What Is a Hernia?

Abnormal Protrusion of Organs Through Surrounding Muscle

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A hernia occurs when organs push through weak areas of muscle surrounding the body cavities where they are located. Hernias commonly occur in the abdomen, chest, and groin. They can also occur elsewhere in the body, particularly in areas that have scars from surgery.

Sometimes hernias are obvious because they create a bulge under the skin. The hernia might hurt, but not always. If a hernia has its blood supply is cut off (becomes strangulated), it can be a medical emergency. Some hernias will require surgery to fix.

Here is an overview of how hernias work, the different types of hernias, how a hernia can look and feel, how your doctor can diagnose a hernia, and what type of treatment might be needed if you have a hernia.

Stomach pain
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Definition

The term hernia likely came from a very old Latin word that meant "a rupture"—more specifically related to the intestines.

Anatomy

Starting with the outer layer (superficial layer) of skin, there are several layers of fat, muscle, and other tissue that make up the abdomen, groin, and other regions of the body where hernias can occur.

Under the surface area of skin is a layer of fat. The amount of fat that makes up this layer will vary from one person to another. Different muscles and soft tissues are found beneath the layer of fat. In the abdomen, there is a protective layer called the peritoneum beneath the muscles. It protects the organs and keeps them separate from the other layers.

A hernia occurs if there is a space or defect in these layers that allows the organs underneath to be pushed through. This is more likely to occur in areas that are weak (because there are no muscles there) or those that become weak after trauma or surgery.

Types of Hernias

There are many types of hernias. Most are named according to the structures of the body that they are close to, but some are named after the people who discovered them. Some types of hernias are very common, some affect males more than females, and others are considered rare or unusual.

The types (and subtypes) of hernias include:

  • Abdominal or ventral hernias (includes epigastric and Spigelian hernias)
  • Amyand's hernia (involving the appendix)
  • Brain herniation
  • Diaphragmatic hernia
  • Femoral hernias (when in front of the blood vessels, is called a Velpeau hernia)
  • Groin hernias
  • Hiatal hernias (which include paraesophageal hernias)
  • Incisional hernias (occur at or near the site of a surgical scar)
  • Inguinal hernias (can be indirect, direct, or pantaloon hernia)
  • Littre's hernia (related to Meckel's diverticulum
  • Lumbar hernia (includes Petit's and Grynfeltt's hernias)
  • Maydl's hernia (involving the small intestine)
  • Obturator hernia
  • Parastomal hernia (involving a stoma)
  • Perineal hernias
  • Richter's hernia (involves loops of the intestine)
  • Sciatic hernia
  • Sliding hernias (can include the stomach, bowel, and bladder)
  • Sports hernia (chronic groin pain in athletes)
  • Umbilical hernias (can also be paraumbilical)

Hernias most commonly occur in the abdomen, which includes the inguinal region and groin. In 2015, 18.5 million people in the United States were diagnosed with an abdominal, inguinal, or femoral hernia.

Males are more likely to have inguinal hernias—about 1 in 4 men will have an inguinal hernia in their lifetime. Femoral hernias are more common in females, especially when they are pregnant or if they are overweight.

Reducible vs. Irreducible

Hernias can also be classified according to whether or not they can be pushed back into their proper place. These types of hernias are termed reducible. If a hernia cannot be put back into its correct anatomical spot is called an irreducible or incarcerated hernia.

Reducible hernias might not need to be repaired with surgery, but irreducible hernias can sometimes lead to complications.

Obstructed and Strangulated Hernias

Complicated hernias are those that become obstructed or strangulated. For example, a hernia in the abdomen might compress parts of the intestine and cause a bowel obstruction.

If a hernia becomes strangulated, blood is unable to get to the organs and tissues, which can lead to the death of the tissue (necrosis). In some cases, it can cause a serious infection that can be fatal.

Red Flags

If you develop signs and symptoms of a strangulated or obstructed hernia, seek immediate medical care.

Red flags to watch out for include:

  • Fever
  • Nausea and vomiting
  • Pain
  • Tenderness and redness over the area where your hernia is located

How Hernias Look and Feel

The appearance of a hernia and any symptoms associated with it will depend on where it is and whether it is complicated. Some hernias do not cause symptoms and a person might not even need treatment (other than keeping an eye on it to make sure it does not become complicated).

Appearance

A hernia can look like a bump, lump, or bulge under the skin. Some hernias will develop and the lump will remain, while others might go away and come back. A hernia might appear gradually or suddenly (such as right after you have lifted a heavy object).

If you press on the lump, it will usually feel like a soft mass of tissue. You might be able to move it, or it might stay more or less where it is when you press on it. Hernias might bulge or move in response to certain activities, such as straining to have a bowel movement, lifting, or coughing.

Hernias can also get bigger over time and might swell. You might not notice a hernia until it becomes quite large or causes symptoms (although, sometimes larger hernias cause fewer symptoms than smaller ones).

Signs and Symptoms

Some hernias do not cause any symptoms. When they do cause symptoms, they are typically related to the surrounding organs and structures.

For example, hernias in the abdomen can cause acid reflux, constipation, or abdominal pain. Hernias involving the diaphragm can cause shortness of breath and chest pain. Hernias in the groin can cause pain in the testicles.

Sixty-six percent of people with hernias in their groin have symptoms, most commonly pain that is worse if they cough, lift, exercise, or have a bowel movement. Sometimes, the pain, swelling, and other symptoms will get better when a person lays down. The bulge from the hernia might be easier to see when someone is standing.

A hernia that is causing pain is more likely to develop complications (such as strangulation) than one that does not hurt. If you have a hernia that becomes painful or is getting bigger, make sure you tell your healthcare provider.

Diagnosing Hernias

If you think you could have a hernia, your healthcare provider can do an exam. Some hernias can be easily identified by looking at and feeling the affected area. If you have symptoms or risk factors that are associated with hernias (such as having had surgery or having a history of hernias in your family) that can help your doctor be more sure about the diagnosis.

Your doctor might want to do imaging tests such as computerized tomography (CT) scan or ultrasound to help them to determine if the hernia is complicated or causing other problems (such as a bowel obstruction). These tests also help them be more sure that your symptoms are not being caused by something else ("ruling out" other medical causes).

If a person has symptoms like heartburn and acid reflux, a hiatal or esophageal hernia might be diagnosed during an endoscopy (a procedure where a tube and lighted camera is put down the throat).

Risk Factors

Certain lifestyle habits, activities, and medical or health conditions might make you more likely to get a hernia in your lifetime. Sometimes, a tendency to get hernias runs in families, meaning there could be a genetic component.

A baby can also be born with a type of hernia that affects the diaphragm; this condition is thought to occur in about 1 in every 2,000 births and requires surgery.

Most hernias are acquired, meaning certain things happen that lead a person to develop one. Hernias are more likely to occur if someone:

  • Exercises strenuously, lifts weights, or overexerts themselves regularly
  • Is obese 
  • Is pregnant 
  • Has a condition that causes pressure or fluid in the abdomen
  • Has a family member who has had a hernia
  • Has an illness or condition that causes them to experiences prolonged, hard bouts of coughing (such as lung diseases like COPD or asthma)
  • Has chronic constipation and frequent straining to have bowel movements 
  • Has had surgery
  • Has poor posture and weakened muscles
  • Lifts heavy objects (especially if they do not use proper form)
  • Smokes (which can cause or worsen coughing)
  • Sustains a sharp blow or trauma to the abdomen (such as in an accident)

Do Hernias Need Treatment?

If you have a hernia that is not causing pain or other symptoms, your healthcare provider might recommend certain lifestyle changes to help prevent the hernia from becoming complicated.

In some cases, certain hernias that are likely to develop complications (such as inguinal hernias) should be fixed surgically before a problem develops. Usually, this can be done as an elective surgery (which is one that you can plan with your doctor because it is not an emergency).

If you have a hernia but your healthcare provider does not think it warrants surgery, you might be told to avoid certain activities, such as lifting heavy objects or straining to cough or have a bowel movement. Your doctor might also recommend that you lose weight or quit smoking if it is thought that it would help prevent your hernia from becoming worse.

You might have heard about belts or other external support devices that you can wear to keep a hernia "tucked in." It's not clear whether these devices are helpful. In some cases, they might actually make a hernia worse by causing compression that leads to strangulation.

If you have symptoms, your doctor might want you to start by trying a few lifestyle changes to see if they improve. For example, some people with a hiatal hernia who experience heartburn feel better if they change their diet, sleep with their head propped up with extra pillows, and take acid reflux medication.

Some hernia repair procedures do not require you to be put to sleep with anesthesia. Instead, you will have anesthesia injected into your skin near the hernia (local anesthesia), which will prevent you from feeling pain while the surgeon fixes it. You might also be given medication to relax you. You might not remember much about the procedure even though you were awake.

If a hernia is causing pain or becomes complicated by obstruction or strangulation, you will need to have surgery to fix it. In some cases (such as when a hernia has caused an obstruction), the surgery might be an emergency.

Depending on where the hernia is and how complicated it is, the surgeon might need to use a big incision (laparotomy). Some hernias can be repaired with small incisions or even with help from surgical robots. Laparoscopy can be used for many hernia repairs and has less recovery time than open surgery.

When a surgeon repairs a hernia, they often use a special type of material to help keep it in the right place. When used by skilled surgeons, surgical mesh is an effective way to fix a hernia. In some cases, people have developed problems (such as pain and infection) after having surgery to repair a hernia where mesh was used.

Some surgical techniques to repair hernias do not use mesh; however, whether a surgeon will choose these methods depends on their experience and preference, as well as the needs of a specific patient.

After surgery to repair a hernia, most people recover well and quickly—although, they will have restrictions on certain activities for an extended period of time until their body heals. A person who is recovering from a hernia repair will not be able to lift or perform any intense activity for at least a month, if not up to three months or longer.

A Word From Verywell

Hernias are a common medical problem with many possible causes. You might be more likely to have a hernia if your life if you do a lot of heavy lifting or strenuous exercise, have a family history of hernias, or have had surgery.

Some hernias do not cause symptoms and are unlikely to develop complications. However, your healthcare provider still might suggest that you have a hernia fixed before it becomes a problem.

Complications of hernias, such as strangulation, can be serious—if not life-threatening. If you develop symptoms that are being caused by a hernia, your doctor might suggest certain lifestyle changes first. Avoiding constipation, quitting smoking, and losing weight are a few recommendations your health care provider might make.

If there are complications, you might need to have emergency surgery to repair the hernia. If you have surgery to fix a hernia, you may or may not have to be put to sleep with anesthesia.

If your hernia is fixed with open surgery, you will have a longer recovery time than if it is done laparoscopically. In either case, having surgery to repair a hernia means you will need to avoid certain activities (like heavy lifting or strenuous exercise) while your body is healing—potentially up to several months.

While hernias can be painful and can lead to complications, there are effective ways to treat them. If you think you have a hernia, tell your doctor. They can make sure that your symptoms are not being caused by something else and, if you do have a hernia, help you decide the best course of action to take.

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