Hernia

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Introduction

What is a hernia?

A hernia is a condition in which an organ or other structure protrudes through a weak part of tissue or muscle. In some cases, a hernia can create a visible lump or bulge in the skin.

Many people do not understand what a hernia is. Hernias are classified according to the site of protrusion:

  • Congenital diaphragmatic hernia is a birth defect that allows abdominal organs to protrude up into the chest cavity.

  • Femoral hernia is the protrusion of abdominal fat or part of the intestines through the abdominal muscles into the upper thigh area.

  • Hiatal hernia is the protrusion of a portion of the stomach through an opening in the diaphragm called the hiatus. Hiatal hernia is also called a hiatus hernia.

  • Incisional hernia is a hernia that develops through a surgical incision.

  • Inguinal hernia is the protrusion of abdominal fat or part of the intestines through the abdominal muscles into the groin area (also called the inguinal canal). Inguinal hernia is the most common type of hernia.

  • Umbilical hernia is the protrusion of part of the intestines or abdominal lining through the abdominal wall around the belly button. It most often occurs in infants ages six months and younger.

In some cases, a hernia may not cause any symptoms and treatment is not necessary. However, a hernia can be uncomfortable, painful, or even a medical emergency in some cases. Hernias are often readily treated through lifestyle changes, medication, and surgery.

Complications of a hernia can be serious and include incarcerated hernia and strangulated hernia. Seek prompt medical care if you suspect that you, or your infant, have a hernia. Early diagnosis and treatment can minimize discomfort and the risk of complications. Seek immediate medical care (call 911) if you, or someone you are with, have difficulty breathing or severe abdominal pain, or if your hernia becomes discolored or does not go back in place by itself or with gentle pressure.

Symptoms

What are the symptoms of a hernia?

Hernia symptoms vary in nature and severity depending on the type of hernia and individual factors.

Symptoms of a hiatal hernia

Most people who have a hiatal hernia do not have symptoms and are unaware of the condition. When symptoms of hiatal hernia do occur, they can be related to acid reflux (regurgitation of stomach acid into the esophagus). This is because some people with hiatal hernia also have a condition called GERD (gastroesophageal reflux disease). Large hiatal hernias can be accompanied by symptoms that range in severity from mild to severe and include:

Symptoms of inguinal and femoral hernias

The hallmark symptom of inguinal and femoral hernias is a small bump or bulge in one or both sides of the groin or testicles (inguinal) or upper thigh (femoral). The bump may be associated with the following symptoms:

  • Burning or tenderness

  • Pain when lifting something heavy or when exercising

  • Pressure in the groin or thigh

  • Swelling or pain in the testicle area

Symptoms of an umbilical hernia

The main symptom of an umbilical hernia is a bulge around the belly button that is particularly visible when the affected infant, child or adult is upright or when he or she cries, coughs or strains. Umbilical hernias are typically painless.

Symptoms of a congenital diaphragmatic hernia

Symptoms of a congenital diaphragmatic hernia can be observed in the affected infant when still in the uterus or right after he or she is born. Prenatal signs of a hernia include:

  • Excessive amount of amniotic fluid

  • Ultrasound showing contents of abdominal cavity in the chest area

Symptoms that might indicate a serious or life-threatening condition

When an inguinal, femoral, hiatal or umbilical hernia becomes incarcerated (trapped), it can lead to a strangulated hernia, in which the blood supply is cut off to the affected organ. This can result in serious or life-threatening complications, such as gangrene. Seek immediate medical care (call 911) if you, or someone you are with, have any of these symptoms:

  • Chest pain, tightness or pressure

  • Fever

  • Hernia that does not go back in place by itself or with gentle pressure

  • Inability to have a bowel movement or pass gas

  • Nausea and vomiting

  • Redness or discoloration of the hernia

  • Severe abdominal pain

  • Sudden hernia pain

  • Testicle pain or swelling

  • Vomiting blood

Symptoms of a congenital diaphragmatic hernia that appear immediately after birth are serious or life threatening. Seek immediate medical care (call 911) if your newborn infant has any of the following symptoms:

  • Bluish coloring (cyanosis) of the lips, nails and skin

  • Concave abdomen

  • Difficulty breathing or rapid breathing

  • Lopsided-looking chest

  • Rapid heart rate (tachycardia)

Causes

What causes a hernia?

The cause of a hernia depends on the type of hernia. In some cases, a hernia can be due to a congenital (present at birth) defect; whereas, in other cases, certain risk factors have been documented but the underlying cause is not known.

Hiatal hernia

A hiatal hernia is the protrusion of a portion of the stomach through an opening in the diaphragm. A hiatal hernia can be caused by an unusually large hiatus, which is a hole in the diaphragm through which the esophagus passes into the stomach. In most cases, the cause of hiatal hernia is unknown, but the likelihood of developing a hiatal hernia increases with age and other factors.

Inguinal hernia

The cause of an inguinal hernia depends on whether it is a congenital inguinal hernia (present at birth) or a direct inguinal hernia, which occurs later in infancy, childhood or adulthood. Congenital (or indirect inguinal) hernia is caused when the opening to the inguinal canal does not close properly during fetal development, leaving an area in the abdominal wall susceptible to rupturing. Direct inguinal hernias are caused by weakening or deterioration of the abdominal muscles over time and can be made worse by such activities as heavy lifting, straining during bowel movements, and coughing.

Umbilical hernia

Umbilical hernias occur when the abdominal muscles through which the umbilical cord passes during fetal development do not close properly just after birth. If the muscles do not close properly, part of the intestines can push through the opening.

Congenital diaphragmatic hernia

Congenital diaphragmatic hernias are formed when the diaphragm, diaphragmatic tendons, or digestive tract does not grow properly during fetal development. In some cases, a congenital diaphragmatic hernia is a feature of a genetic or chromosomal disorder such as Donnai-Barrow syndrome, Fryns syndrome, or Pallister-Killian mosaic syndrome. But in most cases, the underlying cause of congenital diaphragmatic hernia is unknown.

What are the risk factors for a hernia?

A number of factors increase the risk of developing different types of hernia. Not all people with risk factors will develop a hernia.

Risk factors for hiatal hernia

Risk factors for hiatal hernia include:

Risk factors for inguinal or femoral hernia

Risk factors for an inguinal or femoral hernia include:

  • Age 50 years or older (for femoral hernia)

  • Chronic cough or constipation (causing you to strain during bowel movements)

  • Family history of inguinal or femoral hernia

  • Female gender

  • Large amount of time spent standing up or lifting heavy items

  • Male gender (for inguinal hernia)

  • Obesity

  • Pregnancy

  • Premature birth

Risk factors for umbilical hernia

Risk factors for an umbilical hernia include:

  • African American ethnicity

  • Beckwith-Wiedemann syndrome

  • Down syndrome

  • Low birth weight or premature birth

  • Mucopolysaccharidoses (inherited metabolic disorder)

Risk factors for congenital diaphragmatic hernia

The only known risk factor for congenital diaphragmatic hernia is having a parent or sibling born with a congenital diaphragmatic hernia.

Treatments

How is a hernia treated?

Treatment varies depending on the type of hernia, the severity of symptoms, the presence of coexisting diseases, and your age and medical history. Treatment of hernia includes an individualized, multifaceted plan that minimizes the discomfort of symptoms and decreases the risk of developing complications, such as a strangulated hernia or respiratory distress.

Treatment of a hiatal hernia

Treatment of a hiatal hernia can include:

  • Avoiding large meals by eating several small meals every day

  • Elevating the head of the bed during sleep to prevent acid reflux

  • Losing excess weight

  • Medications, including over-the-counter antacids, such as Tums, Tagamet or Pepcid

  • Not eating late at night or up to two hours before bedtime

  • Not smoking or drinking alcohol, coffee, and acidic beverages to excess

  • Wearing loose clothing to minimize pressure and constriction of the abdomen

For more serious cases of hiatal hernia accompanied by gastroesophageal reflux disease (GERD), medical treatment may include:

  • Hospitalization and surgery to repair the hernia

  • H2 blockers, which reduce stomach acid

  • Prokinetics, which help the stomach to empty faster

  • Proton pump inhibitors, which decreases the production of stomach acid

Treatment of an inguinal or femoral hernia

Inguinal and femoral hernias can grow over time or stay the same size with very few symptoms. If an inguinal or femoral hernia gets larger and causes significant discomfort, or if it becomes strangulated and blood supply is cut off to the intestines, surgery may be performed to push the protruded organs back into the abdominal cavity and seal off the tissues. This surgery may be performed traditionally (called “open” hernia surgery) or laparoscopically, depending on your medical history and the location and size of the hernia.

Treatment of an umbilical hernia

Umbilical hernias in infants often disappear by themselves by age four. If an umbilical hernia gets larger and causes significant discomfort, or if it becomes strangulated and blood supply is cut off to the intestines, surgery may be performed to push the protruded organs back into the abdominal cavity and seal off the tissues. This surgery may be performed traditionally or laparoscopically.

Treatment of a congenital diaphragmatic hernia

Congenital diaphragmatic hernias are generally considered an emergency upon diagnosis and typically need to be surgically corrected soon after birth. This is because infants with this type of hernia cannot breathe well enough to sustain themselves. The surgery involves moving the organs that moved into the lung cavity back into the abdominal area. Then the diaphragm is repaired with stitches or a patch, depending on the size of the tear. The infant is typically kept on a breathing machine (ventilator) after surgery until his or her lungs recover and start to expand to provide enough oxygen on their own.

What are the possible complications of a hernia?

Hernia complications vary widely depending on the type of hernia, the severity of symptoms, the presence of coexisting diseases, and your age and medical history.

The complications of severe cases of hiatal hernia can be serious, even life threatening, and can include obstructed hiatal hernia and strangulated hiatal hernia, which can lead to infection and death of intestinal tissue (gangrene).

When an inguinal, femoral or umbilical hernia becomes incarcerated (trapped), it can lead to a strangulated hernia, in which the blood supply is cut off to the affected organ. A strangulated hernia can cause infection and death of intestinal tissue (gangrene).

The complications of congenital diaphragmatic hernia can include asphyxia (inability to breathe effectively) and lung infection.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Dec 29
  1. What is an Inguinal Hernia? Boston Children’s Hospital. http://www.childrenshospital.org/conditions-and-treatments/conditions/i/inguinal-hernia
  2. Congenital Diaphragmatic Hernia in Children. Boston Children’s Hospital. http://www.childrenshospital.org/conditions-and-treatments/conditions/congenital-diaphragmatic-hernia/overview
  3. Congenital Diaphragmatic Hernia. National Institutes of Health. Genetics Home Reference. https://ghr.nlm.nih.gov/condition/congenital-diaphragmatic-hernia
  4. Diaphragmatic hernia repair – congenital. MedlinePlus, U.S. National Library of Medicine. https://medlineplus.gov/ency/article/002936.htm
  5. Inguinal Hernia. National Institutes of Health. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/inguinal-hernia
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