Key takeaway

  • A hernia occurs when an organ or tissue pushes through a weakness in the peritoneum, creating a bulge that may cause discomfort or pain. Common types include inguinal, femoral, hiatal, umbilical, and incisional hernias.
  • Some risk factors for hernia include obesity, older age, pregnancy, and lifting heavy items.
  • Treatment options range from watchful waiting for mild cases to surgical repair. Procedures include open surgery and laparoscopic techniques, each with different benefits and risks.

Hernias can often be harmless and pain-free, but at times they can cause discomfort and pain.

This article investigates what a hernia is, the common causes of hernia, and how doctors treat hernias.

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A hernia occurs when there is a weakness or hole in the peritoneum, the muscular wall that usually keeps abdominal organs in place.

This defect in the peritoneum allows organs and tissues to push through, or herniate, producing a bulge.

The United Kingdom’s National Health Service (NHS) notes that the lump may disappear when the person lies down, and sometimes it can be pushed back into the area it is protruding from. Coughing or straining may make it reappear.

Hernias can commonly occur in the following areas:

  • groin
  • upper part of the abdomen
  • belly button
  • abdominal surgery scar

For many people, a hernia is no more than a painless swelling that presents no problems and needs no immediate medical attention.

However, a hernia may cause a feeling of pressure, discomfort, or pain when it bulges through the opening. Symptoms often become worse when standing, straining, or lifting heavy items. People who notice increasing swelling or soreness may want to consider seeing a doctor.

The NHS notes that, sometimes, a hernia needs immediate surgery. For instance, if the hernia is likely to cause bowel obstruction or become strangulated.

People should seek immediate medical attention if a hernia produces acute abdominal complaints such as:

  • pain
  • nausea
  • vomiting
  • difficulty passing stool or wind

The swelling, in these cases, is typically firm and tender and cannot be pushed back up into the abdomen.

A hiatal hernia can produce symptoms of gastroesophageal reflux disease (GERD), such as heartburn, which results from stomach acid getting into the esophagus.

There are several different types of hernia:

  • Hiatal or hiatus hernia: Hiatal hernias occur when the upper part of the stomach pushes out of the abdominal cavity and into the chest cavity through an opening in the diaphragm.
  • Femoral hernia: A femoral hernia creates a bulge just below the groin.
  • Inguinal hernia: An inguinal hernia is a bulge in the groin. In people with scrota, the scrotum may appear enlarged.
  • Umbilical hernia: An umbilical hernia may cause a bulge near the navel, or belly button.
  • Epigastric hernia: An epigastric hernia is a bulge that develops between the belly button and breastbone.
  • Incisional hernia: An incisional hernia is a bulge that occurs through a scar from past abdominal surgery.

With the exception of an incisional hernia (a complication of abdominal surgery), in most cases, there is no obvious reason for a hernia to occur.

The risk of hernia increases with age, although a hernia can be congenital (present at birth) or develop in children who have a weakness in their abdominal wall.

Activities and medical problems associated with hernia development include:

For a hernia without symptoms, the usual course of action is to watch and wait. However, it is likely that a person will require surgery to remove the hernia eventually.

A doctor will monitor a person’s condition and recommend surgery if or when it is necessary. The NHS notes that, sometimes, the risks of surgery outweigh the potential benefits. It also highlights that while a hernia will not get better without surgery, that does not necessarily mean it will get worse.

Types of surgery

Although surgical options depend on individual circumstances, including the location of the hernia, there are two main types of surgical intervention for hernia: open surgery and laparoscopic operation (keyhole surgery).

Open surgical repair closes the hernia using sutures, mesh, or both, and a surgeon closes the surgical wound in the skin with sutures, staples, or surgical glue.

Doctors recommend laparoscopic repair for repeat operations to avoid previous scars, and while usually more expensive, is less likely to cause complications such as infection. Surgical repair of a hernia guided by a laparoscope allows for the use of smaller incisions, enabling a faster recovery from the operation.

Surgeons repair the hernia in the same way as in open surgery, but it is guided by a small camera and a light introduced through a tube. They insert surgical instruments through another small incision. The abdomen is inflated with gas to help the surgeon see better and give them space to work. The surgeon performs the whole operation under general anesthetic.

Hernia in children

Doctors always treat inguinal hernia in infants and children with surgery. This is to prevent the tissue from becoming pinched or strangulated.

A 2014 systematic review of 20 years of data on conventional open hernia repair (herniorrhaphy) and laparoscopic hernia repair in infants and children found that laparoscopic surgery is faster than open surgery for bilateral hernias, but that there is no significant difference in operating time for unilateral inguinal hernia repair.

The rate of recurrence is similar for both types of procedure, but complications, such as wound infection, are more likely with open surgery, especially in infants.

A hernia occurs when there is a weakness or hole in the peritoneum, causing a bulge that may lead to pain and discomfort. There are several types of hernia, including hiatal, femoral, umbilical, and inguinal hernias.

A healthcare professional will monitor a person’s hernia and recommend surgery if or when it is necessary. Surgeons may perform open or laparoscopic surgery.

Anyone who thinks they are experiencing a hernia should contact a doctor for assessment.