Symptoms and Causes

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Symptoms

Small hernias
Most small hiatal hernias cause no problems.

Large hernias
Larger hernias may cause the following signs and symptoms when stomach acids back up into your esophagus.

Heartburn
Belching
Chest pain
Nausea
These signs and symptoms tend to become worse when you lean forward, strain, lift heavy objects or lie down, and they can also worsen during pregnancy.

In rare cases
Sometimes, the part of your stomach that protrudes into your chest cavity may become twisted (strangulated) or have its blood supply cut off, leading to:

Severe chest pain
Difficulty swallowing (dysphagia)
Obstruction of your esophagus

Causes
The exact cause of hiatal hernias isn't known. Your chest cavity and abdomen are separated by your diaphragm — a large dome-shaped muscle that's responsible for a major part of normal breathing. Your esophagus passes into your stomach through an opening in the diaphragm called the hiatus. Hiatal hernias occur when the muscle tissue surrounding this opening becomes weak, and the upper part of your stomach bulges up through the diaphragm into your chest cavity.

Pressure on the abdomen
Some people develop a hiatal hernia after an injury to the area. Others are born with an inherent weakness or an unusually large hiatal opening. But anything that puts intense pressure on your abdomen — including persistent or severe coughing or vomiting, pregnancy, straining while going to the bathroom, increased abdominal fluid or lifting heavy objects — can contribute to a hernia.