Most hiatal hernias don’t need to be “gotten rid of” at all. The overwhelming majority of diagnosed cases never require surgery, and small, symptom-free hernias are typically managed with observation alone. But if your hernia is causing persistent heartburn, chest pain, or difficulty swallowing, there’s a clear ladder of treatments, from simple habit changes to minimally invasive procedures, that can either eliminate your symptoms or fix the hernia itself.
Why Most Hiatal Hernias Don’t Need Fixing
A hiatal hernia happens when part of your stomach pushes up through the opening in your diaphragm where your esophagus passes through. The most common type, called a sliding hernia, is often small and causes no symptoms at all. Clinical guidelines recommend that these symptom-free hernias simply be watched over time. Many people have one and never know it.
The real problem isn’t the hernia itself. It’s what the hernia does to the valve between your esophagus and stomach. When that valve weakens, stomach acid flows upward, causing reflux. So treatment decisions are based on how much trouble the hernia is actually causing: the size, the type, the severity of your symptoms, and whether medications are keeping things under control.
Lifestyle Changes That Reduce Symptoms
For many people, changing a few daily habits is enough to make a hiatal hernia essentially a non-issue. These changes won’t shrink the hernia, but they reduce the acid reflux and discomfort it causes.
Eat smaller meals more frequently instead of two or three large ones. After eating, stay upright for at least two to three hours before lying down, which means no late-night snacking. If nighttime reflux is a problem, elevating the head of your bed by six inches (using blocks under the bed frame, not extra pillows) helps gravity keep acid where it belongs.
Certain foods and drinks tend to make symptoms worse: chocolate, mint, alcohol, spicy foods, high-fat foods, pepper, and caffeinated drinks like coffee, tea, colas, and energy drinks. You don’t necessarily need to cut all of these out permanently. Try eliminating one at a time and see if your symptoms improve. Losing weight also helps if you’re carrying extra pounds, since abdominal fat increases pressure on the stomach and pushes it upward through the diaphragm opening.
Medications for Acid Control
When lifestyle changes aren’t enough on their own, acid-reducing medications are the next step. Two main types are available over the counter.
H2 blockers (like famotidine, sold as Pepcid) reduce acid production and work well for occasional or mild symptoms. The downside is they gradually lose effectiveness with consistent daily use. If you find yourself reaching for them every day, a proton pump inhibitor, or PPI, is a better long-term option. PPIs block acid production more completely and are the standard treatment for chronic reflux caused by a hiatal hernia.
Many people manage their hiatal hernia symptoms for years with a combination of lifestyle adjustments and a daily PPI. This approach doesn’t repair the hernia, but it controls the main consequence of having one.
The Heel Drop Technique
You may have come across advice about a physical maneuver that involves drinking a glass of room-temperature water, then rising up on your toes and dropping sharply onto your heels 10 to 15 times. The idea is that the weight of the water in your stomach, combined with the gentle jolt, helps pull the stomach back down below the diaphragm.
This technique is popular in alternative health circles, and some people report temporary symptom relief. However, there is no clinical research confirming that it actually repositions the stomach or has any lasting effect on a hiatal hernia. It’s unlikely to cause harm if you try it, but it shouldn’t replace proven treatments if your symptoms are significant.
When Surgery Becomes the Right Option
Surgery enters the conversation when medications and lifestyle changes aren’t controlling your symptoms, or when the hernia is large enough to pose risks on its own. According to guidelines from the Society of American Gastrointestinal and Endoscopic Surgeons, candidates for repair include people with persistent symptoms that can’t be explained by another condition, those with objective evidence of reflux damage, and those showing signs of stomach contents reaching the lungs (micro-aspiration). If a large hernia is found but isn’t causing problems, and you understand the small risk of it twisting on itself over time, watchful waiting is a reasonable choice.
Nissen Fundoplication
The traditional surgical fix is called a Nissen fundoplication. A surgeon wraps the top of your stomach around the lower esophagus to recreate a tight valve that prevents acid from flowing upward. At the same time, the hernia itself is repaired by closing the widened opening in the diaphragm. This is now done laparoscopically through small incisions, making recovery much faster than open surgery.
Most people can return to normal daily activities within a few days, though strenuous exercise is typically restricted for several weeks. You’ll eat soft foods for the first week to 10 days. The procedure is effective, but about 10% of people eventually need a second surgery. Some people experience side effects like difficulty swallowing, bloating, or trapped gas because the new valve is intentionally tight. These issues can persist for months and, in some cases, the valve loosens within eight to 10 years.
Transoral Incisionless Fundoplication (TIF)
A newer, less invasive option called TIF rebuilds the valve between the esophagus and stomach using a device passed through the mouth, with no external incisions at all. The valve created with TIF tends to be longer and not as tight as one made during a Nissen procedure, which translates to fewer side effects like swallowing difficulty and bloating.
TIF does have limits. It works best for people with small hiatal hernias, generally under 2 centimeters. Larger hernias need to be repaired laparoscopically first, sometimes in a combined procedure. Before being approved for TIF, you’ll undergo pH monitoring with a small capsule to measure the severity of your reflux and confirm you’re a good candidate. If symptoms return after TIF, some people need a repeat procedure or go back to taking PPIs.
Signs That Need Emergency Attention
Hiatal hernias rarely become emergencies, but it can happen. A strangulated hernia occurs when the portion of stomach that’s pushed through the diaphragm gets its blood supply cut off. This is a medical emergency.
Warning signs include sudden, severe abdominal pain that keeps getting worse and doesn’t let up, nausea and vomiting, and skin color changes around the area of the hernia (the skin may turn reddish, then noticeably darker than usual). If you experience these symptoms together, call 911. A strangulated hernia requires immediate surgery to restore blood flow before the tissue is permanently damaged.