Hernia: Symptoms, Causes & Treatment

A hernia occurs when an organ or tissue pushes through a weak area in the surrounding muscle, causing a bulge under the skin. Hernias can develop in the groin, abdomen, belly button, upper thigh, chest or spine, depending on the type.

Hernia symptoms commonly include a visible bulge, swelling and pain that may worsen with physical activity, coughing or straining. An inguinal hernia is the most common type, but hiatal, umbilical, femoral, incisional, muscle and spinal hernias can also occur.

A hernia is usually diagnosed with a physical exam and, in some cases, imaging tests such as an ultrasound, CT scan or MRI. Treatment depends on the type of hernia and may include observation, medication, physical therapy or surgery, while sudden severe pain, discoloration or rapid enlargement of a bulge requires emergency medical care.

Types of hernia

The types of hernia vary depending on their cause and location. The main types include:

1. Inguinal hernia

An inguinal hernia is a bulge that appears in the groin. It occurs when an opening or weak area in the abdominal muscles allows part of the intestine or another abdominal organ to push through.

This type of hernia usually does not cause pain, but it may appear as a small swelling in the groin. The swelling may always be present or may only appear during physical activity or straining.

An inguinal hernia can occur in both men and women. In men, it may also extend into the scrotum and cause pain or difficulty walking.

2. Herniated disc

A herniated disc affects the spine and develops in one of the intervertebral discs, which act as cushions between the vertebrae. It is more common in older adults because of the natural aging process, but it may also be associated with obesity, heavy lifting or weakness in the abdominal and back muscles that support the spine.

Symptoms are more likely to occur when the herniated disc is in the lower back. They may include leg pain, tingling or numbness caused by pressure on nerves near the affected vertebra.

3. Hiatal hernia

A hiatal hernia occurs when part of the stomach pushes through the hiatus, an opening in the diaphragm, the muscle that separates the chest from the abdomen.

When this happens, part of the stomach moves into the chest cavity. Some people have no symptoms, while others develop symptoms of gastroesophageal reflux (GERD), such as heartburn, regurgitation, belching, coughing, and nausea.

4. Umbilical hernia

An umbilical hernia occurs when part of the intestine pushes through the abdominal muscles, usually causing a bulge around the belly button. This type of hernia is more common in babies and children and generally does not require specific treatment.

5. Femoral hernia

A femoral hernia occurs when part of the intestine pushes through the abdominal muscles near the femoral canal. This causes a bulge in the upper thigh or groin.

A femoral hernia may also cause abdominal pain, nausea, vomiting or intestinal cramps.

6. Muscle hernia

A muscle hernia can develop in any muscle in the body, but it is most common in the legs, particularly between the knee and ankle. This type of hernia is more common in adolescents and young adults who participate in intense physical activity.

7. Incisional hernia

An incisional hernia can develop at the site of a previous abdominal surgery, months or years after the procedure. It usually does not cause symptoms other than a small lump or swelling around the surgical scar.

Over time, an incisional hernia may become larger and cause pain in the affected area. In these cases, surgery may be recommended.

Hernia symptoms

Symptoms of a hernia may include:

• A visible bulge
• Swelling in the affected area
• Pain, especially after physical activity or straining
• Pain when having a bowel movement or coughing

In some cases, a healthcare provider can diagnose a hernia based on the symptoms and a physical examination. During the exam, the provider may feel the affected area for an abnormal protrusion. An ultrasound may be ordered to confirm the diagnosis.

Go to the emergency room immediately if the bulge suddenly enlarges, changes color or causes severe pain. According to the National Institute of Diabetes and Digestive and Kidney Diseases, these symptoms may indicate an incarcerated or strangulated hernia, which requires immediate medical care because blood flow to the trapped tissue may be reduced or cut off.

Confirming a diagnosis

A healthcare provider initially diagnoses a hernia by reviewing the person’s symptoms and performing a physical examination. Depending on where the symptoms occur, the provider may examine and feel the abdomen, groin or back.

In some cases, an imaging test such as an ultrasound, CT scan or MRI may be ordered to confirm the diagnosis, locate the hernia or assess its severity.

What causes a hernia?

The main causes of a hernia include:

• Lifting or frequently carrying heavy objects
• Excessive or persistent coughing
• Intense physical strain
• Straining during bowel movements
• Having several pregnancies within a short period

Hernias can occur at any age, but they are more common in adults. According to the American Academy of Pediatrics, umbilical hernias in children often close on their own by 4 or 5 years of age, although medical follow-up is recommended to monitor the hernia.

Hernia treatment

Treatment depends on the type of hernia and may include:

1. Surgery

Surgery is the most effective treatment for most hernias. It involves returning the displaced organ or tissue to its proper position and, when necessary, placing surgical mesh to help prevent the hernia from coming back.

Surgery may be recommended for umbilical hernias in adults, inguinal hernias, femoral hernias, muscle hernias and incisional hernias. It may also be considered for a herniated disc that does not improve with physical therapy.

For a hiatal hernia, laparoscopic surgery may be performed in severe cases that do not improve with medication.

Surgery may be recommended soon after diagnosis to help prevent complications such as strangulation. A strangulated hernia occurs when trapped tissue loses its blood supply.

2. Medications

The medications used to relieve hernia-related symptoms depend on the type of hernia.

For a herniated disc, treatment may include pain relievers such as acetaminophen. A doctor may prescribe an opioid pain medication for severe pain.

For a hiatal hernia, medications such as omeprazole or esomeprazole may be used to relieve heartburn and acid reflux.

3. Physical therapy

Physical therapy may be recommended to help relieve symptoms of a herniated disc. Treatment may include heat therapy, transcutaneous electrical nerve stimulation (TENS), massage, and strengthening and flexibility exercises. In some cases, a physical therapist may also use dry needling.

Learn more about herniated disc exercises that may be recommended by a physical therapist.

4. Observation

Observation is recommended for umbilical hernias in babies and young children because they usually do not require specific treatment. Regular medical follow-up may be all that is needed.

Treatment for a muscle hernia may include rest or compression stockings recommended by a doctor. Surgery is generally reserved for cases that cause severe pain.