Digestive Health Heartburn Hiatal Hernia Hiatal Hernia Guide Hiatal Hernia Guide Symptoms Causes Diagnosis Treatment Coping Causes and Risk Factors of Hiatal Hernia By Heidi Moawad, MD Heidi Moawad, MD Facebook LinkedIn Heidi Moawad is a neurologist and expert in the field of brain health and neurological disorders. Dr. Moawad regularly writes and edits health and career content for medical books and publications. Learn about our editorial process Updated on September 14, 2021 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Robert Burakoff, MD, MPH Medically reviewed by Robert Burakoff, MD, MPH LinkedIn Robert Burakoff, MD, MPH, is board-certified in gastroentrology. He is the vice chair for ambulatory services for the department of medicine at Weill Cornell Medical College in New York. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Common Causes Genetics Lifestyle Frequently Asked Questions Next in Hiatal Hernia Guide How a Hiatal Hernia Is Diagnosed A hiatal hernia is caused by weakness of the muscles of the diaphragm. Most of the time, it is not clear why a hiatal hernia develops, although there are some risk factors. Conditions that cause pressure on the muscles of the diaphragm or conditions that weaken the muscle can increase your chances of developing a hiatal hernia. © Verywell, 2018 Common Causes Weakness of the diaphragmatic muscles allows the stomach to enter the area above the diaphragm instead of remaining securely below the diaphragm, where it belongs. The diaphragm is a powerful muscle that separates the upper chest cavity from the abdominal compartments. It has an opening through which the esophagus connects with the stomach, as the esophagus is normally above the diaphragm, while the stomach is normally below the diaphragm. The diaphragm also helps open the space in the chest cavity when you take a deep breath in, so it is normally well anchored in the body. Causes of Diaphragmatic Muscle Weakness Aging: Overall, the chances of having a hiatal hernia increase as you get older. The diaphragmatic muscles naturally become weaker and more flexible with advancing age, and, as you get older, you are more likely to experience the risk factors for hiatal hernia. Exceptions include congenital (from birth) and hereditary hiatal hernia, which develops at an early age. Trauma: Traumatic injury can contribute to pressure on the diaphragm, causing expansion of the opening in muscle. Surgery: Abdominal surgery may increase your chances of developing a hiatal hernia. Congenital: Babies and young children can have a hiatal hernia from birth. This can be repaired surgically. Displacement of the stomach because of weakened diaphragm muscles can cause various types of hernia. Sliding Hernia A sliding hernia is a condition in which your stomach can periodically slide above the diaphragm due to a wide opening in the diaphragm or weakness of the diaphragmatic muscle. If you have a sliding hernia, your stomach is not anchored in place, but the anatomical relationship between your stomach and your esophagus, which lies right above it, is maintained as a normal anatomical relationship. The hernia worsens during times of abdominal pressure, with the stomach literally sliding into the space above the diaphragm. The stomach can then return to its original position when there is no excessive abdominal pressure. Paraesophageal Hernia This type of hernia is caused when the stomach goes through an enlarged opening in the diaphragm. In this type of hiatal hernia, the stomach sits next to the esophagus. It does not move around or slide, but remains in the abnormal position next to the esophagus, where it may actually become squeezed or strangled by the diaphragm. Hiatal Hernia Doctor Discussion Guide Get our printable guide for your next doctor's appointment to help you ask the right questions. Download PDF Email the Guide Send to yourself or a loved one. Sign Up This Doctor Discussion Guide has been sent to {{form.email}}. There was an error. Please try again. Genetics In general, a hiatal hernia is not believed to be genetic, but the most common hereditary condition that may be associated with a hiatal hernia is Ehlers Danlos syndrome. This is connective tissue disease that has a variety of clinical manifestations, including easy bruising and overly flexible joints. Hiatal hernia may be present as well. Lifestyle There are a few lifestyle risk factors that increase your chances of having a hiatal hernia. For many of these risk factors, the link to hiatal hernia is well established, but the cause is unclear. Obesity: Obesity is one of the biggest risk factors for hiatal hernia. This may be due to increased pressure on the diaphragm due to heavy weight.Heavy lifting: It is believed that heavy lifting puts stress on the diaphragmatic muscle, increasing the chances of an enlarged hole that allows the stomach to protrude above the diaphragm.Coughing: The abdominal pressure caused by coughing can allow or cause the stomach to squeeze through the diaphragm.Straining: Straining may increase the chances of having a hiatal hernia due to excess pressure on the diaphragm. This includes straining for a bowel movement. Pregnancy: The abdominal pressure and hormonal changes of pregnancy can increase the chances of a hiatal hernia.Smoking: Smoking weakens the muscles of the diaphragm, allowing the stomach to protrude above the diaphragm. Frequently Asked Questions What does a hiatal hernia feel like? A hiatal hernia may not cause any symptoms. If it does, you might have burping, nausea, vomiting, acid reflux, trouble swallowing, or pain in the abdomen or chest. Chest pain can also be a symptom of a heart attack, so seek immediate medical care if you're experiencing chest pain. What aggravates hiatal hernia symptoms? Symptoms can be aggravated in the same way as gastroesophageal reflux disease (GERD). If you have a hiatal hernia, the esophagus sphincter muscle doesn't close all the way, causing stomach acid to come up into the esophagus. To help prevent symptoms, try eating smaller meals, avoiding meals two to three hours before going to bed, limiting foods that cause heartburn, and wearing loose clothing around the stomach area. How a Hiatal Hernia Is Diagnosed Was this page helpful? Thanks for your feedback! Get nutrition tips and advice to make healthy eating easier. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 5 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. U.S. National Library of Medicine. Hiatal Hernia. Dean C, Etienne D, Carpentier B, Gielecki J, Tubbs RS, Loukas M. Hiatal hernias. Surg Radiol Anat. 2012;34(4):291-9. doi:10.1007/s00276-011-0904-9 Nelson AD, Mouchli MA, Valentin N. Ehlers Danlos syndrome and gastrointestinal manifestations: a 20-year experience at Mayo Clinic. Neurogastroenterol Motil. 2015 Nov;27(11):1657-66. doi:10.1111/nmo.12665. Cedars Sinai. Hiatal hernia. Cleveland Clinic. Hiatal hernia. Additional Reading Garvey EM, Ostlie DJ. Hiatal and paraesophageal hernia repair in pediatric patients. Semin Pediatr Surg. 2017 Apr;26(2):61-66. doi:10.1053/j.sempedsurg.2017.02.008