Hernia: All You Need To Know

Hernias typically result from a combination of muscle weakness and strain. Doctors may suggest watchful waiting for complications or surgery to repair the hernia, depending on severity. 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.

Many hernias occur in the abdomen between your chest and hips, but they can also appear in the upper thigh 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 dangerous complications.

Types of hernia

There are several different types of hernias. Below, we’ll explore some of the most common ones.

Inguinal hernia

Inguinal hernias are the most common type of hernia. They 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 attaches to the testicles. In women, the inguinal canal contains a ligament (called the round ligament) that helps hold the uterus in place. Inguinal hernias are more common in men because the testicles descend through the inguinal canal shortly after birth. The canal is supposed to close almost completely behind them. Sometimes the canal doesn’t close properly, leaving a weakened area.

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 irregularity. Hiatal hernias almost always cause gastroesophageal reflux disease (GERD). In GERD, the stomach contents leak backward into the esophagus, causing a burning sensation.

Umbilical hernia

Umbilical hernias can affect children and babies. They occur when the intestines bulge through the abdominal wall near the belly button. You may notice a bulge in or near your child’s belly button, 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.

This typically happens by the time the child is 1 or 2 years old. If the hernia hasn’t gone away by 5 years of age, surgery can be performed to correct it. Adults can also have umbilical hernias. They can occur from repeated strain on the abdomen due to conditions such as obesity, fluid in the abdomen (ascites), or pregnancy.

Ventral hernia

A ventral hernia happens when tissue bulges through an opening in the muscles of your abdomen. You may notice that a ventral hernia decreases in size when you’re lying down. Although a ventral hernia can be present from birth, it’s more commonly acquired at some point during your lifetime.

Common factors in ventral hernia formation include obesity, pregnancy, and strenuous activity. Ventral hernias can also occur at the site of a surgical incision. This is called an incisional hernia and can result from surgical scarring or weakness of the abdominal muscles at the surgical site. 

Hernia symptoms

The most common symptom of a hernia is a bulge or lump in the affected area. For example, 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 may find that the lump “disappears” when you’re lying down.

You’re more likely to feel your hernia through touch when you’re standing up, bending down, or coughing. Discomfort or pain in the area around the lump may also be present. Some types of hernia, such as hiatal hernias, can have more specific symptoms. These can include heartburn, trouble swallowing, and chest pain.

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

Hernia causes

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. Some common causes of muscle weakness or strain that can lead to a hernia include:

• a congenital condition, which occurs during development in the womb and is present from birth
• aging
• damage from an injury or surgery
• strenuous exercise or lifting heavy weights
• chronic coughing or chronic obstructive pulmonary disorder (COPD)
• pregnancy, especially having multiple pregnancies
• constipation, which causes you to strain when having a bowel movement
• being overweight or having obesity
• ascites

There are also certain risk factors that make you more likely to develop a hernia. They include:

• being born prematurely or having a low birth weight
• being older
• chronic cough (likely due to the repetitive increase in abdominal pressure)
• cystic fibrosis
• pregnancy
• chronic constipation
• being overweight or having obesity
• smoking, which leads to the weakening of connective tissue
• a personal or family history of hernias

Hernia treatment

The only way to effectively treat a hernia is through surgical repair. Whether or not you need surgery depends on the size of your hernia and the severity of your symptoms. Your doctor may want to simply monitor your hernia for possible complications. This approach is called watchful waiting.

In some cases, wearing a truss may help to ease the symptoms of a hernia. A truss is a supportive undergarment that helps to hold the hernia in place. Always see your doctor to make sure that a truss fits properly before using it. If you have a hiatal hernia, over-the-counter (OTC) and prescription medications that reduce stomach acid can relieve your discomfort and improve symptoms. These include antacids, H2 receptor blockers, and proton pump inhibitors.

Hernia diagnosis

To diagnose your condition, your doctor will first perform a physical examination. During this examination, the doctor may feel for a bulge in your abdominal or groin area that gets larger when you stand, cough, or strain. Your doctor will then take your medical history. They may ask you a variety of questions, including:

• When did you first notice the bulge?
• Have you experienced any other symptoms?
• Do you think something in particular may have caused it to occur?
• Tell me a little bit about your lifestyle. Does your occupation involve heavy lifting? Do you exercise rigorously? Do you lift weights professionally or recreationally? Do you have a history of smoking?
• Do you have a personal or family history of hernias?
• Have you had any surgeries in your abdominal or groin area?

Your doctor will also likely use imaging tests to aid in their diagnosis. These can include:

• Abdominal ultrasound. Abdominal ultrasound uses high-frequency sound waves to create an image of the structures inside the body.
• Abdominal CT scan. Abdominal CT scan combines X-rays with computer technology to produce an image.
• Abdominal MRI scan. Abdominal MRI scan uses a combination of strong magnets and radio waves to create an image.

If your doctor suspects a hiatal hernia, they may use other tests that allow them to assess the inside of your stomach:

• X-rays of your digestive tract. A healthcare professional will have you drink a liquid containing diatrizoate meglumine/diatrizoate sodium (Gastrografin) or a liquid barium solution. These liquids help your digestive tract appear highlighted on X-ray images.
• Endoscopy. During an endoscopy, a healthcare professional threads a small camera attached to a tube down your throat and into your esophagus and stomach.

Home remedies for hernia

Home remedies won’t cure your hernia, but there are some things you can do to help ease your symptoms. Increasing your fiber intake may help relieve constipation. Constipation can cause straining during bowel movements, which can aggravate a hernia. Some examples of high fiber foods include whole grains, fruits, and vegetables.

Dietary changes can also help with the symptoms of a hiatal hernia. Try to avoid large or heavy meals, don’t lie down or bend over after a meal, and keep your body weight in a moderate range. To prevent acid reflux, avoid foods that may cause it, such as spicy foods and tomato-based foods. Additionally, giving up cigarettes may also help, if you smoke.

Hernia exercises

Exercise may work to strengthen muscles around the hernia and promote weight loss, helping reduce some symptoms. A study investigated the effects of an exercise program on people with obesity who were undergoing ventral hernia repair surgery. The people who completed the exercise program had fewer complications following surgery.

Remember that some types of exercise, such as weightlifting or exercises that strain the abdomen, may increase pressure at the area of the hernia. This may actually cause the hernia to bulge more. The same is true for exercises that are done improperly.

If you have a hernia, it’s best to discuss exercising with a doctor or physical therapist. They can work closely with you to let you know which exercises are best for you and how to perform them properly to prevent irritating your hernia.

Hernia recovery

It’s important to recognize the symptoms of a hernia and to see a doctor if you suspect that you have one. An untreated hernia won’t go away by itself, and hernias can cause complications that are life threatening. A doctor can assess your hernia and determine the best treatment option. Early medical care and lifestyle changes can minimize symptoms. However, surgery is the only way to effectively treat a hernia.

There are different types of hernia repair surgeries, and a surgeon can advise on which one is right for your condition. The outlook for people who undergo hernia repair surgery is generally very good. However, it can depend on the nature of the hernia, your symptoms, and your overall health. In some cases, the hernia may recur after repair surgery.

Hernia repair surgery

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

Sometimes a hernia results in one of the body’s passageways opening even wider than it should. For example, this can occur in the space where the esophagus is meant to pass through the diaphragm. In these cases, surgery can be performed to tighten the opening. Hernias can be repaired with either open or laparoscopic surgery.

During open surgery, the surgeon makes an incision close to the site of the hernia, and then pushes the bulging tissue back into the abdomen. They then sew the area shut, sometimes reinforcing it with surgical mesh. Finally, they close the incision.

Laparoscopic surgery uses a tiny camera and miniaturized surgical equipment to repair the hernia. It only requires a few small incisions and is less damaging to the surrounding tissue. Not all hernias are suitable for laparoscopic surgery. If your hernia requires an open surgical repair, your surgeon will work with you to determine which technique is best for your condition.

Recovery from surgery

After your surgery, you may experience pain around the surgical site. Your surgeon will prescribe medication to help ease this discomfort while you recover. Be sure to carefully follow your surgeon’s instructions involving wound care. Contact them promptly if you notice any signs of infection such as fever, redness or drainage at the site, or pain that suddenly worsens.

Following your hernia repair, you may be unable to move around normally for several weeks. You’ll need to avoid any strenuous activity. Additionally, you should avoid lifting objects heavier than 10 pounds (4.5 kilograms) during this period. This is slightly more than the weight of a gallon of milk. Open surgery often requires a longer recovery process than laparoscopic surgery. Your surgeon will let you know when you can return to your normal routine.

Hernia in babies

Between 10 and 25 percent of babies are born with an umbilical hernia. This type of hernia is also more common in babies who are born prematurely or with a low birth weight. Umbilical hernias occur near the belly button. They form when the muscles surrounding the hole left by the umbilical cord don’t close properly. This causes a portion of the intestine to bulge out.

If your child has an umbilical hernia, you may notice it more when they’re crying or coughing. Umbilical hernias in children are typically painless. However, when symptoms such as pain, vomiting, or swelling at the hernia site occur, you should seek emergency medical attention.

See your child’s pediatrician if you notice that your child has an umbilical hernia. Umbilical hernias typically go away when a child is 1 or 2 years old. If it doesn’t disappear by the age of 5, surgery can be performed to repair it.

Pregnancy and hernia

If you’re pregnant and think that you have a hernia, see a doctor. They can evaluate it and determine if it poses any health risks. Often, hernia repair can wait until after delivery. If a small hernia that’s present before or during the pregnancy begins to get larger or cause discomfort, surgery may be advised to repair it.

The recommended time to have this performed is during the second trimester. Hernias that have been repaired in the past may return with later pregnancies. This is because pregnancy places a strain on abdominal muscle tissue that may have been weakened by surgery.

Hernias can also occur following a cesarean delivery. During a cesarean delivery, a doctor makes an incision into the abdomen and uterus. The baby is then delivered through these incisions. An incisional hernia can sometimes occur at the site of a cesarean delivery.

Hernia complications

Sometimes an untreated hernia can lead to potentially serious complications. Your hernia may grow and cause more symptoms. It may also put too much pressure on nearby tissues, which can cause swelling and pain in the surrounding area. A portion of your intestine could also become trapped in the abdominal wall. This is called incarceration.

Incarceration can obstruct your bowel and cause severe pain, nausea, or constipation. 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.

Some symptoms that can signal that you need to seek out emergency medical attention for your hernia include:

• a bulge that becomes red or purple
• pain that suddenly gets worse
• nausea
• vomiting
• fever
• not being able to pass gas or have bowel movements

Hernia prevention

You can’t always prevent a hernia from developing. Sometimes a hernia occurs because of an existing inherited condition or a previous surgery. However, you can make some simple lifestyle adjustments to help lower your risk of a hernia. These steps aim to reduce the amount of strain you place on your body.

Here are a few general prevention tips:

• If you smoke, consider quitting. You can work with your doctor to create a smoking cessation plan that’s right for you.
• See a doctor when you’re sick to avoid developing a persistent cough.
• Maintain a moderate body weight.
• Try not to strain while having a bowel movement or during urination.
• Eat enough high fiber foods to prevent constipation.
• Perform exercises that help to strengthen the muscles of your abdomen.

• Avoid lifting weights that are too heavy for you. If you must lift something heavy, bend at your knees and not your waist or back. Also avoid holding your breath when lifting heavy objects. Instead, exhale during the lift to decrease the chance of a hiatal hernia happening or worsening.