Joey Jarrard Joey Jarrard

The truth about hiatal hernias

So, Your Doctor Says You Have a Hiatal Hernia—Is That Bad?

Let’s break it down.

First Things First: It’s Common

Hiatal hernias are actually pretty common. There are different types, each with varying symptoms, risks, and treatment approaches. In this post, I’ll cover the basics and offer a clear overview—no complicated jargon (for the most part). We’ll save the deep dive for your appointment!

What Is a Hiatal Hernia?

Your diaphragm, a large muscle that helps you breathe, separates your chest (thoracic cavity) from your belly (abdominal cavity). Above the diaphragm: your heart, lungs, and esophagus. Below it: your stomach, liver, intestines, etc.

There’s a natural opening in the diaphragm—called the hiatus—that allows your esophagus to pass through and connect to your stomach. A hiatal hernia happens when part of the stomach pushes up through this opening into the chest.

Why the Hiatus Matters

The area where the esophagus transitions to the stomach is called the gastroesophageal junction—and it’s where your body’s natural reflux "valve" lives. This valve relaxes to let food into the stomach, then contracts to keep stomach contents from coming back up.

But when pressure increases in your abdomen—like from coughing, sneezing, lifting, weight gain, or pregnancy—it can push the stomach upward through the hiatus. That disrupts the valve and often leads to acid reflux or GERD (gastroesophageal reflux disease).

Types of Hiatal Hernia

There are four types of hiatal hernia:

  • Type 1: Sliding Hernia
    The most common kind. The gastroesophageal junction moves (or “slides”) above the diaphragm. These typically cause reflux and are managed with medication. Surgery is only needed if symptoms persist despite treatment.

  • Type 2: Paraesophageal Hernia
    The junction stays in place, but part of the stomach pushes through the hiatus. Much less common and more likely to cause swallowing issues than reflux.  These should be repaired surgically.

  • Type 3: Mixed Hernia
    A combination of types 1 and 2—the junction and part of the stomach move above the diaphragm. These vary in size and severity, but often require surgical repair.

  • Type 4: Complex Hernia
    The stomach plus another organ (like the colon or spleen) move into the chest. These also typically require surgical repair.

Why Fix a Hernia?

You might wonder, “What happens if I don’t fix it?” Let’s break this down into two main types of problems that can develop.

1. Reflux-Related Problems

Acid reflux might seem like a nuisance, but it’s more serious than you think. Chronic exposure to stomach acid can cause:

  • Inflammation

  • Ulcers or bleeding

  • Barrett’s esophagus (a risk factor for developing cancer)

  • Esophageal cancer

Concerned about long-term medication use? It's a common question. Yes, acid-reducing meds have side effects. But overall, they’re safer than surgery and much safer than letting reflux go unchecked.

2. Mechanical Problems from the Hernia Itself

When the stomach lives in the chest, it crowds out space meant for your heart and lungs. This can lead to:

  • Trouble swallowing

  • Chest pain or shortness of breath

  • Aspiration (food/liquid going into the lungs)

  • Pneumonia or chronic lung disease

  • Gastric volvulus – a dangerous twisting of the stomach, which can cut off its blood supply and become life-threatening without emergency surgery

Bottom Line

Hiatal hernias are common—and not always a cause for alarm. Here’s what to ask your doctor:

  • What type of hernia do I have?

  • Are my symptoms under control?

  • Do I need a surgical opinion?

If you have a small sliding hernia with manageable symptoms, you probably don’t need surgery. But if it’s larger or your symptoms are worsening, it’s worth seeing a specialist—even if you’ve been told your hernia is “too big to fix” or has come back after prior surgery.

When in doubt, ask and find out.

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