What is a hernia? Symptoms and treatment explained

A hernia happens when an organ, tissue or fat pushes through the muscle or connective tissue (the fascia) that surrounds it. Hernias mainly affect your chest, tummy or groin area.

It is a common condition, with almost 100,000 hernia repairs carried out by the NHS each year.

Symptoms of a hernia

If you have a hernia, you’ll often notice a bulge in the affected area. The bulge can feel sore and sometimes can be pushed back in. In some cases, the bulge will disappear when you lie down or you may only notice it when you strain or cough.

Sometimes a hernia won’t cause any symptoms and you’ll only find out you have one during a medical examination.

Types of hernia

There are several different types of hernia. The four most common types are inguinal hernia, umbilical hernia, hiatus hernia and femoral hernia.

Inguinal hernia

An inguinal hernia causes a bulge in your groin area. It is a common type of hernia and affects men more often than women. It happens when a part of your large intestine pushes through your lower abdominal wall into your groin.

Umbilical hernia

An umbilical hernia affects your tummy. It happens when a part of your large intestine pushes through the abdominal wall near your belly button.

It most often affects babies and young children and happens when the opening where the umbilical cord entered their tummy doesn’t close up properly. You might see a bulge in their tummy, especially when they cry.

The hernia will often go away without any treatment as your child’s abdominal wall grows stronger. If they’ve still got it by the age of five, treatment is usually needed.

Hiatus hernia

A hiatus hernia happens when part of your stomach pushes up into your chest cavity through your diaphragm. Your diaphragm is one of the main muscles you use when breathing and it sits between your chest and the organs in your abdomen.

A hiatus hernia is most common in people over the age of 50. If you have one, you may get heartburn, which is caused by stomach acid leaking into your gullet (the tube that food and liquids pass through when going from your mouth to your stomach). This is called gastroesophageal reflux.

Femoral hernia

Like an inguinal hernia, a femoral hernia affects your groin and happens when a part of your large intestine pushes through your lower abdominal wall. It pushes through at a slightly lower point in the groin than an inguinal hernia.

Femoral hernias are more common in women than men.

What causes a hernia?

Hernias are usually caused by a combination of straining and muscle weakness. Muscle weakness makes it more likely that an organ or tissue will push through the wall of muscle or connective tissue surrounding it when it is under strain.

Causes of muscle weakness include ageing, injury or damage from surgery.

Excessive strain can be caused by:

• A build-up of fluid in your abdomen
• Being overweight or obese
• Chronic obstructive pulmonary disorder (COPD)
• Constipation
• Intensive exercise or weightlifting, or lifting heavy objects improperly (eg lifting a heavy bag of rubbish or garden waste)
• Pregnancy — particularly after multiple pregnancies

You’re more likely to get a hernia as you get older and if you have a family history of hernias. Smoking also increases your risk because it weakens your connective tissue.

How is a hernia diagnosed?

To diagnose a hernia, your doctor will first carry out a physical examination. They will feel for a lump and might ask you to strain or cough to see if the lump bulges out.

You may then have a scan so your doctor can get an image of the inside of your body and investigate the size and type of hernia you have. Scans used to diagnose hernias include:

• An abdominal ultrasound scan, which uses high-frequency sound waves
• A CT scan, which uses X-rays
• An MRI scan, which uses radio waves and strong magnets

How is a hernia treated?

A hernia is usually treated with surgery, though treatment is not always recommended.

When considering whether surgery is the best option for you, your doctor will assess whether the hernia is growing and advise you on whether it is likely to cause an obstruction or become strangulated. This depends on the type of hernia you have.

If there's a risk that your hernia will cause an obstruction or become strangulated, it will usually be treated. An obstruction caused by a hernia can be painful and make you vomit. A strangulated hernia is when the hernia becomes trapped in the wall of muscle or connective tissue that it has pushed through and consequently, its blood supply is cut off — this can be life-threatening.  

Your doctor will also consider the effect your symptoms are having on your daily life and your general health. If your general health is poor, surgery may be too much of a risk.

Types of surgery

Treating a hernia involves either open surgery or keyhole surgery (laparoscopic surgery).

With open surgery, a surgeon will make a cut in your tummy so they can push the protruding bulge back into place.

Keyhole surgery is less invasive. Your surgeon will make three small cuts in your tummy or groin and insert a tube with a light and camera on it. The camera transmits an image to a video screen.

Your surgeon will then push the bulge back into place using special precision instruments. 

Whether you have open surgery or keyhole surgery, your surgeon will repair your abdominal wall during the surgery using a surgical mesh to reduce the chance of the hernia recurring.

Most people make a full recovery from hernia surgery in a few weeks.

Reduce your chances of getting a hernia

If you’re over the age of 50 and have a higher chance of developing a hernia, eg if you are obese or have a family history of hernias, avoid straining and excessively strenuous activity, such as lifting heavy weights. When lifting heavy objects, make sure you bend your knees, not your back, and hold the object close to your body. 

If you smoke, try quitting. Smoking doesn’t just increase your risk of hernias but is linked to other medical problems, including cancer, diabetes and heart disease. Read our tips for help with quitting smoking.