Hernia

Overview

A hernia occurs when tissue pushes through a weak area of muscle or connective tissue. Types include inguinal (groin), hiatus (stomach pushing into the chest), umbilical (belly button) and incisional (at a surgical scar). Adult hernias usually do not close on their own; childhood umbilical hernias often do.

How common is it?

Hernias are common and can occur at different ages. Groin hernias are more common in men; umbilical hernias are common in young children. The frequency depends on the type.

Causes and risk factors

Hernias develop at natural weak points or damaged areas of muscle wall. A combination of straining forces and pre-existing weakness causes tissue to bulge through.

Common risk factors

• Chronic straining (constipation, heavy lifting, coughing)
• Pregnancy (increased abdominal pressure)
• Obesity
• Previous abdominal surgery creating scar weakness
• Congenital muscle weakness (some inguinal hernias present from birth)
• Age-related tissue weakening
• Ascites (fluid in abdomen)

Symptoms

• A visible lump or bulge that appears during standing, coughing, or straining and disappears on lying down
• Discomfort or dull aching at the site, especially when bending over or lifting
• A feeling of heaviness or pressure in the groin
• For hiatus hernia: heartburn, regurgitation and difficulty swallowing
• No symptoms in many cases (found incidentally)

When to see a doctor

Seek immediate emergency assessment for sudden severe hernia pain, vomiting, inability to pass stool or wind, or a firm tender lump that no longer reduces. Do not force it back. See a clinician for a new or changing hernia.

Diagnosis

A clinician can often diagnose a hernia by examination. Ultrasound or CT may be needed for uncertain or complicated cases. A hiatus hernia may be assessed with gastroscopy.

Treatments

Self-care and lifestyle

• Maintain a healthy weight to reduce abdominal pressure
• Avoid straining on the toilet by eating a high-fibre diet
• Use correct lifting technique (bend at the knees, not the waist)
• If you smoke, stopping reduces the chronic cough that aggravates hernias

Prevention

No hernia is fully preventable, but maintaining healthy weight, using correct lifting technique, treating chronic constipation, and stopping smoking all reduce risk.