A hernia does not heal on its own. Surgery is the only permanent treatment, although some small or symptom-free hernias may be monitored for a period.
Types of Hernia
Inguinal Hernia
An inguinal hernia is the most common type, making up around three-quarters of all hernias.
It causes a bulge in the groin and may sometimes extend into the scrotum. It is much more common in men.
Femoral Hernia
A femoral hernia causes a bulge in the upper thigh, just below the groin crease.
It is more common in older women and has a greater risk of becoming trapped, so surgical repair is often recommended.
Umbilical Hernia
An umbilical hernia appears as a bulge around the navel.
It is common in babies, and many close naturally by the age of 4 or 5.
In adults, it may occur more often with obesity or following pregnancy.
Incisional Hernia
An incisional hernia develops through the scar of a previous abdominal operation.
Hiatus Hernia
A hiatus hernia occurs when part of the stomach pushes upward through the diaphragm into the chest.
Unlike many other hernias, it usually does not cause a visible bulge. Symptoms may include:
Heartburn
Acid reflux
Belching
Difficulty swallowing
Epigastric Hernia
An epigastric hernia causes a small bulge between the navel and breastbone.
Causes and Risk Factors
Hernias usually develop through a combination of muscle weakness and increased pressure inside the abdomen.
Risk factors include:
Male sex, particularly for inguinal hernia
Increasing age
A weakness present from birth
Heavy lifting and repeated straining
Chronic coughing
Smoking or lung disease
Chronic constipation
Straining to urinate because of an enlarged prostate
Obesity
Pregnancy
Previous abdominal surgery
Family history of hernia
Symptoms
Common symptoms include:
A visible bulge or swelling in the groin, abdomen or navel
A bulge that becomes more noticeable while standing, coughing or straining
A bulge that may disappear when lying down
Aching or discomfort
A heavy or dragging sensation
Pain while lifting or bending
Some hernias cause very few symptoms.
A hiatus hernia usually causes digestive symptoms rather than a visible lump.
Diagnosis
Most hernias can be diagnosed by a doctor through physical examination.
The patient may be asked to:
Stand
Cough
Strain gently
These actions can make the hernia easier to detect.
Imaging
If the diagnosis is unclear, tests may include:
Ultrasound
CT scan, particularly for complex or incisional hernias
A hiatus hernia may be investigated using:
Endoscopy
Barium swallow X-ray
Treatment
Treatment depends on the type of hernia, symptoms, size and risk of complications.
Watchful Waiting
A small hernia that causes no symptoms may sometimes be monitored, particularly in older people or those with significant medical conditions.
However, femoral hernias are usually repaired because they have a greater risk of becoming trapped.
Surgery
Surgery is the only permanent treatment for most hernias.
It is generally recommended when a hernia:
Causes pain or discomfort
Is getting larger
Interferes with everyday activities
Has a higher risk of complications
During surgery, the surgeon returns the protruding tissue to its normal position and strengthens the weakened area.
A synthetic mesh is commonly used to reinforce the abdominal wall and reduce the chance of recurrence.
Open Hernia Repair
Open surgery uses a single incision over the hernia.
Depending on the situation, it may be performed under:
Local anaesthesia
Spinal anaesthesia
General anaesthesia
Laparoscopic Hernia Repair
Laparoscopic or keyhole surgery uses several small incisions and a camera.
Potential advantages include:
Less postoperative pain
Faster recovery
Smaller scars
It may be particularly useful for:
Hernias on both sides
Recurrent hernias
Robotic Hernia Repair
Robotic repair is another form of minimally invasive surgery available at selected centres.
Recovery After Surgery
Many patients can return home the same day or the following day.
Light activities may usually resume within one to two weeks.
Heavy lifting should generally be avoided for approximately four to six weeks, depending on the type of repair and the surgeon's advice.
Hernia Belts and Trusses
A hernia belt or truss may temporarily reduce discomfort in some people.
However, it does not repair or cure the hernia and should not be considered a replacement for surgery when surgery is indicated.
Treatment of Hiatus Hernia
Hiatus hernias are usually managed differently from abdominal or groin hernias.
Treatment may include:
Lifestyle changes
Acid-reducing medicines such as proton pump inhibitors
Surgery is generally considered only when the hernia is large or symptoms remain severe despite treatment.
Umbilical Hernia in Children
Most umbilical hernias in babies close naturally.
Surgery may be considered if the hernia:
Persists beyond the age of 4 or 5
Is particularly large
Causes complications
Complications
Two important complications are incarceration and strangulation.
Incarcerated Hernia
An incarcerated hernia becomes trapped and cannot be pushed back into the abdomen.
This can cause pain and may lead to bowel obstruction.
Strangulated Hernia
A strangulated hernia occurs when the blood supply to the trapped tissue is cut off.
This is a surgical emergency.
Without urgent treatment, the affected tissue may die within hours.
Prevention
Not every hernia can be prevented, but some measures may reduce risk.
These include:
Maintaining a healthy body weight
Using proper lifting technique
Bending the knees rather than the back when lifting
Preventing constipation with adequate fibre and water
Stopping smoking
Treating persistent cough
Seeking treatment for difficulty passing urine
When to See a Doctor
See a doctor if you notice a new bulge in the:
Groin
Abdomen
Navel
This is important even if the bulge is painless.
Seek emergency medical attention if the hernia:
Suddenly becomes very painful
Becomes firm or tender
Turns red or purple
Cannot be pushed back in
Urgent care is also needed if it is accompanied by:
Nausea
Vomiting
Fever
Inability to pass gas
Inability to pass stools
These symptoms may indicate strangulation or bowel obstruction.
The Bottom Line
A hernia develops when tissue pushes through a weak point in the surrounding muscle or abdominal wall.
Some small hernias may be monitored, but surgery is the only permanent repair for most abdominal and groin hernias. Early medical assessment is important because trapped or strangulated hernias can become medical emergencies.
