ConditionDigestive system
Hernias
A hernia happens when an organ or fatty tissue pushes through a weak spot in the surrounding muscle or tissue wall, most often in the abdomen or groin. The most common types are inguinal (groin), umbilical (belly button), incisional (through a surgical scar), femoral and hiatal hernias. Most cause a soft bulge that may ache, appears when standing or straining, and goes back in when lying down. Hernias do not heal on their own; surgery repairs them, and a painful, hard, stuck bulge is an emergency.
Also called: Hernia, rupture (older term), abdominal wall hernia
At a glance
- What it is
- Tissue or an organ bulging through a weakness in a muscle wall.
- Most common
- Inguinal hernia, about 3 in 4 abdominal wall hernias, mostly in men.
- Typical symptom
- A soft bulge that appears with standing, coughing or lifting and disappears when lying down.
- Danger signs
- A painful, firm bulge that will not go back, with vomiting or fever (strangulation).
- Diagnosis
- Examination. Ultrasound or CT if unclear.
- Treatment
- Surgical repair, often keyhole with mesh. Watchful waiting for small, painless groin hernias in men.
When to get help
Call 911 or go to the ER
- A hernia bulge that suddenly becomes very painful, firm, tender, red or purple and cannot be pushed back
- A hernia with vomiting, a swollen belly, and being unable to pass gas or stool (possible bowel obstruction)
- A painful hernia with fever or a racing heart
See a doctor within a day or two
- A hernia that used to go back in but is now stuck, even without severe pain
- A groin lump in a woman, which is more likely to be a femoral hernia with a higher risk of strangulation
- A bulge in a baby's groin or scrotum that is swollen, hard or causes crying or vomiting
Book a routine appointment
- A new bulge in the groin, near the belly button or at a surgical scar
- Aching or heaviness in the groin that worsens with standing or lifting
- Persistent heartburn, regurgitation or difficulty swallowing (possible hiatal hernia)
Usually safe to manage at home
- A known, small, painless hernia that goes back in easily, while waiting for an elective surgical review
How hernias happen
The abdominal wall is made of layers of muscle and tough connective tissue. Some areas are naturally weaker: the inguinal canal in the groin, the belly button, the femoral canal at the top of the thigh, and surgical scars. When pressure inside the abdomen pushes against a weak area, a sac containing fat or intestine can protrude through it.
Types of hernia
| Type | Location | Who gets it |
|---|---|---|
| Inguinal | Groin, may extend into the scrotum | Men much more than women. About 1 in 4 men in their lifetime |
| Femoral | Upper thigh just below the groin crease | More common in women. High risk of strangulation |
| Umbilical | At or near the belly button | Babies (often close by age 4 to 5), adults with obesity, pregnancy or ascites |
| Incisional | Through a scar from previous abdominal surgery | Up to 1 in 5 people after open abdominal surgery |
| Epigastric | Midline between the belly button and breastbone | Adults, often small fat-containing bulges |
| Hiatal | Part of the stomach pushes up through the diaphragm into the chest | Older adults, obesity. Causes reflux rather than a visible bulge |
| Sports hernia | Groin muscle and tendon strain without a true bulge | Athletes in kicking and twisting sports |
| Diaphragmatic | Abdominal organs into the chest through a diaphragm defect | Present at birth or after injury |
Symptoms
Abdominal and groin hernias
- A bulge or lump, more obvious when standing, coughing or straining
- The bulge goes back in when lying down or with gentle pressure (reducible)
- Aching, heaviness, burning or a dragging feeling, often worse at the end of the day
- Discomfort when lifting, bending or coughing
- In men, swelling in the scrotum
Some hernias cause no symptoms and are found during a checkup.
Hiatal hernia
- Heartburn and acid reflux. See gastroesophageal reflux disease
- Regurgitation of food or acid
- Difficulty swallowing
- Chest discomfort or feeling full quickly
- Large hernias can cause breathlessness
Hernia in women
Women are less likely to have inguinal hernias and more likely to have femoral and umbilical hernias. Groin hernias in women can be small and hard to feel, causing groin or pelvic pain rather than an obvious bulge. Because femoral hernias are more likely to strangulate, groin lumps in women are usually repaired promptly.
Complications
- Incarceration: the hernia becomes trapped and cannot be pushed back
- Obstruction: trapped intestine blocks the bowel, causing vomiting and constipation. See bowel obstruction
- Strangulation: the blood supply to trapped tissue is cut off. It causes severe pain, redness and illness and needs emergency surgery within hours to save the bowel
Causes and risk factors
- Being male (inguinal hernias)
- Older age, as muscles weaken
- Family history
- Chronic coughing from smoking or lung disease
- Chronic constipation and straining
- Heavy lifting
- Obesity
- Pregnancy
- Previous abdominal surgery
- Premature birth (inguinal and umbilical hernias in babies)
- Fluid in the abdomen (ascites)
Diagnosis
Most hernias are diagnosed by examination. A doctor feels the area while you stand and cough. If the diagnosis is unclear, ultrasound is usually the first test, with CT or MRI for complex cases. Hiatal hernias are found by upper endoscopy, barium swallow or CT.
Treatment
Watchful waiting
Men with small inguinal hernias that cause few symptoms can safely wait and monitor, as the risk of strangulation is low. Many eventually choose surgery as symptoms increase. Umbilical hernias in babies often close by themselves by age 4 to 5.
Surgical repair
Surgery is the only way to fix a hernia. Options include:
- Open repair: an incision over the hernia, with the tissue pushed back and the wall reinforced, usually with a synthetic mesh
- Laparoscopic (keyhole) or robotic repair: small incisions and a camera, often with faster recovery and less pain. Common for bilateral or recurrent hernias
- Hiatal hernia repair (fundoplication): for large hiatal hernias or reflux not controlled by medicine
Most repairs are day surgery. Light activity is usually possible within days, and heavier lifting after 2 to 6 weeks depending on the repair.
Trusses and binders
Supportive belts may ease symptoms for people who cannot have surgery, but they do not repair the hernia.
Hiatal hernia without surgery
Most are managed with reflux measures: acid-reducing medicine, weight loss, smaller meals, avoiding late eating and raising the head of the bed.
Prevention
- Maintain a healthy weight
- Treat constipation and avoid straining
- Stop smoking to reduce chronic cough
- Lift with your legs and avoid very heavy lifting
- Strengthen core muscles after recovering from abdominal surgery
Frequently asked questions
What are the main types of hernia?
The main types are inguinal (groin), femoral (upper thigh), umbilical (belly button), incisional (through a surgical scar), epigastric (upper midline) and hiatal (stomach through the diaphragm). Inguinal hernias are the most common.
What does a hernia feel like?
Most feel like a soft bulge that may ache, burn or feel heavy, especially when standing, coughing or lifting, and that disappears when lying down. A hiatal hernia instead causes heartburn, regurgitation or difficulty swallowing.
Can a hernia heal on its own?
No. Adult hernias do not heal without surgery, although small ones may cause few symptoms for years. Umbilical hernias in babies often close by themselves by age 4 to 5.
When is a hernia an emergency?
A hernia is an emergency if the bulge becomes very painful, firm, red or purple and cannot be pushed back, or if you have vomiting, a swollen belly, or cannot pass gas or stool. These signal strangulation or obstruction and need surgery urgently.
How long is recovery from hernia surgery?
Most people go home the same day and return to light activity within a few days. Desk work is often possible within 1 to 2 weeks. Heavy lifting and strenuous exercise are usually avoided for 2 to 6 weeks, depending on the type of repair.
Sources
This guide was written from current patient and clinical guidance, including:
- American College of Surgeons: Inguinal Hernia Repair patient education
- HerniaSurge Group: International guidelines for groin hernia management
- NIDDK: Inguinal Hernia
- MedlinePlus: Hernia
- NHS: Hernia
- Society of American Gastrointestinal and Endoscopic Surgeons (SAGES): Guidelines for the management of hiatal hernia