Hernias: Causes, Types, and Treatments

A hernia occurs in an area where the muscle wall is weak.

What Is a Hernia?

Even if you don't have six-pack abs, your belly still has walls of muscle that support you, help you move, and hold things in place inside you. A hernia happens when part of your body squeezes through a weak spot or opening in a muscle wall. It's like an inner tube bulging through a hole in a worn-out tire. You can get different kinds of hernias, but most of them happen somewhere between your hips and chest.

Hernias may always be visible or only when you strain or lift something heavy.

Symptoms

Typically, hernias don't hurt -- you see a bulge or lump in your belly or groin. Sometimes, you only see the bulge when you laugh, cough, or strain, like when you lift a heavy object. Often, you can press it back into place. You may also notice:

  • The bulge gets bigger over time.
  • You have a feeling of fullness.
  • Pain, pressure, or a dull ache around the bulge
  • Pain when you lift something
Inguinal hernias are the most common kind of hernia.

Inguinal Hernias

This is the most common kind of hernia. It happens most often in men, but women sometimes get them during pregnancy. It's when fat or a loop of intestine pushes into your groin through a weakness in your lower belly. You may be born with it, or the problem can come with:

  • Age, as muscles wear down over time
  • Chronic coughing, as with someone who smokes
  • Strain from physical activity or going to the bathroom
Femoral hernias are less common than inguinal hernias.

Femoral Hernia

These are like inguinal hernias, but in a different part of the groin. Women are more likely to get them. They're not common, but they can be dangerous -- you may not notice any symptoms unless a muscle squeezes the hole shut while the intestine is poking through (called strangulation). In that case, the lump will be hard and tender and you might have severe belly pain, nausea, or vomiting. If you have these symptoms, get medical help right away.

A ventral hernia develops between the belly button and the chest.

Ventral Hernias

You get these hernias between your belly button and chest when some tissue or intestine pops through your belly's muscles. You may be more likely to get one if you:

  • Are very overweight
  • Have a cough that doesn't go away
  • Lift heavy objects, like with construction work
  • Strain hard when you go the bathroom
  • Throw up often
An incisional hernia happens in an area where you had surgery.

Incisional Hernias

Incisional hernias are fairly common for people who've had surgery on their bellies. They happen when tissue squeezes through the surgery wound before it totally heals. You're more likely to get one if you run into problems as you heal, like an infection. The only way to fix them is with another surgery, but they're often hard to treat.

 A hiatal hernia occurs when part of the stomach pops through the diaphragm into your chest.

Hiatal Hernias

With this kind of hernia, part of your stomach pops through your diaphragm and into your chest. (Your diaphragm is a sheet of muscle between your belly and chest.) You won't see a bulge, but you might get heartburn, chest pain, and a sour taste in your mouth. People 50 and older and pregnant women are more likely to have them. Pregnancy can put pressure on the belly and weaken its muscles. They're typically treated with medication and lifestyle changes, like having several smaller meals rather than three large ones or not lying down within 3 hours of eating.

Children may get inguinal or umbilical hernias.

Hernias in Children

When kids get hernias, they're typically inguinal or umbilical hernias. Inguinal hernias are most common in babies born early and in boys born with a testicle that hasn't dropped into the scrotum. Umbilical hernias happen right around the belly button. They don't usually hurt and may just look like an outie belly button. They often go back into place on their own by age 2.

Small hernias may get bigger and cause problems.

When to See a Doctor

While a hernia may start out as a harmless bulge, it can get bigger and start to hurt. In some cases, it can even be life-threatening. So even if it doesn't seem like a big deal, it's best to see your doctor if you have symptoms of a hernia, like a lump or bulge you can't explain.

Some signs and symptoms of a hernia warrant an immediate trip to the emergency room.

When to Go to the Emergency Room

If a loop of intestine gets trapped in a hernia, you have a serious problem called incarceration. It blocks the flow of waste through your body. If it's trapped tightly, the intestine's blood flow can get cut off. Get help right away if you have a hernia and these symptoms:

  • Bulge is dark, purple, or red.
  • You can't pass gas or poop.
  • You have a fever.
  • Pain quickly gets worse.
  • You're throwing up or have an upset stomach.
A doctor can usually diagnose a hernia based on a physical exam.

Tests

Most of the time, your doctor can tell you have a hernia with just a physical exam. He may ask you to stand and cough to make the hernia easier to see, but that's usually it. If your doctor's not totally sure, you might have some imaging tests to get a better look. These might include:

  • Ultrasound: High-frequency sound waves make an image of your internal organs.
  • Computerized tomography (CT): X-rays are taken at different angles and put together to make a more complete picture.
  • Magnetic resonance imaging (MRI): This uses a powerful magnet and radio waves to get a detailed view.
The doctor may recommend watchful waiting for a small hernia.

Treatment: Watchful Waiting

You don't always need to treat hernias. Umbilical hernias in kids may heal on their own, so your doctor may suggest you wait until around age 5 for treatment. For adults, especially if surgery could be risky for you, your doctor may suggest just keeping an eye on it as long as the hernia's small and not causing any major problems for you.

A special mesh implanted surgically may help support the abdominal wall.

Treatment: Surgery

The main treatment for any hernia is surgery to put in a mesh that helps support the wall around your belly. You may have open surgery, where your doctor makes a long opening in your skin, or you may get laparoscopic surgery, which uses a few smaller openings. You may heal quicker from laparoscopic surgery, but some studies show the hernia may be a little more likely to come back.

A truss may give you extra support but it won't heal your hernia.

Can a Truss Help?

Not really. This cloth device that's worn like a binder around your middle or like underwear won't make you better. You may get one to wear for a short while after surgery -- it may make you more comfortable -- but that's likely the only time your doctor will suggest it. The same goes for tape, bandages, and anything else to hold a hernia in place -- they won't heal the hernia or prevent more serious problems.

Live a healthy lifestyle to decrease your risk of a hernia.

How to Prevent a Hernia

You can lower your odds of getting a hernia if you:

  • Talk to your doctor if you have a cough or sneezing that won't go away. Quitting smoking helps.
  • Eat fruits, veggies, and whole grains to keep yourself regular.
  • Stay at a healthy weight with diet and exercise.
  • Use good form when you do physical activity. For example, when lifting a heavy object, bend from your knees instead of your waist.
Sources:

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  6. BIOPHOTO ASSOCIATES / Getty Images
  7. Keith A Pavlik / Medical Images
  8. RUTH JENKINSON / Medical Images
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REFERENCES:

  • NHS: “Umbilical Hernia Repair,” “Hernia,” “Inguinal Hernia Repair,” “Hiatus Hernia,” ”Femoral Hernia Repair.”
  • Cleveland Clinic: "Hernia," "Hiatal Hernia."
  • Columbia University, Department of Surgery: "Hernia."
  • Merck Manual: "Abdominal Wall Hernias."
  • Mayo Clinic: "Inguinal Hernia."
  • Johns Hopkins Medicine, Webcast: "Hernia Treatment," "Comprehensive Hernia Center."
  • Dartmouth-Hitchcock Medical Center: "Ventral Hernia."
  • Mt. Sinai Beth Israel: "Hernia Types."
  • The British Hernia Center: "Hernia Overview."
  • KidsHealth, For Teens: "Hernias," For Parents: "Hernias."
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