Why are Hiatal Hernia Symptoms Getting Worse? 10 Causes Explained.

Our content is not intended nor recommended as a substitute for medical advice by your doctor. Use for informational purposes only.

1. Food: The most common cause of worsening hiatal hernia symptoms.

Hiatal hernia is one of the chief causes of gastroesophageal reflux disease (the presentation of hiatal hernia). Eating or drinking foods that can trigger a hiatal hernia will worsen your symptoms.

Food can worsen hiatal hernia symptoms by different mechanisms:

  • Large meals that trigger more reflux episodes (full stomach).
  • The affection of the tone of the lower esophageal sphincter.
  • Increasing the acidity of your stomach contents.

If your hiatal hernia is getting worse, always think of what you eat and drink.

Possible foods that may trigger GERD symptoms and hiatal hernia flare-up (reference).

  • Fatty foods.
  • Fried food.
  • Spicy food.
  • Tomatoes and their derivatives (salsa, tomato sauce).
  • Soft drinks.
  • Coffee and caffeinated drinks.
  • Peppermint and peppermint oil.
  • Citrus fruits such as oranges, lemon.
  • Alcoholo.
  • Onions and garlic.
  • Chocolate.
  • Whole milk.


  • Heartburn after eating certain types of food.
  • Regurgitation of sore fluid or food particles.
  • Nausea.
  • Vomiting.
  • Hiccough.
  • Anorexia and early satiety.
  • Upper-middle abdominal pain or discomfort.
  • The symptoms are often triggered every time you consume one or more of the offending foods.

2. Straining (occasional or habitual).

A hiatal hernia has defined a bulge of your abdominal contents into your chest cavity through an opening in the diaphragm.

Any condition that leads to increased pressure inside your abdominal cavity will push the hernia contents into the chest.

So, straining for any reason can be the reason why your hiatal hernia is getting worse.

Examples of common conditions that lead to straining:

  • Lifting heavyweight.
  • Chronic cough.
  • Chronic constipation and straining during bowel movements.
  • Vigorous physical exercise.
  • Hiccough.
  • Forceful vomiting.

For example, Heavy weight lifting is one of the significant causes of hiatal hernia flare-ups. In addition, patients who lift heavy weight have a 3.6 times higher risk of recurrent hiatal hernia (reference).

3. False Dietary and lifestyle habits.

The following dietary habits will make your hiatal hernia symptoms worse:

  • Overeating: a single large meal can worsen your hiatal hernia, even if it is a healthy meal. Try to eat smaller, more frequent meals instead of two or three large meals a day.
  • Eating before bedtime: This is a significant factor. Going to bed directly after eating will trigger reflux symptoms when you have a hiatal hernia. early meals (4-6 hours before bedtime) improve GERD symptoms. (reference).
  • Laying down directly after eating: laying down on your couch to scrolling social media or watching TV can trigger reflux symptoms.

4. Not elevating your head during sleep.

Head elevation during sleep consistently improved the reflux symptoms in patients with GERD (with or without hiatal hernia) (reference).

Sleeping without head elevation will make your symptoms worse. Instead, use multiple pillows or a specialized wedge pillow to decrease the number of hiatal hernia attacks.

wedge pillows for GERD

5. Large-sized hiatal hernia inside your chest.

In patients with paraesophageal hiatal hernia, a significant part of your stomach can get trapped inside the chest cavity. As a result, this portion will be unable to receive food and drinks.

The remaining portion can be significantly small to cause symptoms every time you eat. This will make your hiatal symptoms worse even with compliance to the diet.

The decreased capacity of your stomach will cause symptoms such as:

  • Upper-middle abdominal pain after eating.
  • Fullness and bloating after eating very little.
  • Nausea, vomiting, or both.
  • Worsening reflux symptoms (heartburn and regurgitation).

6. Strangulated hernia.

A strangulated Hiatal hernia is a medical emergency. It occurs when the hernia cannot slip back into the abdomen together with cutting off its blood supply.

The herniated part will no longer be able to receive blood because of the strangulation. This will lead to dramatic worsening of the hiatal hernia symptoms such as:

  • Extreme abdominal pain that progresses over time.
  • Persistent vomiting.
  • Severe tenderness and pain on touching the abdomen.
  • Vomiting of blood or passage of dark stool.
  • In severe cases, low blood pressure with confusion, fast heartbeats, shortness of breath, and coma can occur.

Fortunately, this complication is rare. Nevertheless, go to the ER or call 911 immediately if you have such extreme symptoms.

8. Reflux of acid into the throat or lungs.

Hiatal hernia leads to the reflux and regurgitation of acid and food up to your throat and oral cavity. Eventually, the acid may enter your airways during sleep or cough and cause chest problems.

The reflux of acid into your throat and chest is a sign of worsening hiatal hernia. Symptoms include (reference):

  • Chronic or recurrent cough.
  • Sore throat that is not going away.
  • Hoarseness of voice.
  • A globus sensation in your throat.
  • Shortness of breath in attacks (reflux asthma).
  • Chest infection (pneumonia).

9. Development of Cameron ulcers.

In 1986, Dr. Cameron first described linear (elongated) stomach ulcers associated with large Hiatal hernias. Later, this type of ulcer was named after his name (Cameron lesions) (reference).

Cameron lesions can cause worsening in the symptoms of hiatal hernia together with bleeding.

Symptoms include:

  • Severe heartburn or epigastric pain (worsening of the existing hiatal hernia pain.
  • Vomiting of blood.
  • Passage of black stool (melena).
  • Symptoms of anemia and blood loss as easy fatigue, fast heartbeats, shortness of breath, dizziness, and others.

10. development of barret’s esophagus and esophageal strictures.

A long-lasting hiatal hernia with an inflamed esophagus can produce permanent damage in your esophagus.

The permanent damage can be in the form of (reference):

  • Barret’s esophagus: a pre-cancerous condition in which the esophageal lining cells change another type due to chronic irritation.
  • Esophageal stricture: narrowing of the lower esophagus as a result of fibrosis and chronic inflammation.
  • Achalasia: extreme esophageal dilatation as a result of narrowing or partial obstruction at the lower esophagus.

The above condition will make your hiatal hernia symptoms worse. Symptoms may include:

  • Dysphagia (difficulty swallowing).
  • Regurgitation of undigested food (food that accumulates in the esophagus without reaching the stomach).
  • Recurrent or persistent vomiting.
  • Odynophagia (painful swallowing).
  • Weight loss.
  • Loss of appetite (anorexia).