Hernia

Medically reviewed by Nancy Choi, MD on August 3, 2017Written by Carmella Wint and Valencia Higuera

What is a hernia?

A hernia occurs when an organ pushes through an opening in the muscle or tissue that holds it in place. For example, the intestines may break through a weakened area in the abdominal wall.

Hernias are most common in the abdomen, but they can also appear in the upper thigh, belly button, and groin areas. Most hernias aren’t immediately life-threatening, but they don’t go away on their own. Sometimes they can require surgery to prevent potentially dangerous complications.

Types Common hernia types

Inguinal hernia

Inguinal hernias are the most common type of hernia. They make up about 70 percent of all hernias, according to the British Hernia Centre (BHC). These hernias occur when the intestines push through a weak spot or tear in the lower abdominal wall, often in the inguinal canal.

The inguinal canal is found in your groin. In men, it’s the area where the spermatic cord passes from the abdomen to the scrotum. This cord holds up the testicles. In women, the inguinal canal contains a ligament that helps hold the uterus in place.

This type of hernia is more common in men than women. This is because a man’s testicles descend through the inguinal canal shortly after birth, and the canal is supposed to close almost completely behind them. Sometimes, the canal doesn’t close properly and leaves a weakened area prone to hernias.

Hiatal hernia

A hiatal hernia occurs when part of your stomach protrudes up through the diaphragm into your chest cavity. The diaphragm is a sheet of muscle that helps you breathe by contracting and drawing air into the lungs. It separates the organs in your abdomen from those in your chest.

This type of hernia is most common in people over 50 years old. If a child has the condition, it’s typically caused by a congenital birth defect. Hiatal hernias almost always cause gastroesophageal reflux, which is when the stomach contents leak backward into the esophagus, causing a burning sensation.

Umbilical hernia

Umbilical hernias can occur in children and babies under 6 months old. This happens when their intestines bulge through their abdominal wall near their bellybutton. You may notice a bulge in or near your child’s bellybutton, especially when they’re crying.

An umbilical hernia is the only kind that often goes away on its own as the abdominal wall muscles get stronger, typically by the time the child is 1 years old. If the hernia hasn’t gone away by this point, surgery may be used to correct it.

Incisional hernia

Incisional hernias can occur after you’ve had abdominal surgery. Your intestines may push through the incision scar or the surrounding, weakened tissue.

Causes What causes a hernia?

Hernias are caused by a combination of muscle weakness and strain. Depending on its cause, a hernia can develop quickly or over a long period of time.

Common causes of muscle weakness include:

  • failure of the abdominal wall to close properly in the womb, which is a congenital defect
  • age
  • chronic coughing
  • damage from injury or surgery

Factors that strain your body and may cause a hernia, especially if your muscles are weak, include:

  • being pregnant, which puts pressure on your abdomen
  • being constipated, which causes you to strain when having a bowel movement
  • lifting heavy weight
  • fluid in the abdomen, or ascites
  • suddenly gaining weight
  • surgery in the area
  • persistent coughing or sneezing

Risks Am I at risk for a hernia?

The factors that increase your risk of developing a hernia include:

Conditions such as cystic fibrosis can also indirectly increase your risk of developing a hernia. Cystic fibrosis impairs the function of the lungs, causing a chronic cough.

Symptoms What are the symptoms of a hernia?

The most common symptom of a hernia is a bulge or lump in the affected area. In the case of an inguinal hernia, you may notice a lump on either side of your pubic bone where your groin and thigh meet.

You’re more likely to feel your hernia through touch when you’re standing up, bending down, or coughing.

If your baby has a hernia, you may only be able to feel the bulge when their crying. A bulge is typically the only symptom of an umbilical hernia.

Other common symptoms of an inguinal hernia include:

  • pain or discomfort in the affected area (usually the lower abdomen), especially when bending over, coughing, or lifting
  • weakness, pressure, or a feeling of heaviness in the abdomen
  • a burning, gurgling, or aching sensation at the site of the bulge

Other symptoms of a hiatal hernia include:

In some cases, hernias have no symptoms. You may not know you have a hernia unless it shows up during a routine physical or a medical exam for an unrelated problem.

Diagnosis How is a hernia diagnosed?

Inguinal or incisional hernias are usually diagnosed through a physical examination. Your doctor may feel for a bulge in your abdomen or groin that gets larger when you stand, cough, or strain.

If you have a hiatal hernia, your doctor may diagnose it with a barium X-ray or endoscopy.

A barium X-ray is a series of X-ray pictures of your digestive tract. The pictures are recorded after you’ve finished drinking a liquid solution containing barium, which shows up well on the X-ray images.

An endoscopy involves threading a small camera attached to a tube down your throat and into your esophagus and stomach.

These tests both allow your doctor to see the internal location of your stomach.

If your child has an umbilical hernia, your doctor may perform an ultrasound. An ultrasound uses high-frequency sound waves to create an image of the structures inside the body.

Treatment Treatment options for a hernia

Whether or not you need treatment depends on the size of your hernia and the severity of your symptoms. Your doctor may simply monitor your hernia for possible complications. Treatment options for a hernia include lifestyle changes, medication, or surgery.

Lifestyle changes

Dietary changes can often treat the symptoms of a hiatal hernia, but won’t make the hernia go away. Avoid large or heavy meals, don’t lie down or bend over after a meal, and keep your body weight in a healthy range.

Certain exercises may help strengthen the muscles around the hernia site, which may reduce some symptoms. However, exercises done improperly can increase pressure at that area and may actually cause the hernia to bulge more. It’s best to discuss what exercises to do and not do with your doctor or physical therapist.

If these changes don’t eliminate your discomfort, you may need surgery to correct the hernia. You can also improve symptoms by avoiding foods that cause acid reflux or heartburn, such as spicy foods and tomato-based foods. Additionally, you can avoid acid reflux by losing weight and giving up cigarettes.

Medication

If you have a hiatal hernia, over-the-counter and prescription medications that reduce stomach acid can relieve your discomfort and improve symptoms. These include antacids, H-2 receptor blockers, and proton pump inhibitors.

Surgery

If your hernia is growing larger or causing pain, your doctor may decide it’s best to operate. Your doctor may repair your hernia by sewing the hole in the abdominal wall closed during surgery. This is most commonly done by patching the hole with surgical mesh.

Hernias can be repaired with either open or laparoscopic surgery. Laparoscopic surgery uses a tiny camera and miniaturized surgical equipment to repair the hernia using only a few small incisions. Laparoscopic surgery is less damaging to the surrounding tissue.

Open surgery requires a longer recovery process. You may be unable to move around normally for up to six weeks. Laparoscopic surgery has a much shorter recovery time, but the risk of your hernia reoccurring is higher.

In addition, not all hernias are suitable for laparoscopic repair. This includes hernias where a portion of your intestines has moved down into the scrotum.

Complications Potential complications of a hernia

If left untreated, your hernia may grow and become more painful. A portion of your intestine could become trapped in the abdominal wall. This can obstruct your bowel and cause severe pain, nausea, or constipation. An untreated hernia can also put too much pressure on nearby tissues. This can cause swelling and pain in the surrounding area.

If the trapped section of your intestines doesn’t get enough blood flow, strangulation occurs. This can cause the intestinal tissue to become infected or die. A strangulated hernia is life-threatening and requires immediate medical care.

Prevention Preventing a hernia

You can’t always prevent the muscle weakness that allows a hernia to occur. However, you can reduce the amount of strain you place on your body. This may help you avoid a hernia or keep an existing hernia from getting worse. Prevention tips include:

  • not smoking
  • seeing your doctor when you’re sick to avoid developing a persistent cough
  • maintaining a healthy body weight
  • avoiding straining during bowel movements or urination
  • lifting objects with your knees and not your back
  • avoiding lifting weights that are too heavy for you

Outlook Outlook

It’s important to recognize the early signs of a hernia. An untreated hernia will not go away on its own. However, with early medical care or lifestyle changes, you can minimize the effects of a hernia and avoid life-threatening complications like strangulation.