A hernia occurs when an organ pushes through an opening in the muscle or tissue that holds it in place. For instance, the intestines may break through a weakened area in the abdominal wall. Hernias are most common in the abdomen, but they can also appear in the upper thigh, belly button, and groin areas. Most hernias aren’t immediately life-threatening, but they don’t go away on their own.
- In an inguinal hernia, the intestine or the bladder breaks through the abdominal wall or into the inguinal canal in the groin. About 96% of all groin hernias are inguinal, and most occur in men because of a natural weakness in this area.
- In an incisional hernia, the intestine pushes through the abdominal wall at the site of previous abdominal surgery. This type is most common in elderly or overweight people who are inactive after abdominal surgery.
- A femoral hernia occurs when the intestine enters the canal carrying the femoral artery into the upper thigh. Femoral hernias are most common in women, especially those who are pregnant or obese
- In an umbilical hernia, part of the small intestine passes through the abdominal wall near the navel. Common in newborns, it also commonly afflicts obese women or those who have had many children.
- A hiatal hernia happens when the upper stomach squeezes through the hiatus, an opening in the diaphragm through which the esophagus passes.
A hernia may be congenital and present at birth or it may develop over time in areas of weakness within the abdominal wall. Increasing the pressure within the abdominal cavity can cause stress at the weak points and allow parts of the abdominal cavity to protrude or herniate.
Increased pressure within the abdomen may occur in a variety of situations including chronic cough, increased fluid within the abdominal cavity (ascites), peritoneal dialysis used to treat kidney failure, and tumors or masses in the abdomen. The pressure may increase due to lifting excess weight, straining to have a bowel movement or urinate, or from trauma to the abdomen. Pregnancy or excess abdominal weight and girth are also factors that can lead to a hernia. In many cases, a hernia is no more than a painless swelling that presents no problems and needs no immediate medical attention.
In some cases, a hernia needs immediate surgery, for instance, when part of the gut becomes obstructed or strangulated by an inguinal hernia.
Immediate medical attention should be sought if an inguinal hernia produces acute abdominal complaints such as:
Factors that contribute to developing an inguinal hernia include:
- Being male. Men are eight times more likely to develop an inguinal hernia than are women.
- Being older. Muscles weaken as you age.
- Being white.
- Family history. You have a close relative, such as a parent or sibling, who has the condition.
- Pregnancy. Being pregnant can weaken the abdominal muscles and cause increased pressure inside your abdomen.
- Premature birth and low birth weight.
Whether or not you need treatment depends on the size of your hernia and the severity of your symptoms. Your doctor may simply monitor your hernia for possible complications. Treatment options for a hernia include lifestyle changes, medication, or surgery.
If your hernia is small and isn't bothering you, your doctor might recommend watchful waiting. In children, the doctor might try applying manual pressure to reduce the bulge before considering surgery. Enlarging or painful hernias usually require surgery to relieve discomfort and prevent serious complications. Get emergency medical care if you develop nausea, vomiting or fever or if your hernia bulge turns red, purple or dark.