Overview
A hernia occurs when an internal organ or fatty tissue squeezes through a weak spot in the surrounding muscle or connective tissue. The most common types are inguinal (groin), hiatal (stomach pushing into chest), umbilical (belly button), and incisional (at a surgical scar). Most hernias are not immediately dangerous but do not heal on their own.
How common is it?
Inguinal hernias affect around 27% of males and 3% of females during their lifetime. Hiatal hernias are present in about 15 to 20% of adults, increasing with age. Umbilical hernias are common in infants and overweight adults.
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 hiatal hernia: heartburn, regurgitation, and difficulty swallowing
- No symptoms in many cases (found incidentally)
When to see a doctor
A hernia that becomes painful, cannot be pushed back (irreducible), is red, or is associated with vomiting and severe pain is a surgical emergency. This may indicate strangulation, where blood supply to the herniated tissue is cut off.
Diagnosis
Clinical examination is usually sufficient. The hernia is palpated and its reducibility assessed. Ultrasound confirms uncertain cases. CT scan for large or complicated hernias. Endoscopy for hiatal hernias.
Treatments
Watchful waiting
Small, symptomless inguinal hernias in men can be monitored without immediate surgery. However, watchful waiting carries a small risk of emergency strangulation over time.
Open hernia repair
A surgical incision is made to push tissue back into place. A synthetic mesh is placed over the weakness to strengthen the wall. Day-case procedure with local or general anaesthetic.
Laparoscopic (keyhole) repair
Several small incisions allow a camera and instruments. Recovery is faster, with less pain and a lower risk of chronic pain than open repair. Preferred for bilateral and recurrent hernias.
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.