What Is a Hernia? Understanding Causes, Symptoms and Treatments
Medically Reviewed by Madeline Hubbard, RN, BSN
What Is a Hernia? Understanding Causes, Symptoms and Treatments
A hernia is a medical condition that occurs when a weakened portion of muscle wall or membrane allows internal organs and/or surrounding fatty tissue to protrude outside of the space where they normally sit in your body. There are several different types of hernias, and they’re classified based on the area of your body where they develop. Hernias are most commonly found around the abdomen and lower torso regions.
Regardless of the location, hernias can range in severity; some hernias resolve on their own and some require surgical intervention to prevent dangerous consequences. Read on to find out how hernias can be prevented, identified and managed.
Hernia Symptoms and Warning Signs
There are several different types of hernias. Out of those listed below, nearly 80% of hernias people experience are inguinal or femoral.
- Inguinal: Occurs in the groin area where the skin of the thigh and the torso joins (also known as the inguinal fold)
- Femoral: Occurs at the top of the thigh below the inguinal ligament
- Umbilical: Occurs when increased abdominal pressure leads to a hernia in the abdomen surrounding the belly button
- Incisional: Occurs after abdominal or pelvic surgery when the weakened tissues around the surgery site may serve as the site for incisional hernias
- Diaphragmatic/Hiatal: Occurs when there’s a defect in the diaphragm (a muscle that separates the abdomen and the lung cavity) and part of the stomach or intestines may protrude upward into the chest cavity, causing internal bulges
Hernias can occur suddenly and without warning or develop more slowly over time. Depending on the hernia's anatomical location as well as its cause, symptoms can range from nonexistent to severe. Mild hernias sometimes won’t cause any symptoms due to the small size of the protrusion. If you do experience symptoms, they may include:
- Bulging of your skin that you can see, feel or even push back into your body
- A sensation of pressure, especially when you tense the muscles surrounding the hernia
- Pain or a burning sensation that may increase during straining activity like coughing or a bowel movement
- Acid reflux or heartburn, which appears with diaphragmatic hernias
In some cases, intestinal tissue can become trapped within the herniated area. This can lead to two serious medical complications that result in the following symptoms:
- Obstruction (blockage of the intestinal tract): Severe pain, nausea, vomiting, stomach pain
- Strangulation (loss of blood supply): Increased pain, bruise-like discoloration of the hernia, increased heart rate, fever — strangulation is a medical emergency and can lead to significant tissue death if not treated right away
If you’re experiencing any of the above symptoms, they’re indications you’ve developed a hernia. If bulges under your skin increase in size when you’re coughing or straining — or if you have recurring discomfort or pain at the same generalized location when lifting heavy objects or during strained bowel movements or urination — this may be a warning sign. Visit your doctor as soon as possible to have them confirm the presence of a hernia or provide another diagnosis.
Causes of and Risk Factors for Hernias
Hernias can happen to almost anyone at any time, although the majority of hernias occur in adults. Some individuals may be more at risk than others. Generally, the presence of a hernia is related to increased internal body pressure and/or weakened muscle or connective tissue. The following factors can contribute to the onset of a hernia:
- Repeated strain: A chronic cough or constipation can increase internal pressure and worsen a hernia.
- Heavy lifting: Workplace or recreational heavy lifting can strain your body and lead to the development or worsening of a hernia.
- Injury: Muscle strains or joint dislocations can make you more vulnerable to developing hernia protrusions.
- Age: Connective tissue typically becomes weaker in older adults over time.
- Assigned sex: Hernias occur more commonly in people who are assigned male at birth.
- Pregnancy: Increased internal organ pressure can trigger a hernia.
- Surgery: Surgical incisions and scarring can lead to weakened tissue areas where hernias can more easily occur.
- Connective tissue disorders: These conditions may be present since birth and lead to hernias.
- Premature birth or fetal development: Failed embryonic closures in male fetuses can set the stage for inguinal hernias to form later in adult life.
- Family history: Having close relatives with a history of hernias increases your likelihood of developing this condition.
- Previous hernia: Having already had a hernia makes it more likely that another will occur.
If you have multiple risk factors or suspect that you’re experiencing symptoms of a hernia, it’s important to contact your healthcare provider for assessment and treatment options.
Hernia Testing and Diagnosis
Because hernias are external or internal protrusions of body parts due to a combination of weakened muscle tissue and increased internal body pressure, the two most common methods for testing and diagnosing hernias are physical exams and X-ray imaging. Depending on the area where the hernia is present, your healthcare provider may perform additional diagnostic testing to rule out other more serious medical conditions that are unrelated to hernias.
- Physical exam: A healthcare provider usually palpates, or feels, the affected bulge to gauge the texture, size and fullness of the protrusion and see its reaction to pressure. They’ll also visually evaluate the protrusion for discoloration; inflammation or abnormally dark blotches may signify infection or strangulation.
- Medical history: Your healthcare provider may ask about previous surgeries, a family history of hernias, recent activity levels or injuries and recent symptoms you’ve experienced.
- Imaging: Your provider may order an X-ray, ultrasound, CT scan or MRI to confirm the presence of a hernia or visualize its severity. This is especially common with internal hernias.
- Endoscopy: Depending on the area of your body where the hernia is present, your medical provider may order an endoscopy procedure. This involves sending a small camera through your mouth to display your internal organs and help your doctor see the location of the hernia.
- Other tests: Blood tests, tissue biopsies or stool samples may be ordered so your provider can evaluate whether other medical conditions may be related to or presenting as a hernia.
Hernias share symptoms with many other medical conditions that require completely different treatments. These can include heartburn, appendicitis, pancreatitis, irritable bowel syndrome and gallstones, to name a few. Untreated hernias can also lead to serious conditions that can be life-threatening, so it’s important to consult with a medical provider upon the first warning signs or symptoms of a hernia.
Preventing and Treating Hernias
Hernias are typically the result of excessive internal bodily pressure combined with defects in the supporting muscles that hold your organs in place. This means you can sometimes keep a hernia from developing by reducing the pressures exerted inside your body and by strengthening organ-supporting muscles, such as your abdominal muscles. Some strategies you can use to reduce your risk of developing a hernia include the following:
- Exercise: Regular gentle strengthening exercises can help buffer against weakened muscle tissue that makes it easier for hernias to form.
- Maintain your weight: Drastic weight fluctuations can also weaken muscle tissues, cause strain and allow hernias to form.
- Eat fiber: Increasing your daily fiber intake can prevent abdominal hernias by alleviating constipation, which is one of the causes of increased internal body pressure.
- Avoid strain: Use caution when doing any activity that involves heavy lifting.
- Manage underlying conditions: It’s important to seek treatment for any acute or ongoing conditions that might lead to a chronic cough or body fluid buildup, as these conditions can increase your risk of developing a hernia.
- Follow post-op advice: If you’ve recently had surgery, be sure to avoid heavy lifting and smoking, and maintain a balanced diet in order to support healing and lower your risk of an incisional hernia.
People with tissue and muscle disorders, pregnant people and professional athletes or individuals whose jobs require constant heavy lifting should consult with a healthcare professional for specialized preventative advice that can help them avoid internal pressure buildup and muscle tissue strains.
Hernias generally don’t heal spontaneously. They usually increase in size if left untreated. In mild cases, your doctor may be able to gently push a protrusion back into your body cavity and monitor it over time. However, to prevent a recurrence, it still may be important to treat the tissue defect that allowed the hernia to form.
The only available treatment option for hernias is surgery. Depending on the location of the hernia, the duration of the surgical procedure and the length of time it takes to recover can vary. A successful surgery will repair the hernia and relieve all of your symptoms.
Usually, you’ll have general anesthesia before this type of procedure, so you won’t feel pain during the surgery. However, there are risks with anesthesia, so be sure to discuss possible alternatives with your provider. During the procedure, the surgeon will make a small incision at the hernia site and carefully move the hernia back to the proper space in your body. Afterward, the doctor will place a piece of synthetic mesh at the site to help strengthen the tissue walls. Gradually, the mesh will grow into the weakened tissue to help form a stronger barrier, with the intention of preventing further weak spots.
In some cases of abdominal-area hernias, you may need a slightly different procedure called laparoscopic surgery. In this procedure, the surgeon uses a fiber-optic viewing tube known as a laparoscope, along with special instruments, to repair the hernia. Three small incisions, roughly 10 millimeters each in length, are made in your belly button and on each side of your abdomen. The surgeon inserts the laparoscope through the incisions and repairs the protrusion using special instruments. In more serious cases, like intestinal strangulation, the surgeon may choose to entirely remove the contents of the hernia. Because this surgery utilizes tiny incisions, it requires less recovery time than traditional hernia repair surgery.
If you notice any signs of a hernia forming, make an appointment with your healthcare provider to discuss whether intervention is necessary. Remember that leaving a hernia untreated can lead to a sudden medical emergency, so it’s important to manage your symptoms early on.