatus (the opening through which the esophagus passes) may become enlarged. This is the most common reason why hiatal hernias are more prevalent in people over 50 years old.

Increased pressure in the abdomen: Chronic or repeated increases in abdominal pressure can push the stomach through the hiatus. This pressure can result from:

• Persistent coughing or vomiting
• Straining during bowel movements (chronic constipation)
• Heavy lifting or strenuous physical activity
• Pregnancy, especially multiple pregnancies
• Obesity, which creates constant pressure on the abdomen

Congenital factors: Some people are born with an unusually large hiatus, making them more susceptible to developing a hiatal hernia later in life. In rare cases, babies can be born with a hiatal hernia.

Injury or trauma: Blunt force trauma to the area or injury from surgery can sometimes damage the diaphragm and lead to a hiatal hernia.

Prior surgery: Surgical procedures in the area of the diaphragm or esophagus may sometimes weaken the tissues, predisposing to hernia formation.

Prevention Strategies

While not all hiatal hernias can be prevented, especially those related to age or congenital factors, there are several lifestyle modifications that can reduce your risk or prevent an existing small hiatal hernia from worsening:

Maintain a healthy weight: Excess body weight increases abdominal pressure, which is a major risk factor for hiatal hernias. Losing weight if you’re overweight can significantly reduce your risk and may even improve symptoms if you already have a hiatal hernia.

Avoid heavy lifting: When you must lift heavy objects, use proper technique by bending at the knees rather than the waist, and avoid straining. Consider asking for help with very heavy items.

Don’t strain during bowel movements: Prevent constipation by eating a high-fiber diet, drinking plenty of water, and staying physically active. This reduces the need to strain, which can increase abdominal pressure.

Manage chronic cough: If you have a persistent cough due to smoking, asthma, or other respiratory conditions, work with your healthcare provider to address the underlying cause and control the cough.

Eat smaller, more frequent meals: Large meals distend the stomach and increase pressure. Eating smaller portions more frequently can help reduce this pressure.

Avoid foods that trigger reflux: Even if you don’t have a hiatal hernia yet, managing acid reflux can prevent complications. Common triggers include spicy foods, citrus, chocolate, caffeine, alcohol, and fatty foods.

Don’t lie down immediately after eating: Wait at least 2-3 hours after eating before lying down. This allows time for the stomach to empty and reduces the likelihood of reflux.

Elevate the head of your bed: Raising the head of your bed by 6-8 inches can help prevent acid reflux at night by using gravity to keep stomach contents down.

Frequently Asked Questions

Can a hiatal hernia go away on its own?

A hiatal hernia typically does not resolve on its own. Once the stomach has herniated through the diaphragm, it usually remains that way. However, symptoms can often be managed effectively with lifestyle changes and medical management. Small hiatal hernias that cause no symptoms may not require any treatment at all.

Where is hiatal hernia pain located on a woman?

The location of hiatal hernia pain is generally the same for women and men. It’s typically felt in the upper abdomen, behind the breastbone in the center of the chest, or in the epigastric region just below the ribcage. Some women may experience pain that radiates to the back. The symptoms are not gender-specific, though women may sometimes attribute chest discomfort to other causes and delay seeking evaluation.

What does a hiatal hernia feel like?

A hiatal hernia can feel different for different people. Many describe it as heartburn or a burning sensation in the chest, while others feel pressure or discomfort in the upper abdomen. Some people experience a feeling of food getting stuck, bloating, or chest pain. In many cases, a small hiatal hernia causes no noticeable symptoms at all and may only be discovered during tests for other conditions.

Is a sliding hiatal hernia serious?

A sliding hiatal hernia, which is the most common type, is usually not serious. In this type, the junction where the esophagus meets the stomach slides up through the hiatus and back down. Most sliding hiatal hernias are small and cause minimal or no symptoms. However, they can lead to gastroesophageal reflux disease (GERD) and its complications if left unmanaged. It’s important to work with your healthcare provider to manage symptoms and monitor the condition.

Can you have weird symptoms with a hiatal hernia?

Yes, hiatal hernias can cause some unusual or “weird” symptoms that people might not immediately associate with a digestive issue. These can include heart palpitations, a feeling of something stuck in the throat, excessive burping, hiccups, bad breath, and even shortness of breath. Some people report feeling like they can’t get a satisfying deep breath. These atypical symptoms occur because of the hernia’s location near the heart and lungs and the effects of acid reflux on the throat and airways.

Do I need to see a doctor for hiatal hernia symptoms?

Yes, you should consult with a healthcare provider if you experience symptoms that might indicate a hiatal hernia. This is especially important if you have persistent heartburn, difficulty swallowing, chest pain, or if symptoms interfere with your daily life. Severe symptoms such as intense chest pain, severe difficulty swallowing, vomiting blood, or black stools require immediate medical attention as they may indicate complications.

What’s the difference between a hiatal hernia and an esophageal hernia?

The terms “hiatal hernia” and “esophageal hernia” are often used interchangeably and refer to the same condition. Both describe the protrusion of the stomach through the esophageal hiatus in the diaphragm. The medical term most commonly used by healthcare providers is “hiatal hernia,” but you may encounter both terms in medical literature and general discussion.

Can stress make hiatal hernia symptoms worse?

While stress doesn’t directly cause a hiatal hernia, it can definitely worsen symptoms. Stress can increase stomach acid production, slow digestion, and cause muscle tension, all of which can exacerbate heartburn and discomfort associated with a hiatal hernia. Additionally, stress may lead to behaviors that worsen symptoms, such as eating quickly, consuming trigger foods, or smoking. Managing stress through relaxation techniques, exercise, and adequate sleep may help reduce symptom severity.

References:

• Mayo Clinic – Hiatal Hernia
• National Institute of Diabetes and Digestive and Kidney Diseases – GERD
• Cleveland Clinic – Hiatal Hernia
• Johns Hopkins Medicine – Hiatal Hernia
• MedlinePlus – Hiatal Hernia