Hernia is a condition that usually happens in your groin (private area) or abdomen (lower stomach). An organ such as your intestines can push out between the muscles, which causes a bulge under the skin. This lump is usually visible.

There are many types of hernia, including:

• Inguinal hernia is the most common type. About 75% of all hernias are this kind and mostly affect men. They happen when part of your bowel (intestines) protrudes into your inguinal canal, a passageway that runs down your inner thigh.

• Femoral hernia is a less-common type of groin hernia that occurs in the femoral canal, which runs under the inguinal canal. Fatty tissue can push through the muscle into this area.

• Hiatal hernia is another common type of hernia that people develop over a lifetime. It happens when the top of your stomach pushes up through the diaphragm ‑ the thick muscle under your lungs ‑ into your chest.

• Congenital diaphragmatic hernia is a serious condition present from birth, in which the diaphragm doesn’t close all the way during fetal development. It can cause abdominal organs to slip up into the chest cavity while the organs are still growing, crowding the lungs.

• Incisional hernia happens when tissue pushes through an old incision in your abdominal wall that weakened over time. It’s a common side effect of abdominal surgery.

• Umbilical hernia happens when part of your intestine enters an opening in your abdominal wall near your navel (belly button). Most umbilical hernias are congenital (present from birth).

• Ventral hernia describes any hernia that occurs through the front wall of your abdomen, including umbilical and incisional hernias. An epigastric hernia is a ventral hernia above the belly button.

• Perineal hernia describes when organs or tissue push through an opening or weakness in your pelvic floor into your abdominal cavity. These hernias are relatively rare.

Signs and Symptoms

Although a bulge in the area is a common symptom of several types of hernia, different kinds of hernia have different symptoms. Sometimes the bulge can come and go. Sometimes there is no pain or discomfort.

Common symptoms of a hernia are:

• A bulge where you shouldn’t have one, such as the abdomen (lower stomach) or thigh.
• Dull ache or pressure when the tissue pushes through the opening.
• A feeling like heartburn or indigestion, which may mean a hiatal hernia.
• A bulge that occurs when you bend over, squat or engage in physical activity.
• Unexplained groin pain.

See a doctor right away if:

• You have a visible bulge or lump and nausea, vomiting, fever or chills.
• Your hernia or bulge changes color or goes numb.

Causes

The main causes of hernia include:

• Weakness or an existing opening in your muscle or connective tissue that allows an organ or other tissue to push through
• Weakness or opening that is present at birth
• A traumatic injury or surgery that creates an opening in the muscle or connective tissue
• Years of pressure or exertion from higher weight, long periods of standing or squatting or other activity that wears the muscle down or causes an opening

Diagnosis

When you visit a health care provider about a hernia, they usually will start with a simple physical exam. Depending on what kind of hernia you have, this may be enough to diagnose your condition. Your health care provider may be able to see or feel the hernia pushing through. They might ask you to cough or adjust your position so they can see if or how the hernia moves. Sometimes a hernia can be physically pushed back in, which can help determine how serious it is. If the health care provider can’t determine if you have a hernia, they may order a soft tissue test such as an abdominal ultrasound, CT scan or MRI.

Treatments

The most common treatment for hernia is surgery, although you probably won’t need it immediately (unless you have symptoms such as fever, chills, nausea and vomiting, or the hernia goes numb or changes color).  If the hernia is small or only pushes out sometimes, your health care provider may want to wait and see if it gets worse. Hernias don’t go away on their own and typically will need surgery at some point.

During this common procedure, the surgeon will push the tissue of the hernia back into place. Surgical mesh or stitches are used to keep in in place. This surgery usually is done with minimally invasive techniques, which means small incisions and less scarring, usually less postoperative pain and faster recovery.

Laparoscopic surgery uses a long, thin tube with a lighted camera on the end to look inside the surgical site. A second thin tube is inserted, through which long, thin surgical tools can be used to repair the herniated tissue. Robotic-assisted surgery for hernia repair is similar, but the surgeon controls the tools from a computer console, using robotic arms. Some hernias may need traditional more invasive open surgery.

Lifestyle Changes

You may be able to stop a hernia from getting worse, or from recurring, by making some changes in your lifestyle:

• Stop smoking.
• Manage your weight.
• Avoid constipation.

Risk Factors

There are also some risk factors that may make it more likely that you will develop a hernia.

You may be more likely to develop a hernia if you have:

• A job that involves heavy lifting or many hours of standing
• A chronic cough or allergies that cause chronic sneezing
• Chronic constipation and straining to use the toilet
• A history of abdominal or pelvic surgery
• Have had a pregnancy, especially repeat pregnancies
• Chronic obesity (a body mass index higher than 30)
• Diabetes

You also may be at higher risk for hernia if you smoke.

Complications

Most hernias are reducible, which means that the herniated tissue can be pushed back into the abdominal cavity. However, some hernias are irreducible (also called incarcerated hernias), which means they cannot be pushed back to their correct position.

This can cause the following complications from hernia:

• Strangulation: Pressure placed on the tissue pushing out through the weekend muscle may stop or limit the blood supply to a section of an organ or tissue. This can lead to cell death or even gangrene. A strangulated hernia is life-threatening and requires immediate surgery
• Obstruction: If part of the intestines pushes out into a hernia, the contents of the intestine no longer can pass through the herniated area. This causes cramps, nausea and vomiting. It can also cause you to stop having a bowel movement.

 A small hernia might never bother you. All hernias, however, tend to grow bigger over time. As the opening continues to weaken and stretch, the more tissue gradually works its way through. The more tissue that pushes through, the more likely it is to become incarcerated, leading to pain and other complications.

Next Steps

Surgeons at Norton Audubon Hospital have had additional training in complex hernia repairs, including component separation and minimally invasive options for repair. Our specialists are actively involved in the Abdominal Core Health Quality Collaborative, an organization with a mission to improve outcomes for hernia patients. Our board-certified physicians are nationally recognized specialists in hernia repair. Make an appointment via Norton MyChart or call (502) 636-7111.