Many healthy people age 50 and over experience a small hiatal hernia, although hiatal hernias usually do not require treatment. However, treatment may be necessary if the hernia is in danger of becoming strangulated (twisted in a way that cuts off blood supply). Treatment may also be needed if the hernia is causing esophagitis (inflammation of the esophagus) or a condition called gastroesophageal reflux disease or GERD. In such cases, a doctor may perform surgery to reduce the size of the hernia or to prevent strangulation.

Untreated hernias can cause pain and health problems.  Therefore, the goals of hiatal hernia treatment are to relieve symptoms and prevent complications.  Your doctor may recommend lifestyle changes and weight loss to help you manage the symptoms of a hiatal hernia once you have been diagnosed.  If lifestyle changes and weight loss aren't effective, some antacids or other medicines may help ease symptoms.  If these don't help, you may need surgery.

Lifestyle
If you experience symptoms of a hiatal hernia you might try eating small meals, avoiding certain foods, not smoking or drinking alcohol, and losing weight to help alleviate the symptoms. A high-fiber diet combined with plenty of fluids can help avoid constipation and strain during bowel movements. Losing weight can reduce abdominal strain as well.

Medications
Reducing the backflow of stomach contents into the esophagus (gastro esophageal reflux) can help relieve pain caused by a hiatal hernia. Medications that neutralize stomach acidity, decrease acid production, or strengthen the lower esophageal sphincter (the muscle that prevents acid from backing up into the esophagus) may be prescribed.

Prevention
For those who've had hernia surgery and for those who want to try to avoid getting a hernia in the first place, there are some ways to reduce your hernia risk. Basically, this involves avoiding those things that contribute to hernias. For example, avoid heavy lifting or strain. 

Surgery
The most common treatment for a hernia is surgery to repair the opening in the muscle wall.  Operations for hernias are among the most common procedures performed today. In fact, about 750,000 hernia repairs are performed annually.  If you are experiecing a paraesophageal or mixed hiatal hernia, surgery generally is recommended to avoid complications. Consult your doctor for more information.

1. Conventional surgery - Surgery involves an abdominal incision, after which the protruding tissue is either removed or pushed back into the abdomen and the abdominal wall is repaired and strengthened. The abdominal wall can be strengthened by sewing surrounding muscle over it, or it can be strengthened with a special type of mesh. There have been reports of complications with some mesh products. The Food and Drug Administration (FDA) says patients who are considering hernia surgery should let the surgeon know about any past reaction to materials used in surgical mesh or sutures.
2. Laparoscopic surgery - During a laparoscopic fundoplication, small (1 cm) incisions are made in the abdomen, through which instruments and a fiber optic camera are passed. The operation is performed using these small instruments while the surgeon watches the image on a video monitor. Laparoscopic fundoplication results in less pain and shorter hospitalization times than the open operation.

Occasional or mild symptoms of hiatal hernia can generally be treated with home treatment, including lifestyle changes and nonprescription medicines.  However, some cases require or respond best to surgery.  For more information or if you have any concerns about treating hiatal hernia, talk with your doctor.