Does Your Dog Have a Hiatal Hernia?
Regurgitation, gagging, and drooling after meals. Here's what a hiatal hernia looks like in dogs and how it's managed.
If your dog keeps bringing food back up right after eating, or you’ve noticed chronic gagging and drooling that won’t quit, a hiatal hernia might be what’s going on. Here’s what that means: part of your dog’s stomach is slipping up through the diaphragm, the muscle wall separating the chest from the abdomen, into the chest cavity. When that happens, acid and stomach contents can wash back into the esophagus, causing real discomfort and, over time, serious complications. It’s especially common in flat-faced breeds like Bulldogs and French Bulldogs.
TL;DR
- A hiatal hernia in dogs happens when part of the stomach pushes up through the diaphragm into the chest, causing acid reflux, regurgitation, and discomfort.
- Flat-faced breeds like Bulldogs and French Bulldogs are most at risk, often due to brachycephalic obstructive airway syndrome (BOAS) creating abnormal chest pressure.
- Signs to watch for include regurgitation, vomiting, gagging, drooling, poor weight gain, and coughing after meals.
- Most dogs are managed with reflux medications and feeding adjustments first; surgery (like gastropexy) is reserved for severe or unresponsive cases.
- Vet imaging, long-term medication like omeprazole, and potential surgery can get costly fast, so enrolling in pet insurance before symptoms start matters.
What is a hiatal hernia in dogs?
Your dog’s diaphragm has a small natural opening called the esophageal hiatus, which lets the esophagus (the food tube) pass through on its way to the stomach. A hiatal hernia happens when that opening becomes too large or too loose, allowing part of the stomach to slide up into the chest where it doesn’t belong.
There are two main types. A sliding hiatal hernia is the most common: the stomach slides back and forth through the hiatus depending on body position or breathing pressure. A fixed hernia (also called a paraesophageal hernia) is less common and more serious, where part of the stomach stays permanently in the chest. Most dogs have the sliding type, which is why symptoms often come and go rather than being constant.
Some dogs are born with this, known as a congenital hiatal hernia. Others develop it after trauma, or as a secondary effect of brachycephalic obstructive airway syndrome (BOAS), where the effort of breathing through narrow airways creates pressure changes in the chest that pull the stomach upward.
What are the signs your dog might have a hiatal hernia?
The symptoms are mostly tied to gastroesophageal reflux (acid from the stomach washing back up into the esophagus) and the irritation it causes. What you’ll likely notice at home:
- Regurgitation: Food or liquid coming back up passively, often right after eating, without the heaving motion of vomiting
- Vomiting: More active than regurgitation, and may include bile or stomach acid
- Gagging or retching: Especially after meals or during exercise
- Excessive drooling: Often a sign of nausea or esophageal irritation
- Poor weight gain: Especially in puppies, who can’t hold food down long enough to absorb it
- Coughing: Particularly after eating, which can be an early sign of aspiration pneumonia (a dangerous complication where stomach contents are inhaled into the lungs)
- Discomfort or restlessness after meals
If your dog is coughing frequently, breathing harder than usual, or running a fever alongside any of these signs, call your vet right away. Aspiration pneumonia can develop quickly and needs prompt treatment.
What are the causes and which dogs are most at risk?
Hiatal hernias can be congenital (present from birth) or acquired later in life. The most common causes and risk factors include:
- Genetics and congenital defects: Some dogs are simply born with a looser or larger hiatal opening
- Brachycephalic obstructive airway syndrome (BOAS):The abnormal breathing effort in flat-faced breeds like Bulldogs, French Bulldogs, Pugs, and Boston Terriers creates negative pressure in the chest that physically tugs the stomach upward
- Trauma: A hard impact (like being hit by a car) can disrupt the diaphragm and cause a hernia
- Chronic increased abdominal pressure: From persistent vomiting or respiratory disease
Brachycephalic breeds deserve a special mention here. BOAS is a structural condition caused by the way flat-faced dogs are built: narrowed nostrils, an elongated soft palate, and a narrowed trachea all make every breath harder work than it should be. That extra breathing effort creates pressure changes in the chest cavity that, over time, can pull the stomach partially through the diaphragm. It’s a cycle: BOAS worsens the hernia, and the hernia worsens reflux, which can further irritate the airways. Managing BOAS is often a key part of managing the hernia itself.
How is a hiatal hernia diagnosed?
Your vet will likely start with a physical exam and a detailed history of your dog’s symptoms. From there, the main diagnostic tools are imaging-based.
- X-rays: chest X-ray can sometimes show the stomach or gas pockets sitting above the diaphragm where they shouldn’t be. Because sliding hernias come and go, a single X-ray might look normal even in an affected dog.
- Fluoroscopy: A real-time moving X-ray that lets your vet watch your dog swallow and see what’s happening in the esophagus and stomach in motion. This is especially useful for catching sliding hernias and confirming reflux.
- Endoscopy: A small camera passed down the esophagus to look directly at the lining and check for esophagitis (inflammation and irritation of the esophagus from repeated acid exposure).
Treatment and managing reflux at home
Many dogs with hiatal hernias respond well to medical management, especially if the hernia is mild to moderate. Surgery is reserved for dogs who don’t improve with medication or whose hernia is severe.
Medical treatment
Your vet may recommend one or more of the following, always tailored to your dog’s specific situation:
| Medication | What it does |
|---|---|
| Proton pump inhibitors (like omeprazole) | Reduces the amount of acid the stomach produces, limiting damage to the esophagus from reflux |
| Antacids or H2 blockers | Additional acid-control options often layered in alongside other medications |
| Prokinetics | Help the stomach empty faster and keep contents moving in the right direction, reducing reflux |
| Sucralfate | Coats and protects the lining of an irritated esophagus |
Managing reflux at home
Medication works best when paired with consistent daily habits. Here’s what makes a real difference:
- Elevated feeding: Raise your dog’s bowl so they eat with their head slightly up, reducing how much food and acid travels back toward the esophagus.
- Small, frequent meals: Split daily food into three or four smaller portions instead of one or two large ones to reduce stomach pressure.
- No exercise right after eating: Keep your dog calm for 30 minutes post-meal to let gravity do its job.
- Weight control: Extra weight adds pressure to the abdomen and worsens hernias. Keeping your dog lean matters.
- Elevated sleeping position: Letting your dog sleep with their front end slightly raised can help reduce overnight reflux.
- Manage BOAS proactively: If your Bulldog or French Bulldog also has BOAS, talk to your vet about corrective airway surgery. Reducing breathing effort can directly improve hernia symptoms.
- Watch for aspiration pneumonia: Coughing after meals, labored breathing, fever, or lethargy are warning signs that stomach contents may have been inhaled into the lungs. This needs emergency vet care.
Surgical treatment
When medical management isn’t enough, surgery becomes the next step. The most common procedure is a gastropexy, where the surgeon anchors the stomach to the abdominal wall so it can no longer slide up through the diaphragm. The hiatal opening may also be surgically tightened. Costs vary widely depending on severity, facility, and location, but can range from several thousand dollars or more for complex cases requiring specialist care.
Does pet insurance cover hiatal hernias in dogs?
Yes, hiatal hernias are eligible for coverage under a Lemonade Pet accident and illness policy, when the condition isn’t pre-existing. That means your dog shouldn’t be showing any signs or symptoms before your policy starts or during your waiting period.
The diagnostic workup alone, including X-rays, fluoroscopy, and possible endoscopy, adds up quickly. Add long-term medications like omeprazole and potentially a gastropexy surgery, and the costs can be significant. For flat-faced breeds especially, getting coverage in place while your dog is young and healthy is what makes it actually useful when you need it.
Before we go
Watching your dog struggle with chronic regurgitation or gagging is hard. The reassuring part is that hiatal hernias are manageable, especially when caught early and treated consistently. Stay on top of the feeding routine, keep up with medications, and don’t ignore signs that something might be escalating. If your dog is a flat-faced breed, it’s worth having a proactive conversation with your vet before symptoms develop.
And if your dog isn’t already covered, now is a good time to look into it.
Frequently Asked Questions
What is the difference between regurgitation and vomiting in dogs with a hiatal hernia?
Regurgitation is passive: food or liquid flows back up without effort, often immediately after eating, and the food looks undigested. Vomiting is more active and involves abdominal heaving. Dogs with hiatal hernias often regurgitate rather than vomit, though both can occur.
Is a hiatal hernia in dogs curable?
It depends on the severity. Many dogs are successfully managed long-term with medication and feeding adjustments. Dogs who don’t respond to medical treatment may need surgery, such as a gastropexy, which can resolve the hernia effectively.
Why are Bulldogs and French Bulldogs more likely to get hiatal hernias?
Flat-faced breeds have brachycephalic obstructive airway syndrome (BOAS), which makes breathing harder work. That extra effort creates abnormal pressure in the chest that can pull the stomach up through the diaphragm over time.
How is a hiatal hernia diagnosed in dogs?
Vets typically use chest X-rays and sometimes fluoroscopy (a real-time moving X-ray) to catch the stomach sitting above the diaphragm or to observe reflux in action. Endoscopy may also be used to check for esophageal inflammation (esophagitis).
A few quick words, because we <3 our lawyers: This post is general in nature, and any statement in it doesn’t alter the terms, conditions, exclusions, or limitations of the policies issued, which differ according to your state of residence. You’re encouraged to discuss your specific circumstances with your own professional advisors. The purpose of this post is merely to provide you with info and insights you can use to make such discussions more productive! Naturally, all comments by, or references to, third parties represent their own views, and Lemonade assumes no responsibility for them. Coverage may not be available in all states. Please note that statements about coverages, policy management, claims processes, Giveback, and customer support apply to policies underwritten by Lemonade Insurance Company or Metromile Insurance Company, a Lemonade company, sold by Lemonade Insurance Agency, LLC. The statements do not apply to policies underwritten by other carriers.