What Is Hernia? Symptoms, Causes, Diagnosis, Treatment, and Prevention

A hernia happens when fat, tissue, or part of an organ pushes through a weak spot or hole in the abdominal muscle or connective tissue. (1) Depending on the type of hernia you have and how severe it is, the condition can range from slightly bothersome to life-threatening. (2)

In adults, hernias are most common in the groin or abdomen. (1) When you have a hernia, you may see or feel a bulge in one of these areas. You may also experience pain that worsens during certain activities, such as when you lift something or stand for a long period of time.

You can develop a hernia all of a sudden after you bend, cough, laugh, or lift weights or heavy items. Alternatively, it can form over a period of weeks or months. (3)

Most hernias are external, which means the tissue is pushing through the abdominal wall toward the outside of the body. This often creates a bulge that you can see. But a hernia can also be internal, which means that it remains inside the body (within the abdomen).

Signs and symptoms of a hernia include: (4)

• A lump or bulge that you can push back in or that disappears when you lie down
• Swelling or bulge in your groin or scrotum (in men)
• Pain at the site of the bulge that increases
• Pain when you are lifting
• A bulge that increases in size over time
• A dull ache
• A sense of feeling full

Learn More About Signs and Symptoms of a Hernia

Types of Hernias

There are several types of hernias. The most common types include:

Inguinal Hernia This is the most common type of hernia. (3) An inguinal hernia happens when tissue or part of your small intestine pushes into your groin or scrotum, causing a visible bulge. Inguinal hernias are much more common in men. You can be born with an inguinal hernia, or it can develop over time.

Femoral Hernia A femoral hernia occurs when fatty tissue or part of the intestine pushes through the groin. (4)

Umbilical Hernia An umbilical hernia happens when fatty tissue or part of the intestine protrudes through the abdomen near your belly button. (4) Umbilical hernias are most common in infants, especially those who are premature or have a low birth weight, but adults can get them, too. A protruding belly button or soft swelling or bulge near the navel are signs of an umbilical hernia. (5)

Hiatal Hernia A hiatal hernia occurs when part of the stomach pushes through an opening in the diaphragm and up into the chest cavity. (4) Symptoms of a hiatal hernia may include heartburn, indigestion, having a hard time swallowing, frequently regurgitating food, and chest pain.

Incisional Hernia An incisional hernia occurs when tissue pushes through a scar from an abdominal or pelvic operation.

Inguinal and femoral hernias can be caused by weakened muscles, aging, or repeated strain on the abdominal and groin areas. This strain may come from physical activity, heavy lifting, obesity, frequent coughing, or constipation (which can lead to straining during a bowel movement). (4)

In men, inguinal hernias can be caused by problems in the inguinal canals, from which the testicles descend before or after birth. When muscles in these canals don’t close the way they are supposed to, the area can become weakened and lead to a hernia. (3)

Umbilical hernias can be caused during pregnancy, when the umbilical cord passes through an opening in an infant’s abdominal muscles. (5) The opening normally closes just after a baby is born. If the muscles don’t fully join together in the middle of the abdominal wall, an umbilical hernia may occur at birth or later in life. In adults, too much abdominal pressure can lead to umbilical hernias, from causes including obesity, multiple pregnancies, and previous abdominal surgery.

Doctors don’t exactly know what causes hiatal hernias, but a weakened diaphragm due to aging or pressure on the abdomen may play a role. (4)

Risk Factors for a Hernia

Risk factors for inguinal hernias include: (6)

• Being male
• Being white
• Being an older person
• Being born prematurely, or having low birth weight
• Having a close family member with a hernia
• Chronic cough (which can be due to smoking)
• Chronic constipation
• Pregnancy, which can make your abdominal muscles weaker and increase the pressure in your abdomen
• Previous inguinal hernia or hernia repair surgery

A doctor can usually detect a hernia by seeing or feeling a bulge during a physical exam. (4) Your healthcare provider is likely to ask you to stand and cough or strain, because this can make a hernia more visible. (6) If you’re a man, your doctor may ask you to cough while he feels the area around the testicles and groin. (4) In some cases, an ultrasound or CT scan is used to diagnose a hernia. (6)

Your doctor may also suggest that you get an MRI scan, especially if you experience pain that gets worse when you exercise. (7) Playing sports can cause a hernia that has no visible bulge in the early stages, but an MRI can detect a tear in the abdominal muscles.

If you’re a woman in your childbearing years, your doctor may suggest an ultrasound to check for other pelvic conditions that can also cause abdominal pain.

Prognosis of a Hernia

A hernia can grow in size, become more painful, or develop complications over time. (4) In some cases, a hernia may not cause any symptoms. (8) Hernias that are painful or getting larger usually require surgery to ease discomfort and prevent serious complications. (6)

For severe hernias, emergency surgery may be necessary. (2)

Hernias (other than umbilical hernias in babies) typically do not go away on their own. (4) If you have surgery to repair a hernia, it may take a few weeks before you can get back to your usual activities. (6)

Surgery

There are three types of hernia surgery: (4)

• Open surgery, where a cut is made into the body at the site of the hernia, the protruding tissue is put back in place, and the muscle wall is stitched back together. Mesh may be implanted to provide extra support.
• Laparoscopic surgery is similar to open surgery, but instead of a cut to the outside of the abdomen or groin, a surgeon makes small incisions in order to insert surgical tools to complete the procedure.
• Robotic hernia repair, where a surgeon handles surgical instruments from a console in the operating room. Robotic surgery can be used for some smaller hernias or weak areas, as well as to reconstruct the abdominal wall.

RELATED: Connecting the Dots: Understanding the Link Between Hiatal Hernia and GERD

Watchful Waiting

Instead of surgery, your doctor may advise watchful waiting if your hernia is small or causes no symptoms, or if you have conditions that increase your risk for complications from surgery. (8) With watchful waiting, you see your doctor once a year or if any of your symptoms, such as pain, get worse.

Medication Options

If you have a hiatal hernia that causes heartburn and acid reflux, your doctor may recommend: (9)

• Antacids Over-the-counter antacids like calcium carbonate and magnesium hydroxide (Rolaids) can help neutralize stomach acids.
• H2-Receptor Blockers These medications — including cimetidine (Tagamet), famotidine (Pepcid), and nizatidine (Axid) — reduce acid production.
• Proton Pump Inhibitors These medications — including lansoprazole (Prevacid 24HR) and omeprazole (Prilosec) — are stronger acid blockers than H2-receptor blockers.

Complementary and Integrative Approaches and Therapies

In some cases, a supportive truss may be worn to relieve hernia symptoms. Check with your doctor to make sure that the truss fits properly. (6) In children, a doctor might apply manual pressure to reduce the bulge before contemplating surgery.

Learn More About Treatment for a Hernia: Medications, Alternative and Complementary Therapies, Surgery Options, and More

Prevention of Hernia

You can help prevent an inguinal hernia by reducing strain on your abdominal muscles and tissues in the following ways: (6)

• Maintain a healthy weight with diet and exercise.
• Eat foods high in fiber, like fruits, vegetables, and whole grains, to prevent constipation.
• Lift heavy objects with care or avoid heavy lifting. If you have to lift something heavy, it’s important to always bend from your knees.
• If you smoke, quit. Smoking can cause a chronic cough that can lead to an inguinal hernia or make it worse.

In some cases, a hernia can lead to complications. These include:

• Incarcerated or Obstructed Hernia If the contents of the hernia get stuck in the weak spot in the abdominal wall, it can obstruct the bowel, which can lead to extreme pain, nausea, and vomiting, and prevent you from having a bowel movement or passing gas. (6)
• Strangulation An incarcerated hernia can cut off blood flow to part of your intestine, leading to the death of the affected tissue. A strangulated hernia is life-threatening; immediate surgery is necessary.
• Pressure on Surrounding Tissues In men, large hernias can push into the scrotum, which can cause pain and swelling.
• Recurrence, Infection, or Chronic Pain These can arise after hernia surgery. (2)

Learn More About the Complications of a Hernia: How It Affects Your Body in the Short and Long Term

About 25 percent of men will experience an inguinal hernia at some point. (3) Men are eight times more likely to develop an inguinal hernia than women. (6)

Femoral hernias mainly affect older women. (4)

About 20 percent of babies are born with an umbilical hernia, but most of these cases will go away on their own by the time the child is 5 years old. (2)

Research indicates that some types of hernias are more prevalent in certain BIPOC (Black, Indigenous, and People of Color) populations. Umbilical hernias, for example, are known to be more common in Black children than in white children. (10)

Black and Hispanic Americans and Hernia Surgery

A study published in 2017 found that Black and Hispanic patients seeking inguinal hernia repairs were more likely to be seen via the emergency department compared with white patients. (11) Patients in the study sample who were admitted through the emergency department also showed a 67 percent higher postoperative mortality rate compared with patients who underwent electively scheduled hernia repair surgery.

Several conditions are associated with hernias, and still other conditions can be mistaken for hernias.

Conditions that cause chronic coughing, such as chronic obstructive pulmonary disease, or COPD, can put you at greater risk of developing a hernia. (3) COPD is most often caused by exposure to cigarette smoke.

Sometimes hernia symptoms are confused with other conditions, such as endometriosis in women. (7) Endometriosis occurs when the tissue that lines the inside of the uterus, called the endometrium, grows outside the uterus. The condition can cause mild or severe pain, or in some cases, it causes no symptoms.

A so-called sports hernia is not actually a hernia, but its symptoms are similar. (12) A sports hernia, technically known as athletic pubalgia, causes pain and pressure due to torn tendons that attach to the pelvis. Sports hernias are usually caused by repetitive or explosive motions, so they tend to happen during sports that require twisting of the pelvis, such as football, hockey, soccer, rugby, skiing, running, and hurdling. The soft tissues found in the lower abdomen and pubic area are most commonly torn or injured. Athletic activity can also lead to a true hernia.

RELATED: What Is COPD? Symptoms, Causes, Diagnosis, Treatment, and Prevention

RELATED: What Is Endometriosis? Symptoms, Causes, Diagnosis, and Treatment

NYU Langone Health

New York University’s Langone hospital in New York City, one of the nation’s leading academic medical centers, features a team of surgeons who are experts in hernia repair. Their website offers information about hernia types, diagnosis, and treatment.

Johns Hopkins Medicine

Headquartered in Baltimore, Johns Hopkins Medicine specializes in medical education, research, and clinical care. Their website features a guide that will help you identify a hernia and whether it could be dangerous, as well as provide you with more information about specific types of hernias.

Cleveland Clinic

Cleveland Clinic is a nonprofit academic medical center that combines clinical and hospital care with research and education. Their website features information on how to diagnose, manage, treat, and prevent hernias.