Hernia: Causes, Types, & Treatment

By John Bernard, MD
Medically reviewed checkmarkMedically reviewed
May 1, 2020

Everyone has an abdominal wall that keeps their internal organs in place. But a hernia occurs when this abdominal wall becomes weak or develops a hole, causing organs such as the intestines to protrude through. People with hernias frequently have a painful bulge that protrudes when they cough or strain, and they’re usually able to push the bulge back in.

There are many kinds of hernias, and each type can have unique symptoms. Hernia causes vary depending on the type of hernia a person has. Generally, hernias are more common in men, and the chances of developing a hernia tend to be higher for overweight individuals, smokers, and older people. There’s no way to guarantee you won’t get a hernia, but fortunately, a healthy lifestyle can reduce your chances of developing one.

Since hernias don’t usually heal on their own and can cause complications in rare cases, it’s important to seek medical care if you suspect you may have one. Typically, hernias are easy to diagnose with a physical exam and on the basis of your symptoms, but in some cases, your doctor may order a CT scan or MRI.

The most common form of treatment for a hernia is surgical repair, but your doctor can recommend the best course of treatment for you based on your unique scenario.

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What Is a Hernia?

A person’s abdominal organs are kept in place by a muscular wall called the peritoneum. When this wall is weak or has a hole in it, an internal organ may protrude through—or herniate—and create a localized bulge or lump in a person’s abdominal or groin area. This is known as a hernia.

Hernias can be painful, especially when a person coughs, sneezes, strains to use the restroom, bends over, or lifts something heavy. When a person engages in these activities, the hernia bulge may become more prominent; people can usually push them back in afterward.

While hernias aren’t typically dangerous, they don’t improve on their own. Most of the time, hernias require surgery to repair. Without proper medical intervention, hernias can lead to other medical complications, such as a bowel obstruction or intestinal strangulation, where blood supply gets cut off to the intestines.

Hernias can occur in anyone, but they are most common in men. Aging also increases the risk of a person getting a hernia.

Types of Hernias

All hernias have to do with an internal organ protruding through a muscular wall, but there are several types of hernias that affect different areas of the body and may cause different symptoms. Inguinal and femoral hernias are by far the most common, making up up to 80% of all hernias.

Here are some of the most common kinds of hernias people experience:

Inguinal hernia

The most common type of hernia is an inguinal hernia, and it occurs more commonly in men than in women. In men, the inguinal canal is a passageway that leads from the spermatic cord and blood vessels to the testicles. In women, this canal contains the round ligament that supports the womb. When someone has an inguinal hernia, a part of the intestine or fatty tissue pokes into the groin, around the top of the inner thigh.

Femoral hernia

A femoral hernia occurs when fatty tissue or part of the intestine pushes into the groin at the top of a person’s inner thigh. Femoral hernias more commonly affect older women, and while they are somewhat common, they occur less frequently than inguinal hernias.

Umbilical hernia

When fatty tissue of part of a person’s intestine protrudes through the abdomen near the belly button, it causes an umbilical hernia. Umbilical hernias are most common in babies, affecting 10-20% of newborns. Umbilical hernias can go away on their own as a child gets older, but if not, they typically require surgery.

Hiatal hernia

A hiatal hernia, also called a hiatus hernia, happens when part of the stomach pushes up into a person’s chest cavity through an opening in a person’s diaphragm, which is the horizontal muscle that separates the chest and abdomen.

Less common types of hernia

Less common types of hernias include:

  • Incisional hernia: An incisional hernia is when tissue pushes through the site of an abdominal scar from an abdominal or pelvic surgery.
  • Diaphragmatic hernia: A diaphragmatic hernia occurs when organs in a person’s abdomen move into their chest cavity through an opening in their diaphragm.
  • Epigastric hernia: An epigastric hernia happens due to tissue pushing through the abdominal area between the navel and breastbone (the lower part of the sternum).
  • Spigelian hernia: This type of hernia occurs when a part of the intestines push through a person’s abdomen at the side of the abdominal muscle, more below the navel than in an umbilical hernia.

What Causes a Hernia?

At the most basic level, hernias are caused by weakened muscles that allow organs or other fatty tissues in the abdomen or groin to pass through. Some people may have been born with weak muscles, while other people may develop weakened muscles as they age or due to repeated strain. Hernia causes vary by type.

Inguinal and femoral hernias can be caused by strain due to:

  • Physical exertion involving the abdomen
  • Frequent, severe coughing
  • Pregnancy
  • Obesity
  • Straining on the toilet due to chronic constipation
  • Straining to urinate

Umbilical hernias may be caused by:

  • Straining the abdominal area repeatedly
  • Frequent, severe coughing
  • Obesity
  • Giving birth

Spigelian hernias may be caused by:

  • Lung conditions that cause a chronic cough, such as COPD or asthma
  • Chronic constipation
  • Injury to the abdomen
  • Frequently straining to lift heavy objects
  • Liver problems that result in fluid accumulating in the abdomen
  • Obesity
  • Pregnancy

Diaphragmatic hernias can be congenital (present at birth) or acquired (as the result of an injury to the abdomen). Common causes of acquired diaphragmatic hernias include:

  • Vehicle accidents
  • Falls that injure the diaphragm area
  • Surgeries on the abdomen region
  • Stab or gunshot wounds

Doctors aren’t totally sure what causes hiatal hernias. One theory is that aging, which can lead to weakening in the diaphragm, may be a contributing factor.

Incisional hernias are generally caused by surgical incisions after prior operations. Usually, epigastric hernias are present at birth and occur due to incomplete development of the abdominal wall.

Hernia Signs and Symptoms

Since a hernia is caused by an internal organ protruding through a muscle, it can create a painful, visible bulge in the abdomen or a lump in the groin. This bulge is usually painful when a person coughs, strains, or lifts something heavy. After these activities, a person can usually push the bulge back in. But a lump or bulge may not be the only symptoms of a hernia.

Other signs of a hernia include:

  • Abdominal pain or swelling in the site of the bulge
  • Groin pain
  • Gradual increase in the bulge’s size
  • Pain while lifting or performing strenuous activities
  • A sense of “feeling full”

Hiatal hernias don’t typically cause a visible bulge. Instead, this type of hernia comes with unique symptoms, such as:

  • Acid reflux or heartburn caused by stomach acid coming up to a person’s esophagus
  • Indigestion
  • Difficulty swallowing
  • Chest pain
  • Regurgitation (bringing food back up after eating)

How is a Hernia Diagnosed?

Your symptoms and your bulge may be enough to diagnose a hernia. While your doctor may be able to see or feel the hernia during a physical exam, he or she may ask you to strain or cough to make the bulge more prominent and easier to examine.

For patients with a suspected inguinal hernia, the doctor may examine the groin area twice: once while the patient is at rest, and once while they cough.

Often, an exam is sufficient for diagnosis. To get a better look at the hernia and assist with proper diagnosis, the clinician may order imaging, such as a CT scan, MRI, or abdominal ultrasound.

How to Treat a Hernia

Hernias generally do not improve on their own. If your hernia is not causing symptoms and you can push it back into your abdomen, your doctor might recommend a “watch and wait” approach so you can avoid surgery.

Most hernias do need surgical repair, especially since the risk for potential complications like bowel obstruction or intestinal strangulation tends to increase over time.

If your doctor recommends surgery, he or she will refer you to a surgeon who can determine the best course of action for your hernia. The decision to operate is often a complicated one which will depend on the severity and location of the hernia, your symptoms, the types of chronic medical problems you may have and your age and activity level, among other factors.

Common surgeries to repair a hernia include:

  • Open surgery: where a surgeon cuts into the body at the location of the hernia, sets the tissue back in place, and stitches the muscle together again.
  • Laparoscopic surgery: or keyhole surgery, which includes the same type of repair but is completed with tiny incisions that allow a surgical tool called a laparoscope to enter the abdomen or groin.
  • Robotic hernia repair: where a surgeon operates their tools from a console in the operating room, which is typically used with smaller hernias.

In some people, hernias can recur after surgery due to tissue weakness. A recurring hernia is especially common in people who smoke and those who are obese.

In some young children or babies born with an umbilical hernia, surgery may not be necessary. Sometimes, the hernia heals itself by the time a child turns four or five years old. If not, your child’s doctor may recommend a surgical procedure to repair the hernia.

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Hernia Prevention

Hernias can’t always be prevented. But with a healthy lifestyle, you can reduce your risk of developing a hernia. Focus on healthy behaviors like:

  • Maintaining a healthy body weight
  • Eating a nutritious diet rich with fruits and vegetables
  • Exercising regularly
  • Using correct form or supervision when lifting weights or heavy objects
  • Avoiding smoking
  • Scheduling physical exams regularly, especially if you have a chronic cough

Risk Factors and Complications

With treatment, hernias usually don’t cause long-term problems—but if a person doesn’t seek medical care, complications may arise.

For example, some hernias can lead to intestinal strangulation, a condition where part of the intestine becomes trapped in the abdominal opening, which can result in intestinal rupture or shock. Another potential complication is a bowel obstruction, which happens when digested food can’t fully pass through the intestines. These are considered true emergencies and must be treated and managed immediately, typically in a hospital setting.

Some people are at a higher risk for developing a hernia, including:

  • Males
  • Older adults
  • Smokers, since chemicals found in cigarettes can lead to weaker bodily tissue
  • Pregnant women or women who recently gave birth
  • People who had a recent abdominal or groin surgery
  • Overweight people
  • People who engage in frequent, strenuous activity

When to See a Doctor

Always see your physician or chat with a K Health doctor if you have signs of a hernia, such as bulging in your abdomen or groin and pain when coughing, straining, and lifting. Your provider can help you come up with the best course of action for managing your symptoms and treating your hernia.

It’s important to seek emergency care if you can’t push the bulge back into your abdomen or groin. You should also go to the emergency room or call 911 if you have signs and symptoms of a bowel obstruction or intestinal strangulation, which may include:

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How K Health Can Help

You should talk to a doctor if you think you have signs of a hernia.

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K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

John Bernard, MD

Dr. Bernard is an emergency medicine physician. He graduated from Jefferson Medical College in Philadelphia, and did his residency in emergency medicine at the University at Buffalo.