Hiatal hernias are extremely common. They are one of the most frequently encountered findings on imaging studies, and most are discovered by accident during chest X-rays or CT scans done for completely unrelated reasons. While exact prevalence numbers vary depending on the population studied and the method of detection, the condition is widespread enough that many gastroenterologists consider small hiatal hernias a near-normal finding, especially in older adults.
How Common They Are by Age
Hiatal hernias become increasingly common with age. The opening in your diaphragm where the esophagus passes through can gradually widen over decades of use, allowing part of the stomach to slide upward into the chest cavity. This process is slow and cumulative, which is why the condition is far more prevalent in people over 50 than in younger adults. Some estimates suggest that roughly half of adults over 60 have at least a small hiatal hernia, though many sources note exact population-wide numbers are hard to pin down because so many cases go undetected.
Children and young adults can develop hiatal hernias too, but it’s much less typical. In younger people, the cause is more often related to a congenital difference in the diaphragm or to significant physical strain.
Most Cause No Symptoms at All
One reason hiatal hernias are so “common” yet unfamiliar to many people is that the vast majority never cause noticeable problems. Most are found incidentally, meaning a doctor spots them on imaging ordered for something else entirely. A small sliding hernia, where the junction between the esophagus and stomach slips above the diaphragm, often produces no symptoms and requires no treatment. Many people live their entire lives without knowing they have one.
When symptoms do occur, they typically involve acid reflux: heartburn, regurgitation, or a sour taste in the back of the throat. This happens because the hernia can weaken the natural valve between your stomach and esophagus, making it easier for stomach acid to flow the wrong direction. Between 50% and 94% of people with reflux-related inflammation of the esophagus also have a hiatal hernia, compared to only 13% to 59% of people without reflux problems. The two conditions are closely linked, but having a hiatal hernia does not guarantee you will develop reflux.
The Two Main Types
Not all hiatal hernias are the same. The sliding type (called Type I) accounts for 95% to 99% of all cases. In this version, the upper portion of the stomach and the junction with the esophagus slide upward through the diaphragm opening. These hernias often move in and out of position, which is why they can be tricky to catch on a single imaging study.
The remaining 1% to 5% are paraesophageal hernias (Types II through IV), where a portion of the stomach pushes up alongside the esophagus rather than sliding through with it. These are less common but more concerning because the herniated stomach tissue can become trapped or lose its blood supply. The rarest subtype, a giant hiatal hernia, occurs in roughly 0.1% of cases and sometimes involves other abdominal organs pushing through the diaphragm opening as well.
Obesity Significantly Raises the Risk
Carrying extra weight is one of the strongest risk factors. In a study of people with severe obesity (average BMI of 43), 37% had a hiatal hernia on imaging. That’s notably higher than rates seen in the general population. The mechanism is straightforward: excess abdominal fat increases pressure inside the abdomen, which pushes the stomach upward against the diaphragm over time. Nearly 40% of the same group also showed signs of acid reflux, and the two findings frequently appeared together.
Other factors that increase abdominal pressure can contribute as well. Heavy lifting, chronic coughing, frequent straining during bowel movements, and pregnancy all place extra force on the diaphragm. Age-related weakening of the muscle and connective tissue around the diaphragm opening makes the area more vulnerable to these pressures.
When Treatment Becomes Necessary
Because most hiatal hernias are small and silent, they typically need no treatment. If yours was found incidentally and you have no symptoms, your doctor will generally leave it alone.
For hernias that cause reflux symptoms, treatment usually starts with lifestyle changes (losing weight, eating smaller meals, not lying down after eating) and acid-reducing medications. These steps manage the reflux rather than fixing the hernia itself, and they work well for most people.
Surgery is reserved for cases where symptoms are severe, medications aren’t effective, or the hernia is the paraesophageal type with a risk of complications. Data from a large European surgical registry shows that hiatal hernia repairs have been increasing steadily, from just 198 recorded procedures in 2010 to nearly 3,500 in 2019. Among those surgical patients, about 58% had the common sliding type, 32% had paraesophageal hernias, and 10% were repeat repairs for hernias that had recurred after a previous surgery. The growing numbers likely reflect better detection through widespread imaging rather than an actual increase in the condition itself.
What a Diagnosis Actually Means
If you’ve been told you have a hiatal hernia, you’re in very large company. For the overwhelming majority of people, it’s a minor anatomical variation that will never affect daily life. The size of the hernia matters more than its mere existence. Small sliding hernias rarely progress or cause trouble. Larger hernias, and especially paraesophageal types, deserve closer monitoring because they carry a small but real risk of complications like difficulty swallowing, chest pain, or in rare cases, a medical emergency if stomach tissue becomes trapped.
Paying attention to reflux symptoms is the most practical thing you can do. If heartburn becomes frequent or persistent, or if you develop new difficulty swallowing, those are signals worth investigating, whether or not you already know about a hernia.