Introduction
More than half of middle-aged people have a hiatal hernia (sometimes referred to as a “hiatus hernia“), but most people are only diagnosed when their symptoms become problematic, or inadvertently when having medical tests for something else.
A hiatal hernia is where part of the stomach bulges up through the space (called a “hiatus”, meaning a “gap”) in the diaphragm/abdominal wall where the esophagus normally passes.
Types of Hiatal Hernias
There are two types of hiatal hernias: the sliding type and the fixed type.
The sliding type of hiatal hernia is the more common type and occurs intermittently when the pressure in the abdomen increases. This increased pressure pushes part of the stomach up through the gap in the diaphragm, where only the esophagus is supposed to pass.
The fixed type of hiatal hernia is also called a paraesophageal hiatal hernia and occurs when the opening for the esophagus in the abdominal wall is bigger than usual. The stomach, and sometimes other organs, including the small intestine or colon, may also bulge into the chest cavity through this paraesophageal hernia. Paraesophageal hernias often get worse over time, in which case surgery is required.
A strangulated hernia is not a type of hernia, but rather a significant complication in any one of several different types of hernias. This is a serious condition where the blood supply to the stomach, intestines, or other organs is being cut off because of that part of the body being forced into the small hole of the hernia, and requires immediate medical attention.
What Causes a Hiatal Hernia?
A common contributing factor to the development of a hiatal hernia is obesity — especially when people are carrying their weight around their middles. The presence of increased fat around their internal organs (called visceral fat), as well as the excess fat under their skin (called subcutaneous fat), contributes to increased abdominal pressure, especially when the individual is sitting, bending, or lifting heavy objects.
Other contributing factors are frequent coughing (sometimes secondary to smoking), straining due to constipation, or it may simply be hereditary.
Symptoms of a Hiatal Hernia
Many people with hiatal hernias have no symptoms and don’t even know they have one! However, if their waist-to-height ratio is greater than 0.50, they may be advised to lose weight around the abdomen to reduce pressure. Reducing fat around the belly can prevent the stomach from being pushed up through the hernia [1].
Symptoms may include heartburn, chest pain or pressure, coughing, or frequent burping. Many people with a hiatal hernia have also been diagnosed with GERD (gastroesophageal reflux disease). Simple dietary and lifestyle changes often greatly reduce or even eliminate the symptoms of both.
Final Thoughts
Losing weight, especially around the belly, and simple dietary and lifestyle changes can significantly improve the symptoms that result from a hiatal hernia, as well as GERD, which often accompanies it.
More Info?
I have a hiatus hernia education session that is available as an add-on to the Comprehensive Dietary Package. You can learn about me here.
To your good health!
Joy
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References
- Ashwell M, Mayhew L, Richardson J, Rickayzen B. Waist-to-Height Ratio Is More Predictive of Years of Life Lost than Body Mass Index. PLoS One. 2014 Sep 8;9(9):e103483. [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0103483]
- HealthLink BC. Hiatal Hernia. 2020. [https://www.healthlinkbc.ca/health-topics/hiatal-hernia]
- Simic PJ. Hiatal Hernia. eMedicineHealth. 2020 Mar 3. [https://www.emedicinehealth.com/hiatal_hernia/article_em.htm]
© 2025 BetterByDesign Nutrition Ltd.
Joy is a Registered Dietitian Nutritionist and owner of BetterByDesign Nutrition Ltd. She has a postgraduate degree in Human Nutrition, is a published mental health nutrition researcher, and has been supporting clients’ needs since 2008. Joy is licensed in BC, Alberta, and Ontario, and her areas of expertise range from routine health, chronic disease management, and digestive health to therapeutic diets. Joy is passionate about helping people feel better and believes that Nutrition is BetterByDesign©.