Hiatal Hernia Causes and Risk Factors

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A hiatal hernia is caused by weakness of the muscles of the diaphragm that causes part of the stomach to bulge into the thorax (chest cavity). While it is often unclear what causes a hiatal hernia occurs, there are certain risk factors that make one more likely.

For instance, conditions that weaken and/or place excessive pressure on the diaphragm—a thin muscle that separates the chest cavity from the abdominal cavity—can increase the odds of a hernia. Severe cases may require hiatal hernia surgery to repair the displacement of the stomach into the thorax.

This article looks at the causes of this common digestive disorder and lists some of hiatal hernia risk factors you should be aware of.

hiatal hernia causes and risk factors
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Common Causes of Hiatal Hernia 

A hiatal hernia may be caused by a condition that increases the opening where the esophagus (feeding tube) passes through the diaphragm. It may also be caused by something that physically forces the stomach upward into the thorax.

Among some of the hiatal hernia causes are:

  • Aging: Overall, the chances of having a hiatal hernia increase as you get older. As you age, the diaphragm naturally becomes weaker and more flexible.
  • Trauma: Injuries can cause expansion of the opening in the diaphragm or the abnormal displacement of the stomach and esophagus.
  • GERD: Gastroesophageal reflux disorder (GERD) place enormous pressure on the diaphragm by causing frequent acid reflux.
  • Surgery: Abdominal surgery can increase your chances of a hiatal hernia either by directly damaging the diaphragm or altering the normal position of the stomach and esophagus.
  • Congenital: Some children are born with a hiatal hernia due to abnormalities in fetal development.

Are Hiatal Hernias Genetic?

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.

Hiatal Hernia Risk Factors

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 remains 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.

Types of Hernia

There are different types of hernia, each of which is related to a different abnormality in the body.

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.

With a sliding hiatal hernia, the symptoms can come and go based on where the stomach is at any moment.

Paraesophageal Hernia

A paraesophageal hernia is a type of hiatal hernia caused when the stomach is forced upward through an enlarged opening in the diaphragm. Symptoms of a paraesophageal hernia tend to be chronic (persistent).

Unlike a sliding hernia, a paraesophageal hernia does not move or slide around. Rather, it remains in an abnormal position next to the esophagus where it can become incarcerated (trapped) in the diaphragm. This can lead to ischemia (the cutting off of the blood supply), a medical emergency requiring immediate surgery.

Hiatal Hernia Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Woman

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.

  • What aggravates hiatal hernia symptoms?

    Large meals, eating before bedtime, heartburn-inducing foods, and tight clothing can all worsen symptoms by causing stomach acid to reflux. The acid can make its way into the esophagus because the sphincter muscle, which normally acts like a protective door, doesn't close all the way if you have a hiatal hernia.

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.
  1. U.S. National Library of Medicine. Hiatal Hernia.

  2. 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.

  3. 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

  4. Cedars Sinai. Hiatal hernia.

  5. Cleveland Clinic. Hiatal hernia.

Additional Reading

By Heidi Moawad, MD
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.