Hiatus hernia

A hiatus (or hiatal) hernia is when part of your stomach pushes through a gap in the diaphragm into your chest. The diaphragm is a muscle that separates your chest from your abdomen and is important for breathing.

Normally, your stomach sits below the diaphragm, and a muscle (called a sphincter) keeps your oesophagus (food pipe) closed. This stops your stomach contents from coming back up.

What are the different types of hiatus hernia?

There are different types of hiatus hernia:

• Sliding hernia — this is the most common type. The upper part of the stomach connected to the oesophagus slides through the diaphragm.
• Para-oesophageal hernia — part of the stomach pushes through a weak area of the diaphragm next to the oesophagus.
• Mixed hernia — this is a combination of a sliding hernia and a para-oesophageal hernia.

It's also possible for part of another abdominal organ to push through the diaphragm, such as the bowel.

Many people with a hiatus hernia have no symptoms.

In some people with a hiatus hernia, food and acid can move from the stomach back up the oesophagus and cause gastro-esophageal reflux disease (GORD), also called 'reflux' or heartburn.

Other symptoms of hiatus hernia may include:

• chest pain or abdominal pain
• bloating
• difficulty swallowing
• nausea and vomiting

A hiatus hernia happens when there is pressure inside your abdomen, pushing organs upwards. It may be caused by a weakness in the diaphragm muscle where it meets the oesophagus.

You will have a higher chance of developing a hiatus hernia if you:

• are over 50 years of age
• strain your abdominal muscles a lot — such as when coughing, weightlifting or straining to pass bowel motions (poo)
• live with GORD
• do heavy physical work

You should see your doctor if you have heartburn or other symptoms of a hiatus hernia. 

It is especially important to see your doctor if:

• you have pain or difficulty swallowing
• you have pain during or after eating
• you have lost weight without trying to
• you are vomiting often

Your doctor will review your medical history and perform a physical examination.

Your doctor may also refer you for tests such as:

• gastroscopy — using a camera to look inside your oesophagus and stomach
• barium swallow (Opens in new tab)
• manometry — to check the muscles of your oesophagus
• pH test — to measure the acid levels in your oesophagus 
• a computed tomography (CT) scan

Treatment depends on the type of hernia and how severe your symptoms are.

Medicines such as proton pump inhibitors (PPIs) are used to reduce the amount of stomach acid produced. These are often used for symptoms of GORD.

You may need surgery for your symptoms if medicines don't help. There are different types of surgery, including anti-reflux surgery or for a large hiatus hernia. If you have a para-oesophageal hernia, your doctor may recommend surgery to prevent complications.

A para-oesophageal hernia can cause your stomach to become stuck in your chest and twist. This requires emergency surgery.

If you have symptoms of GORD caused by a hiatus hernia, you can try to relieve your symptoms by:

• adjusting your position — sitting upright or elevating the head of your bed
• avoiding eating close to bedtime
• avoiding foods and drinks that cause your symptoms
• losing weight if needed
• quitting smoking

You can buy antacid medicines over the counter to relieve your symptoms. Talk to your pharmacist or doctor about what medicines may be suitable for you.

Find out more about what you can do to relieve symptoms of GORD.

A hiatus hernia can cause problems including:

• incarcerated hernia — this happens when the hernia gets stuck in your chest. It can twist or cut off the blood supply to part of the stomach.
• bowel obstruction — if part of the bowel gets stuck in the chest and becomes blocked
• GORD — this is when stomach acid flows back up your oesophagus. It can cause heartburn and damage your oesophagus. Complications of GORD can include inflammation of the oesophagus (oesophagitis) and changes to the lining of the oesophagus, known as Barrett’s oesophagus.

Find out more about how GORD can damage your oesophagus.

There is no proven way to completely prevent a hiatus hernia. You are less likely to develop a hiatus hernia if you avoid heavy lifting and straining to pass bowel motions.

The Gastroenterological Society of Australia (Opens in new tab) has information about reflux, which often occurs with hiatus hernia. If you’re going to have surgery, it’s good to be prepared. Healthdirect offers information on how to prepare for surgery and provides tips on questions to ask before surgery (Opens in new tab).

Languages other than English

If you are considering surgery, Safer Care Victoria has information in a range of community languages (Opens in new tab) to help you prepare.

Information for Aboriginal and/or Torres Strait Islander peoples

Find an Aboriginal and/or Torres Strait Islander Health and Medical Service (Opens in new tab) in your area.

Find an Aboriginal Community Controlled Health Organisation (ACCHO) (Opens in new tab) or Affiliate near you.