What you need to know about a Hiatal Hernia
Medically reviewed by Dr. Dan Wool, NMD
Arizona-licensed Naturopathic Physician and Gastroenterology Specialist
Updated: December 11, 2025
Summary:
- What is hiatal hernia? A hiatal hernia occurs when your stomach pushes through the diaphragm, causing heartburn, reflux, and chest discomfort. While medications like PPIs reduce acid, they don't fix the hernia itself and may cause long-term side effects. Most cases respond well to lifestyle changes without surgery.
- Start with lifestyle: Eat smaller meals, elevate your bed, lose weight, and avoid trigger foods to reduce symptoms naturally.
- Use medications wisely: PPIs and H₂-blockers provide relief but aren't cures; long-term use can cause nutrient deficiencies
- Try natural remedies: Herbal teas, diaphragmatic breathing, and gentle yoga support healing without pharmaceutical risks
- Watch for emergencies: Seek immediate care for severe chest pain, bloody vomit, or difficulty swallowing
What Is a Hiatal Hernia?
A hiatal hernia occurs when the upper part of your stomach pushes through the diaphragm into the chest cavity. The diaphragm normally helps keep stomach contents in place, but when the hiatus (opening) widens, part of the stomach slips upward. There are two main types of hiatal hernia: sliding hernias (which move up and down and account for most cases) and paraesophageal hernias, which are less common but more serious because they can trap part of the stomach.
Hiatal hernias are common, especially in people over 50, and often go unnoticed. Risk factors include obesity, pregnancy, smoking, chronic coughing, and heavy lifting. Symptoms vary from person to person. While some people have no symptoms, others experience heartburn, acid reflux, chest discomfort, bloating, or difficulty swallowing. Severe cases can cause bleeding, anemia, or obstruction and require urgent care.
Before You Reach for Medication: What You Should Know
When heartburn or reflux from a hiatal hernia bothers you, medication can provide comfort; however, it’s not an overall solution. Medications like antacids, H₂-blockers (e.g., Famotidine), and proton pump inhibitors (PPIs) (e.g., Omeprazole) work by neutralizing or reducing stomach acid, thus giving the irritated tissues time to heal. However, they don’t reposition your stomach or prevent the hernia from sliding upward again. [1]
PPIs tend to be stronger and more effective for daily acid control, but may cause long-term issues like nutrient deficiencies, kidney side effects, and rebound acid hypersecretion when you stop taking them. H₂-blockers offer gentler relief but are commonly used short-term. Medications are best used to manage symptoms, not replace health-supporting habits.
Lifestyle adjustments shouldn't be underestimated. By eating smaller meals, avoiding lying down after eating, quitting smoking, minimizing alcohol, and elevating the head of your bed by 6 to 8 inches, you can ease symptoms and reduce pressure on the diaphragm. Plus, weight loss and gentle strength exercises can lessen abdominal strain.
Did you know? Many hiatal hernias can be manually adjusted by a naturopathic doctor or trained professional.
Medical or surgical intervention, like laparoscopic fundoplication, is considered only when lifestyle measures and medications fail, or the hernia presents complications such as strangulation. Guidelines from SAGES [3] emphasize a shared decision-making approach, tailoring treatment to symptoms, risks, and personal preferences.
Important Considerations Before Treatment
Before diving into medical remedies, it’s essential to determine what’s truly going on and whether your symptoms warrant different care.
1. Confirming Your Diagnosis
A physician typically starts with your symptoms and medical history before ordering tests. If it’s unclear whether heartburn stems from a hiatal hernia or something more serious, imaging is valuable. A barium swallow X-ray helps distinguish a sliding hernia from a paraesophageal one and evaluates size and position. Upper endoscopy (EGD) not only visualizes the hernia but also checks for inflammation and provides material for a biopsy when needed. For persistent symptoms or swallowing difficulty, an esophageal manometry test may assess muscle function. Further imaging (e.g., CT scan) or blood work may help rule out other conditions like esophageal strictures or ulcers.
2. Recognizing Red Flags
Hiatal hernias are usually manageable, but they can sometimes cause emergencies. Seek immediate care if you experience any of the following:
- Sudden, severe chest or upper abdominal pain
- Vomiting blood or passing black, tarry stools
- Trouble swallowing or choking
- Persistent vomiting, bloating, or fever
These symptoms might indicate serious complications, such as strangulation, volvulus, or incarceration, which cut off blood flow and require urgent surgery.
3. Planning Your Path Forward
A hiatal hernia isn’t typically dangerous, but managing it relies on long-term habits. Even benign hernias may worsen if you ignore early symptoms. Gentle lifestyle changes may not offer instant relief, so tracking what you eat, the length and quality of your sleep, and how your body responds helps you adjust wisely. Working with your healthcare provider ensures that weaning off medication and any potential surgical decisions match your individual needs and timeline.
Natural and Complementary Approaches to Hiatal Hernia
Holistic strategies can ease hiatal hernia discomfort and support long-term health. Start with dietary changes such as eating smaller meals, avoiding trigger foods like coffee, chocolate, and spicy dishes, and staying upright after eating. Elevating your bed head by a few inches can really help for reduction of nighttime reflux.
Herbal remedies such as chamomile, slippery elm, and marshmallow root soothe the digestive tract. Apple cider vinegar in water before meals may aid digestion. Diaphragmatic breathing and gentle yoga help relax the hiatus and reduce pressure. Self-massage of the upper abdomen can also encourage the stomach to move downward. Hiatal hernias also can be adjusted by a professional. Combining these approaches with stress management creates a sustainable path to relief.
Frequently Asked Questions about Hiatal Hernia
1. Will I have a hiatal hernia forever?
It depends. Hiatal hernias are anatomic and can worsen. Some, like the most common "sliding" type, can be manually adjusted and with lifestyle changes can resolve. The less common paraesophageal type may require corrective surgery. The greater the gap across the diaphragmatic hiatus (i.e. hole the esophagus passes through to connect with the stomach), the more likley it is that surgical intervention will be necessary.
2. What are the most common hiatal hernia symptoms?
Stomach fullness lasting longer than usual, feeling a knot in the upper-center of the chest (between the rib cages), discomfort taking a deep breath, acid reflux - especially after lying down at night (sliding hernia).
3. Can hiatal hernia cause shortness of breath, heart palpitations or A-Fib-type symptoms?
Yes. When there's a bolus sitting on your diaphragm, your breathing will change until it resolves. Also the hernia can push up against the left side of the chest near the pericardium, which can affect the heart rate as it tries to adjust to the stressor.
4. What can I do at home for hiatal hernia?
Heel drops. Drink a full glass of water, rise up on tiptoes, then drop down on your heels. Repeat 10 times. The water acts like a pile driver and, with the motion, can push a sliding hernia back below the diaphragm.
The Bottom Line on Hiatal Hernias
Hiatal hernia is a common condition that is often manageable with lifestyle changes and natural remedies. Medications help symptoms but do not cure the condition. Surgery is reserved for severe cases. A holistic plan incorporating diet, the right posture, herbal remedies, and stress reduction can offer lasting relief and empower you to take control of your health.
About the Author
Dr. Dan Wool, NMD
Dr. Dan Wool is a naturopathic doctor who specializes in gastroenterology, hormones and men's health in Scottsdale, Arizona. Set up a free 15-minute discovery call with Dr. Wool today!
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