What Is a Hernia?
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Medically reviewed by Jay N. Yepuri, MD
A hernia occurs when the tissue or muscle of the abdominal wall tears or rips, allowing the contents of your abdomen to poke through. It occurs due to a weakness or hole in the fascia—the tissue that surrounds the muscles of the abdomen. Hernias are relatively common; about 27% of people assigned male at birth and 3% of people assigned female at birth develop an inguinal hernia, which is the most common type.
Hernias present as visible lumps in parts of the torso. They are caused by weakness or a hole in the fascia—the tissue that surrounds the muscles of the abdomen. They may be asymptomatic, or cause symptoms such as abdominal bulging and pain. Treatments for hernia depend on the type of hernia you have. Luckily, there are many highly effective options to manage all types of this condition.
Types
Hernias are primarily categorized by the part of the abdomen that’s affected. There are many types, with the most common including:
Inguinal: Inguinal hernia is the most common type of hernia, representing 73% of all hernia cases. It occurs as the intestines push through the inguinal canal, between the abdomen and groin.
Femoral: A femoral hernia is when fatty tissue or intestines poke into your groin at the thigh level. This type is more common if you’re assigned female at birth.
Umbilical: This type, a ventral (front-side) hernia, is caused when the muscles and tissues don’t finish forming—letting intestines or other tissues push through. It causes a bulge around the belly button.
Hiatal: Hiatal hernia is a rip or tear in the hiatus, the membrane that separates the abdomen from the chest, allowing the upper stomach to push through.
Incisional (also called ventral): Incisional hernias occur after abdominal surgery when tissues are able to poke through weakened areas caused by scar tissue.
Hernia Symptoms
The specific symptoms of hernias vary based on the type and individual case. In most cases, the visible bulge that forms won’t cause other symptoms.
Bulging
The primary sign of a hernia is the development of a protruding bulge at the area of weakness or a hole in the abdominal wall. This bulge may appear with certain activities and then disappear, before forming again. Where this area of swelling develops depends on the type you have, such as:
Inguinal hernia: Inguinal hernias affect the groin or area around it; it can affect the scrotum in people assigned male at birth.
Femoral hernia: Femoral hernia forms on the upper thigh and can affect the groin.
Umbilical hernia: The bulge occurs around the belly button.
Hiatal hernia: Hiatal hernia forms in the chest as the stomach pushes into the diaphragm.
Incisional (also called ventral) hernia: This type bulges out the front (ventral) side of your abdomen.
Pain and Discomfort
In most cases, hernia doesn’t cause pain; however, sometimes the lump that develops becomes tender or painful. You may feel pressure, a pinching, or a dull ache, especially when the hernia is pushing outward. Another potential symptom is a sensation of heaviness or pressure in the abdomen or groin.
Pain with Activity
If your hernia is causing pain or discomfort, it will likely get worse when you cough, strain in the bathroom, run, or lift heavy objects. In symptomatic cases, a telltale sign is increased pain and discomfort with physical activity.
What Causes a Hernia?
Hernias occur due to weaknesses or holes in the abdominal wall, a layer of skin, tissue (known as the peritoneum), and muscle that surrounds the stomach, intestines, liver, pancreas, gallbladder, and other organs. Because of the natural internal pressure within the abdomen (known as intrabdominal pressure), the organs, fat, and/or their surrounding tissues push out through the weak or damaged part of the abdominal wall.
Many different factors cause hernia to develop, with the consensus being that both genetics and acquired issues may be involved. Things that can lead to hernia include:
Lifting heavy objects
Excessive straining when using the bathroom
Traumatic injury to the abdomen
Weakness in the abdominal wall following surgery in the abdomen
Congenital deformity, such as gastroschisis and omphalocele, which are when you’re born with an underdeveloped abdominal wall
Risk Factors for a Hernia
A wide range of conditions and factors increase the chances of developing a hernia. There are sex differences depending on the type of hernia. People assigned males at birth are much more likely to develop inguinal hernia, whereas people assigned female at birth are at a higher risk of femoral and umbilical hernias.
The risk factors for this issue include:
Family history of hernia
Chronic constipation (prolonged difficulty pooping)
Chronic coughing or sneezing
Cystic fibrosis, a genetic disorder that causes excess mucus build-up in the lungs and respiratory system
Enlarged prostate
Excess weight or obesity, which is clinically measured by having a body mass index (BMI) of 30 or higher
Ascites, which is the build-up of fluid within the peritoneal cavity (the space around the intestines, stomach, and liver)
Peritoneal dialysis, a treatment for kidney failure
Poor nutrition
Smoking
Undescended testicles
Being born prematurely
Excessive physical exertion
Pregnancy
Diagnosis
The goals of a hernia diagnosis are to assess the severity of the case and rule out other potential causes of the bulging or other symptoms. A number of conditions, including cancers, aneurysms (internal leaking of blood), or abscesses (fluid-filled bumps or growths) can also cause this kind of swelling.
In addition to taking your mental history and assessing your health status, several diagnostic tests may be used:
Physical examination: Your healthcare provider will take a close look at the hernia growth, feeling and lightly pressing (palpating) it. If they can’t push the bulge back into the abdomen, it’s a sign of strangulation, a potentially severe complication.
Ultrasound: Imaging that relies on soundwaves may be used to assess the hernia; this is sometimes accompanied by a breathing technique called a Vasalva maneuver to raise your intrabdominal pressure.
Computerized tomography (CT): CT scans use multiple X-rays to create three-dimensional images of affected areas.
Magnetic resonance imaging (MRI): MRI scans use magnetic fields to visualize the hernia. They are highly effective in detecting hernia cases, correctly identifying inguinal hernias 95% of the time.
Treatments for Hernias
A hernia may or may not require treatment. If it’s causing symptoms or develops complications, surgeries can correct the issue and reinforce the abdominal walls. Following diagnosis by your primary care provider, they’ll talk to you about your options for managing the condition.
Open Surgery
Open surgery is the most invasive type is open hernia repair surgery and is typically reserved for more severe, symptomatic cases. It focuses on repairing the muscles and tissues of the abdominal wall. As the name implies, it involves opening you up while you’re under general anesthesia.
There are several open hernia repair techniques. Protruding tissue may be removed and stitches, staples, or specialized mesh netting are used to close the hole and reinforce the abdominal walls. A 2018 study found that mesh repair for inguinal and femoral hernias may lead to less recurrence when compared to other methods.
Laparoscopic Surgery
In this minimally invasive surgery, the surgeon uses a laparoscope—a specialized camera on an adjustable tube—to work from a live video feed of the hernia. They can then remove problematic tissue and repair the walls of the abdomen using sutures or mesh.
Robotic Surgery
Robotic surgery is the use of robotic assistance to perform laparoscopic hernia repair. It is an emerging technique that involves surgeons controlling robotic arms that use sutures or mesh to fix the abdominal wall. The precise movements that these devices can make are presumed to reduce complications, though, for inguinal hernia, an outright advantage to their use has not been determined in the literature.
Watchful Waiting
Because of the risk of side effects or complications, a general principle in medicine is that if surgery can be avoided, it should be. This is the case with asymptomatic hernias. A little like the saying “if it ain’t broke, don’t fix it,” watchful waiting involves regular check-ups to monitor the condition, reserving surgery only if problems occur. You’ll also be counseled on what you can do to manage what could make your case worse, like physical overexertion or smoking.
Prevention
Hernia prevention focuses on addressing health conditions and behaviors that increase your risk of developing a hernia. Preventive approaches include:
Lift carefully: If possible, avoid heavy lifting altogether because it can cause or worsen a hernia. If you do need to lift things, make sure to use proper lifting techniques, using your legs rather than your back.
Adjust diet: Because the strain of using the bathroom can also impact hernia, boost your fiber intake (as in vegetables, leafy greens, and other sources), and make sure you drink enough water.
Get exercise: Excess weight around the abdomen increases intrabdominal pressure, which can both cause a hernia and make it worse; getting exercise and boosting your level of physical activity can help you lose weight and ease.
Avoid smoking: Tobacco use is a risk factor for hernia because smoking inhibits your body from producing collagen, which can lead to a weaker abdominal wall.
Related: What You Need to Know If You Want to Quit Smoking
Complications
Though rare, the complications of hernia can become serious, especially if untreated. If the organ and tissue causing the hernia grows, it can become cut off from its blood supply, causing what’s called strangulation. Across hernia types, strangulated hernia is rare, affecting only 1-3% of people, though 30% of people with femoral hernias develop this condition.
A strangulated hernia causes several symptoms:
Pain
Swelling
Nausea and or vomiting
An inability to pass gas
Inability to move your bowels
Hernia Repair Complications
You may also develop complications following hernia repair surgery. These include:
Recurrence of the hernia
Pain
Infection
Intestinal blockage
Fistula (abnormal connections between organs)
Living With Hernia
Largely, the outlook after developing a hernia is positive. Hernia repair surgeries are some of the most common surgeries and have a high success rate. Most people with a hernia experience a complete recovery, and the rate of the issue recurring is low. For instance, for inguinal hernia, research has found only between 0.5 and 10% of people require additional surgery because the issue has come back.
The right course of action when it comes to treating a hernia depends on the case. Surgery isn’t always needed, but it’s important to get medical help if you suspect this issue. This reduces the risk of complications, and you can learn strategies for minimizing or preventing any symptoms.
Frequently Asked Questions
How serious is a hernia?
Hernia is a common issue, and the prognosis is very good with treatment. In many cases, hernia growths don’t cause pain or other symptoms, and surgery isn’t always necessary. However, the hernia can become serious if it becomes strangulated, or cut off from blood supply. A strangulated hernia can become life-threatening if untreated.
Is drinking a lot of water good for a hernia?
Straining in the bathroom can cause or worsen hernia; getting plenty of water helps. Ensuring you drink enough fluids, especially water, helps prevent constipation. It can be critical for managing the condition, which is why boosting your fluid intake is frequently recommended if you develop a hernia.
What happens if a hernia is left untreated?
It depends on the case. For many people, the hernia doesn’t cause other symptoms. Surgery generally isn’t required—just medical evaluation and preventive methods. However, symptomatic cases that cause symptoms can persist or worsen, and there’s a chance of complications that can become life-threatening without treatment.
Does hernia surgery hurt?
Hernia repair surgeries are among the most commonly performed types of surgery and are highly successful. You’ll be asleep or treated with anesthetic during the procedure, so you won’t feel pain.
As with any surgery, you can expect to feel mild soreness or pain at the incision sites for up to six weeks afterward. Most see the pain go away within two weeks. You’ll be given medications to treat the discomfort and instructions for the recovery period.
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