Hernia

What is a hernia?

A hernia occurs when part of your insides bulges through an opening or weakness in the muscle or tissue that contains it. Most hernias involve one of your abdominal organs pushing through one of the walls of your abdominal cavity. Hernias can occur gradually as you get older and regular wear and tear on your muscles begins to add up. They can also result from an injury, surgery or birth disorder.

What are some common hernia locations?

You may get a hernia:

• In your lower chest through your diaphragm.
• In your groin through your lower abdominal wall.
• Along the front midline of your abdomen.
• Through a former abdominal surgery incision.

What are some of the different types of hernias?

Specific types of hernias include:

• Inguinal hernia. Inguinal hernias are the most common type, accounting for 75% of all hernias. They mostly affect men or people assigned male at birth (AMAB). They happen when part of your bowel protrudes into your inguinal canal, a passageway that runs down your inner thigh.
• Femoral hernia. A femoral hernia is a less-common type of groin hernia that occurs in the femoral canal, which runs underneath the inguinal canal. Fatty tissue may poke through.
• Hiatal hernia. A hiatal hernia is another common type of hernia that you acquire during your lifetime. It happens when the opening in your diaphragm — where your esophagus passes through — widens, and the top of your stomach pushes up through the opening into your chest.
• Congenital diaphragmatic hernia. A congenital diaphragmatic hernia is a serious birth defect in which the diaphragm doesn’t close all the way during fetal development. It can cause abdominal organs to slip up into the chest cavity while the organs are still growing, crowding the lungs.
• Incisional hernia. An incisional hernia occurs when tissue protrudes through a former incision in your abdominal wall that weakened over time. It’s a common side effect of abdominal surgery.
• Umbilical hernia. An umbilical hernia occurs when part of your intestine pokes through an opening in your abdominal wall near your belly button. Most umbilical hernias are congenital (present from birth).
• Ventral hernia. A ventral hernia is any hernia that occurs through the front wall of your abdomen. It includes umbilical hernias and incisional hernias. An “epigastric hernia” is a ventral hernia above the belly button.
• Perineal hernia. A perineal hernia occurs when organs or tissue push through an opening or weakness in your pelvic floor into your abdominal cavity. These hernias are relatively rare.

How common are hernias?

Overall, hernias are common, though some types are more common than others. Inguinal hernias affect around 25% of all men or people assigned male at birth. Hiatal hernias affect around 20% of people in the U.S. and 50% over the age of 50. Congenital hernias occur in about 15% of newborns, mostly umbilical. Incisional hernias make up about 10% of hernias, and all other types make up another 10%.

How serious is a hernia?

Most aren’t serious, but they can be. They can also become more serious over time. A hernia becomes serious when it gets stuck in the hole that it’s pushed through and can’t go back in. This can become painful, and in severe cases the tissue can become cut off from blood supply, causing necrosis (tissue death). Since hernias tend to worsen over time, most will need surgical repair sooner or later.

What are hernia symptoms?

Not all hernias cause symptoms and different types of hernias may cause different symptoms. One telltale sign of a hernia is a visible lump or bulge that appears during certain activities or in certain physical positions and goes back in at other times. You may also feel pressure, a dull ache or pinching when the hernia comes out. It may come out when you’re straining, lifting, laughing or coughing.

What does a hernia look like?

When you can see it, it looks like a bulge where you shouldn’t have one. Some typical places are in your abdomen or at the top of your inner thigh. It may be visible sometimes but not others. Some hernias are too deep to be visible from the outside, including femoral hernias and hiatal hernias.

What does a hernia feel like?

You may not feel it at all, or you may feel pressure, a dull ache or a sharp pain when the hernia comes through the opening. If you have frequent discomfort, you should see a healthcare provider right away. A hiatal hernia, in particular, may cause chronic acid reflux. You may feel it as heartburn or indigestion.

What are the first signs of a hernia?

You may see or feel a hernia emerge in a precise location when you’re squatting, bending over or exerting yourself. In your baby, you may see a hernia emerge when they’re crying or pooping, and they may be irritable about it. If the same activity routinely causes the same symptoms, it’s likely a hernia.

Are hernia symptoms in women different from hernia symptoms in men?

Not usually, but there are some exceptions. For example, a groin hernia can sometimes slip down into your sex organs. It may cause visible scrotal swelling in people with testicles. Femoral hernias more often occur in women or people assigned female at birth (AFAB), and they may cause invisible, unexplained groin pain.

What is the main cause of hernia?

A hernia occurs when a weakness or a preexisting opening in your muscle or connective tissue allows an organ or other tissue to push through the barrier. Sometimes the weakness or opening is present at birth, but usually, it develops during your lifetime. A traumatic injury or surgery could cause it, but more often, it’s a repetitive stress injury. Years of pressure or exertion can wear the tissue down.

What risk factors contribute to getting a hernia?

You may be more likely to acquire a hernia if you have:

• A job that involves heavy lifting or many hours of standing.
• A chronic cough or allergies that cause chronic sneezing.
• Chronic constipation and straining to poop or pee.
• A history of abdominal or pelvic surgery.
• Pregnancy, especially repeat pregnancies.
• Chronic obesity (a body mass index, or BMI, greater than 30).

Your child may be more likely to be born with a congenital hernia if they:

• Are born prematurely.
• Have cystic fibrosis.
• Have a connective tissue disorder.
• Have congenital hip dysplasia.
• Have undescended testicles.
• Have other problems in their reproductive system or urinary system.

What are the possible complications of a hernia?

In most cases, complications begin when a hernia gets stuck and can’t move back in (incarceration). An incarcerated hernia can become increasingly painful and serious. If it’s your bowel that’s stuck, your bowel may develop an obstruction that makes it unable to pass food or gas. If incarcerated tissue doesn’t have access to blood supply (strangulation), it can lead to tissue death (necrosis or gangrene).

Complications of diaphragmatic hernias are different. In general, organs that herniate through your diaphragm aren’t likely to get stuck. A hiatal hernia rarely causes complications, except for chronic acid reflux. On the other hand, a congenital diaphragmatic hernia (CDH) is always complicated, because it affects the way fetal organs develop. Babies born with CDH are critically ill and will need intensive care.

When should I worry about hernia pain?

Any hernia pain is worth a visit to your healthcare provider. It’s important to have a healthcare provider diagnose hernia pain, since many other conditions can be mistaken for a hernia. If your hernia changes color, goes numb, or causes symptoms like fever, nausea and vomiting, seek medical attention right away.

How is a hernia diagnosed?

A simple physical exam is often enough to diagnose a hernia, depending on the type. Your healthcare provider may be able to see or feel it, or it may emerge when they ask you to cough or adjust your position. They’ll check to see if they can physically reduce it — make it go back in — to determine how serious it is. Some hernias may require a form of soft tissue imaging, such as a CT scan, to diagnose.

What is the treatment for a hernia?

Most hernias will need surgical repair, but not necessarily right away. If you have a small or mild hernia that only comes out occasionally, your healthcare provider may take a wait-and-watch approach to see if it gets much worse. Hernias do tend to worsen over time, which is why providers recommend repairing them. With the exception of umbilical hernias in babies, they don’t go away on their own.

Hernia repair surgery is common and generally a minor procedure unless there are complications. Your surgeon will push the herniated tissue back into place and reinforce the barrier it pushed through with stitches or with surgical mesh. Surgeons can often use minimally-invasive methods for a routine hernia repair, which means smaller incisions, less postoperative pain and a faster recovery.

Laparoscopic surgery uses a laparoscope — a long, thin tube with a lighted camera on the end — to look inside the surgical site. The laparoscope goes in one small hole and long, thin surgical tools go through another. Robotic surgery for hernia repair is similar, but the surgeon controls the tools from a computer console, using robotic arms. Some hernias may need traditional open surgery.

A congenital umbilical hernia will often close on its own as your child grows, but sometimes it won’t. In this case, your child will need umbilical hernia repair. A hiatal hernia often won’t need repair, but it may if it causes chronic acid reflux. Your provider may recommend a Nissen fundoplication to repair this problem. It involves wrapping the upper stomach around the lower esophagus and stitching them together.

What happens if a hernia is left untreated?

A small hernia may never bother you much. But hernias do tend to grow bigger over time. The opening continues to weaken and stretch, and more tissue gradually pushes its way through. The more tissue pushes through, the more likely it is to become incarcerated, leading to pain and other complications.

What are the possible side effects or complications of the treatment?

There’s a small risk of general surgical complications, such as excessive bleeding, wound infection or reactions to the anesthesia. Some people have difficulty urinating for a short time after surgery. About 10% of people report chronic groin pain after inguinal hernia repair, possibly due to nerve damage.

What should I expect if I have a hernia?

Your healthcare provider will assess how severe it is and how fast it’s likely to progress. Some hernias may not need urgent repair, but for most, they’ll recommend it eventually. The surgery is usually a simple outpatient procedure with a short recovery. It’s almost always successful, but there is a 10% chance of the hernia returning sometime later, especially if the conditions that caused it continue.

How should I take care of myself while living with a hernia?

If you have a hernia and aren’t having it repaired, or not yet, you’ll want to try to prevent it from worsening. Your healthcare provider may advise you to adjust your habits or the nature of your work to avoid straining the hernia. In some cases, they might recommend wearing a special restraining belt to hold it in during certain activities. Pay attention to your symptoms and any changes you experience.

What is a sports hernia?

The term “sports hernia” is a misnomer, since it’s not actually a hernia at all. It’s a type of injury that commonly affects athletes, usually in their lower abdomen or groin. These are common places to have hernias, and the injury may cause chronic pain similar to a hernia. But there’s no tissue protruding through other tissue. It’s usually a tear in a tendon or muscle, caused by a sudden twisting movement.

A note from Cleveland Clinic

Hernias are common and most aren’t serious, but complications can occur. Pain and other problems become more likely as time goes on. Keep an eye on your hernia and see your healthcare provider before it becomes serious. Since hernias don’t go away by themselves, you’ll likely need a procedure to fix it. You’ll be in good company: these are among the most common surgeries performed worldwide.