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Under normal circumstances, the hiatus is a small opening in the muscular diaphragm at the juncture where the esophagus meets the stomach. A hiatal hernia develops when the opening widens and allows the upper part of the stomach to protrude upward through the hiatus. Some hiaal hernias are present at birth. Most of them, however, develop during life as the opening of the hiatus becomes stretched, often as a result of pregnancy or excessive weight gain, both of which place upward pressure on the stomach. Severe coughing, vomiting, straining when moving the bowels, or sudden physical exertion may also stretch the hiatus. Although hiatal hernias are quite common, occurring in almost half of the North American population, most people are unaware of the condition because they don’t experience symptoms. A hiatal hernia is usually diagnosed after recurring bouts of indigestion and heartburn, typically as a result of acid reflux into the esophagus. The condition is usually not considered serious. There are, however, exceptions in which frequent exposure to stomach acids causes severe esophageal damage. In such cases, surgical treatment is necessary.