Although most common in people 50 and older, hiatal hernias are frequent across all ages and genders. While there is no exact known cause, people who smoke and/or are overweight tend to be affected more often. Pregnancy can also inflict a hiatal hernia as there is extra fluid buildup in the abdomen causing pressure in the abdominal cavity. 

While many people affected by hiatal hernias never see symptoms, there is a chance you’ll feel gastro-reflux-like symptoms such as heartburn, acid reflux, bloating, and discomfort in the stomach. Smaller hiatal hernias are often associated with little-to-no symptoms, whereas larger hiatal hernias have more frequent GERD-like symptoms, like heartburn when food is being digested. 

Because many hiatal hernias exist without symptoms, you can go without treatment. However, it is encouraged you still seek medical advice for your specific situation, especially if you are seeing GERD-like symptoms. 

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There are four types of hiatal hernias:

• Type I (Sliding): In a sliding hernia, the area where the esophagus meets the stomach—known as the gastroesophageal junction—and a portion of the stomach slide up into the chest through an opening in the diaphragm. The movement is called "sliding" because the herniated portion can move in and out of the chest cavity.² This is the most common type of hiatal hernia, accounting for about 95% of cases.³
• Type II (Rolling): Also known as a paraesophageal hernia, a rolling hernia involves a portion of the stomach bulging through the diaphragm beside the esophagus, next to the gastroesophageal junction.¹ They are far less common than sliding hernias but carry a higher risk of complications that can lead to strangulation of the hernia tissues.⁴
  
• Type III (Mixed): A mix of the Type I Rolling and Type II Sliding, a Type III Mixed hernia is formed when the part of your esophagus that connects your stomach slides up through the hiatus at times and another part of your stomach bulges through at times.¹
• Type IV: An extremely rare paraesophageal hernia, Type IV is essentially a herniation of the entire stomach into the thorax (upside-down stomach orientation). It may also include organs like the small bowel, colon, or pancreas.^3,5
  
  Types III and IV constitute approximately 5% of all hernias.³
   

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Specific treatment for the different types of hiatal hernias will be determined by your doctor and depend on many factors, including the severity of your symptoms, general health, and location of the hernia.

Medication or Lifestyle Changes¹
Type I Sliding is typically managed with medications and/or lifestyle changes, such as:⁶

• Maintaining a healthy weight.
• Avoiding acid foods (citrus, juice, tomatoes, etc.).
• Limiting fatty, fried, and caffeinated items (carbonated drinks, alcohol, condiments, etc.).
• Creating a better bedtime routine by:
  • Eliminating snacks at least 3 hours before bedtime.
  • Elevating your head 6 inches higher than your body when lying down.
• Quitting smoking.
• Reducing the amount of pressure you put on the abdomen by not:
  • Lifting heavy objects.
  • Wearing restrictive clothing that is too tight in the abdomen.

Type II Rolling and Type III Mixed may require surgery if they become symptomatic. In Type IV, when organs such as the small bowel, colon, or pancreas are trapped in the chest, surgery is often necessary.⁶

Surgery¹

Surgery may be required for people with a hiatal hernia who have severe, long-lasting esophageal reflux and its symptoms are not relieved by medical treatments or lifestyle changes.

There are three primary surgical options for hiatal hernia repair: open, laparoscopic, and robotic. The appropriate type of surgery for you may depend on the size, severity, and location of your hernia. Ask your doctor about which option is right for you.

• Open: The traditional method for hernia repair, open surgical procedure involves your surgeon making an incision in the abdomen above the hernia.
• Laparoscopic: A minimally invasive technique, your surgeon will make several small, half-inch incisions. Through one “key-hole,” he/she will insert a thin tube with a video camera attached. Repairs will be made through the other incisions using thing instruments that are guided by the camera.
• Robotic: Similar to laparoscopic repair, a robotic hernia repair is a minimally invasive surgery requiring small incisions where the surgeon controls the procedure from a specialized robotic console.⁷ Patients may also experience a faster recovery following robotic surgery compared to an open surgery.⁸

Surgery may be needed if the hernia is causing your blood supply to be cut off or if you have severe GERD-like symptoms that do not respond to medical treatments. Be sure to talk to your doctor about diagnosing or treatment options if you are experiencing hiatal hernia symptoms.

If you’re concerned about the possibility of a hiatal hernia, contact your doctor or schedule a hernia consultation as soon as possible.

The guidance provided in this article follows general rules that should be discussed with your doctor. This article is for informational and educational purposes only. It does not substitute for medical advice. If in doubt, always consult your doctor.