Overview
A hernia happens when part of an organ or tissue, such as a loop of bowel, pushes through a weak spot in the muscle wall. Most are in the tummy or groin and show as a bulge. Common types are:
- Inguinal, in the groin, the most common
- Umbilical, at the belly button
- Incisional, through the scar of an earlier operation
A hiatus hernia, in which part of the stomach moves up into the chest, is different and often causes heartburn.
Symptoms
The main sign is a lump or bulge. It may:
- Grow bigger when you cough, strain, lift or stand for long, and shrink or vanish when you lie down
- Appear in the groin or scrotum, near the belly button, or over an old scar
Some hernias cause an ache, heaviness or burning that eases with rest. A large hernia may cause no pain, because the muscle around it has stretched.
When to see a doctor
See a doctor about any new lump in the groin, at the belly button or on the tummy, or an ache in the groin, even if it hardly hurts, or if a lump is growing or painful. See one too if a baby's belly button bulge is very large or has not gone by about the age of 5.
Causes
A hernia forms where the muscle wall is weak or under strain. The weak spot may be there from birth, or develop later. Things that may add strain include:
- Heavy lifting, or long hours of standing
- A long-lasting cough
- Constipation and straining
- Being overweight
- Pregnancy
- Fluid in the tummy (ascites), for example from liver disease
- Ageing, or an earlier operation
Risk factors
- Being male (groin hernias are much more common in men)
- Older age, though babies also get them
- A family history of hernia
- Being overweight, or having a persistent cough
Complications
Over time a hernia can grow and become more uncomfortable. The serious risk is that it becomes:
- Stuck (incarcerated), when it cannot be pushed back in
- Strangulated, when the blood supply to the trapped tissue is cut off and it can die
- Obstructed, when a trapped loop of bowel is blocked
A strangulated hernia is life-threatening and needs emergency surgery.
Prevention
Not every hernia can be prevented. These steps help lower the risk:
- Keep a healthy weight
- Stay physically active
- Stop smoking
- See a doctor about a cough that does not clear up
- Treat constipation, so you do not have to strain
Diagnosis
A doctor asks about the lump and examines you, often while you stand, cough or strain, because the bulge shows best then. Most hernias can be diagnosed this way. If the diagnosis is unclear, or to look for complications, an , CT or may be done.
Treatment
Surgery is the usual repair, because the gap in the muscle does not close on its own in adults. Timing depends on the type, size, symptoms and your general health. A small groin hernia with few or no symptoms may sometimes be watched with regular check-ups, but many people eventually need an operation.
Repair can be open surgery, through a cut over the hernia, or keyhole (laparoscopic) surgery, which may allow a quicker recovery. The gap is closed with stitches, a mesh, or both. Risks include infection, lasting pain and the hernia coming back. Most people are back at work within days to two weeks, but heavy lifting takes longer.
A stuck or strangulated hernia needs emergency surgery. In babies, an umbilical hernia usually closes by around the age of 5, and an operation is needed only if it is very large or persists.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Exercise, a tight belt or a home remedy will make the hernia go away.”What is true?
Fact
A hernia is a gap in the muscle wall. In adults it is unlikely to get better on its own, and surgery is usually needed to repair it. Home remedies only delay seeing a doctor.
Myth“Hernias only happen to people who lift heavy weights.”What is true?
Fact
Heavy lifting can add strain, but some people are born with a weak spot that shows up years later, and ageing, a lasting cough, constipation, being overweight, pregnancy, fluid in the tummy and earlier surgery can also lead to a hernia. Women get hernias too.
Myth“If the hernia does not hurt, it is harmless and can be ignored.”What is true?
Fact
A hernia can be painless, particularly a large one, because the muscle around it has stretched. Any hernia can become stuck and lose its blood supply, so a lump should be shown to a doctor even if it does not hurt.
Myth“After hernia surgery you must rest in bed for months.”What is true?
Fact
Recovery is much quicker. Many people return to light activity and work within days to a couple of weeks and need longer before heavy lifting. Full recovery can take about four to six weeks, depending on the operation.
Myth“A coin or tight cloth pressed on a baby's bulging belly button will flatten it.”What is true?
Fact
An umbilical hernia in a baby is usually painless and closes on its own, typically by around the age of 5, so nothing needs to be pressed onto it. Treatment is only needed if it is very large or does not go away.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Can a hernia go away without surgery?
In adults it is unlikely. The gap in the muscle does not close by itself, so surgery is usually recommended. A baby's umbilical hernia is different and usually closes on its own by around the age of 5.
Is it safe to wait for surgery?
Sometimes. A small hernia with few or no symptoms may be watched with regular check-ups if the doctor agrees. It is important to know the emergency signs, because a hernia that gets stuck needs urgent surgery.
Can I exercise or lift weights with a hernia?
Straining, lifting and coughing tend to make the bulge come out and ache more. Ask your doctor what activity is safe for you while you wait, and when you can lift again after surgery.
Can women get hernias?
Yes. Groin hernias are much more common in men, but women can get inguinal, femoral, umbilical and incisional hernias. Pregnancy and earlier surgery can add to the risk.
