Hernia

A hernia occurs when part of the body, such as a loop of bowel or some fatty tissue, pushes through a weakness in the muscle or tissue wall that normally holds it in place. This creates a bulge that can often be seen or felt under the skin.

Hernias are common and most often develop in the abdomen or groin. They can appear gradually or suddenly, for example after lifting something heavy, and they tend to get larger over time.

Inguinal hernias, in the groin, are the most common and occur more often in men. Femoral hernias also appear in the groin, lower down, and are more common in women. Umbilical hernias occur at the belly button, and incisional hernias develop at the site of a previous surgical scar.

A hiatal (hiatus) hernia is different: part of the stomach pushes up through the diaphragm into the chest, and it often causes acid reflux rather than a visible lump.

Most hernias cause a lump or swelling that may be more obvious when you stand up, cough, or strain, and may disappear when you lie down or gently push it back. There can be an aching or dragging feeling, or discomfort that is worse with lifting or activity.

A hiatal hernia may instead cause heartburn, acid reflux, or difficulty swallowing. Some hernias cause few symptoms and are noticed only as a painless bulge.

Hernias develop where the muscle or tissue wall is weak — sometimes present from birth, and sometimes developing with age or after surgery. Anything that repeatedly raises pressure inside the abdomen can contribute, such as heavy lifting, persistent coughing, straining on the toilet, being significantly overweight, or pregnancy.

Because the underlying weakness does not repair itself, a hernia will not go away without treatment, though not every hernia needs surgery straight away.

Most hernias are diagnosed by a doctor examining the lump, sometimes while you stand or cough so it becomes more obvious. This is often all that is needed.

For hernias that are hard to feel, or to plan surgery for larger or complex ones, an ultrasound, CT, or MRI scan may be used to show the exact size and position. A hiatal hernia is usually found on an endoscopy or imaging done for reflux symptoms.

Surgery is the only way to repair a hernia. The operation pushes the bulging tissue back and strengthens the weak area, usually with a mesh that reduces the chance of it returning. It can often be done by keyhole (laparoscopic) or robotic surgery through small incisions, or by open surgery for larger or complex hernias.

Not every hernia needs immediate surgery. A small hernia that is not causing symptoms may simply be monitored, with surgery advised if it grows or becomes uncomfortable. However, repair is recommended if a hernia is painful, enlarging, or at risk of complications. Hiatal hernias are managed primarily with lifestyle changes and acid-suppressing medication (such as PPIs), reserving surgical repair (anti-reflux surgery/fundoplication) for severe, refractory, or large paraesophageal hernias.

The outlook after hernia repair is very good, and most people return to normal activities after a period of recovery, with modern mesh techniques making the hernia unlikely to return. Left untreated, a hernia will not heal and can slowly enlarge.

Not all hernias can be prevented, but you can lower the strain on the abdominal wall by lifting carefully, keeping a healthy weight, eating enough fiber to avoid straining, and not smoking (which causes coughing). Treating a hernia before it becomes large or complicated usually makes the repair simpler.