Hernia 

Introduction  

Hernia: animation

This animation explains how a hernia occurs and the procedures used to treat it

Media last reviewed: 14/11/2013

Next review due: 14/11/2015

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A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall.

In many cases, hernias cause no or very few symptoms, although you may notice a swelling or lump in your tummy (abdomen) or groin.

The lump can often be pushed back in, or will disappear when you lie down. Coughing or straining may make the lump appear.

Types of hernia

Hernias can occur throughout the body, but they most often develop in the area of your body between your chest and hips. Some of the more common types of hernia are described below.

Inguinal hernias

Inguinal hernias occur when fatty tissue or a part of your bowel pokes through into your groin at the top of your inner thigh.

This is the most common type of hernia and it mainly affects men. It is often associated with ageing and repeated strain on the abdomen.

Femoral hernias

Femoral hernias also occur when fatty tissue or a part of your bowel pokes through into your groin at the top of your inner thigh. They are much less common than inguinal hernias and tend to affect more women than men.

Like inguinal hernias, femoral hernias are also associated with ageing and repeated strain on the abdomen.

Umbilical hernias

Umbilical hernias occur when fatty tissue or a part of your bowel pokes through your abdomen near your belly button (navel).

This type of hernia can occur in babies if the opening in the abdomen through which the umbilical cord passes doesn't seal properly after birth. Adults can also be affected, possibly as a result of repeated strain on the abdomen.

Hiatus hernias

Hiatus hernias occur when part of the stomach pushes up into your chest by squeezing through an opening in the diaphragm (the thin sheet of muscle that separates the chest from the abdomen). This type of hernia may not have any noticeable symptoms, although it can cause heartburn in some people.

It's not exactly clear what causes hiatus hernias, but it may be the result of the diaphragm becoming weak with age or pressure on the abdomen.

Other types of hernia

Other types of hernia that can affect the abdomen include:

  • Incisional hernias  these occur when tissue pokes through a surgical wound in your abdomen that has not fully healed.
  • Epigastric hernias  these occur when fatty tissue pokes through your abdomen, between your navel and the lower part of your breastbone (sternum).
  • Spigelian hernias  these occur when part of your bowel pokes through your abdomen at the side of your abdominal muscle, below your navel.
  • Diaphragmatic hernias  these occur when organs in your abdomen move into your chest through an opening in the diaphragm. This can affect babies if their diaphragm does not develop properly in the womb, but can also affect adults.
  • Muscle hernias  these occur when part of a muscle pokes through your abdomen. They can also occur in leg muscles as the result of a sports injury.

When to seek medical advice

You should see your GP if you think you have a hernia, so they can determine whether you need to be referred for surgical treatment.

You should go the accident and emergency (A&E) department of your nearest hospital immediately if you have a hernia and you develop any of the following symptoms:

  • sudden, severe pain
  • vomiting
  • difficulty passing stools (constipation) or wind
  • the hernia becomes firm or tender, or cannot be pushed back in

These symptoms could mean that the blood supply to a section of organ or tissue trapped in the hernia has become cut off (strangulation), or that a piece of bowel has entered the hernia and become blocked (obstruction).

A strangulated hernia and obstructed bowel are medical emergencies and need to be treated as soon as possible. 

Assessing hernias

Your GP will usually be able to identify a hernia by examining the affected area.

In some cases, they may decide to refer you to a nearby hospital to have an ultrasound scan to confirm the diagnosis or assess the extent of the problem. This is a painless scan where high-frequency sound waves are used to create an image of part of the inside of the body.

Once a diagnosis has been confirmed, your GP or hospital doctor will determine whether surgery to repair the hernia is necessary.

A number of factors will need to be taken into consideration when deciding whether surgery is appropriate, including:

  • The type of hernia  some types of hernia are more likely to become strangulated, or cause a bowel obstruction, than others.
  • The content of your hernia  if the hernia contains a part of your bowel, muscle or other tissue, there may be a risk of strangulation or obstruction.
  • Your symptoms and the impact on your daily life  surgery may be recommended if your symptoms are severe or getting worse, or if the hernia is affecting your ability to carry out your normal activities.
  • Your general health  surgery may be too much of a risk if your general health is poor.

Although most hernias will not get better without surgery, they will not necessarily get worse. In some cases, the risks of surgery will outweigh the potential benefits.

Surgery

There are two main ways surgery for hernias can be carried out:

  • Open surgery  where one cut is made to allow the surgeon to push the lump back into the abdomen.
  • Keyhole (laparoscopic) surgery  this is a less invasive, but more difficult, technique where several smaller cuts are made, allowing the surgeon to use various special instruments to repair the hernia.

Most people are able to go home the same day or the day after surgery and make a full recovery within a few weeks.

If you doctor recommends having surgery, it is important to be aware of the potential risks, as well as the possibility of the hernia recurring. Make sure to discuss the benefits and risks of the procedure with your surgeon in detail before having the operation.

More information

To find out more about some common types of hernia surgery, see:

Page last reviewed: 08/07/2014

Next review due: 08/07/2016

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Comments

The 14 comments posted are personal views. Any information they give has not been checked and may not be accurate.

TheJones81 said on 28 October 2014

James, I got my inguinal hernia at around 19 or 20. I ignored it up until yesterday when I went in for the op, a few days before my 33rd birthday. Admittedly I was terrified but everyone at every step of the way was fantastic. Get it done sooner rather than later because given time it will have a negative impact on your life.

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dfen5 said on 21 August 2014

Had an R/H inguinal hernia repair @ Rugby St Cross 11/8/14.

In the place for 07:30, sent down around 9:05. Back to ward, quick check all's well & a wee later I'm off home.

Felt a bit sick @ around 3pm which was a bit scary but this soon passed.

Steady short walks the next day. Longer walks the days after and so on.

Some discomfort around the wound when moving (especially when sleeping) but getting less now.

Having read up on the operation before hand I was a bit worried but pleased it's done now.

A big thank you to the surgeon, nurses and the rest of the team in St. Cross. Put me at ease, which really helped.

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Biegacz said on 10 June 2014

I am a 67 year old male in very good physical condition (active athlete) I have just had an inguinal hernia operation in a Polish hospital (I live in Poland) using the Lichtenstein method and a local anaesthetic. Post operation I have had no pain or discomfort, although the colours on my willy should be photographed and displayed in the Tate Modern. I was walking immediately post op although very slowly. Now, 5 days, post-op my walking speed is slowly increasing, I am out and about (gently) and feel fine. However, I don't expect to be able to run or cycle for several more weeks.
I was really worried before the op. My fears were groundless. I hope this encourages others... and a local anaesthetic is nothing to worry about. Being awake during the operation is a positive experience, and it only takes 20 minutes! Good luck!

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zz123 said on 07 May 2014

To Jamesfl, I had an inguinal hernia a few years ago aged 22/23, please go to your GP as even though it may not be too uncomfortable yet the tear could get larger when you exercise/lift which can lead to complications. Really you should avoid heavy lifting right now. Take a photo on your phone if you want as evidence for the GP of when it is large, always useful as backup. In my experience the GP refers you to a queue to then get in the appointment queue for a consultant, this can take a couple of months or more. To be honest because of time constraints and the discomfort at the time, I went private to get it done quickly and the method I wanted after research; keyhole.
If you get the choice I highly recommend keyhole surgery for this. Link to animation of keyhole repair: youtu.be/BxLrtX_HTUs or search on youtube Bupa keyhole inguinal hernia repair.
The op is simple, day case done under general anaesthetic, and believe me I'm 100% glad I got it done. Get sorted now, and in a few months you'll be back to your old self. Leave it, and it can only get worse. There are no other options apart from surgery, or carrying on in discomfort.
1 navel incision for the camera, 2-3 small ones below for tools (you will need a shave!). The muscle is repaired from inside, and a mesh is used to reinforce the area attached to the gut side of the muscle wall. This is much better than on the outside as per open surgery, as internal pressure from the gut holds the mesh in place rather than pushing it off. The small scars disappear, navel scar is discrete - better than a large one from the open surgery option.
Walking will be awkward for a few days (best to have bed rest), and your testicle on that side may be sore for a couple of weeks as internal swelling goes down, but after that you'll be fine to drive & get about. Minimise exercise involving core at this time. A couple of months after you'll be pretty much back to normal, running etc, just look after that area for a while.

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Jamesfl said on 15 April 2014

I need some advise I have a Inguinal hernia I have had it for a about a year I have no pain at all. It is small but when Woking lifting Heavy items it get really big. But it is small when I am not doing anything. Can someone give me some advise on what to do I am 19 years old and I am male.

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Katie72 said on 16 March 2014

I had an operation for a large tumor in the abdomen 6 weeks ago, I ended up with an adhesion hernia. Three weeks ago I had another operation. I have been having pain especially if I try to lay on my left side or getting in and out of a chair. its like a dragging pain and sometimes excruiating. I have tried to hang on until I see the consultant again on the 18th March. I am now wondering whether I have a strangulated hernia. Really worried about having another operation so soon. You are now only kept in hospital for 1 day. I did phone the hospital but was told it would be painful for a while but this is 3 weeks and swelling has appeared..

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risylee said on 18 September 2013

i had surgery for an inguinal hernia 6 weeks ago and would anyone to be very careful. I now have constant pain. My hospital did this in a day and sent me home with no follow up appointment. The consultant gave me little detailed information. For example they tell you that 10% of people get constant pain, and advise you to have the operation, in case it gets 'stangulated'. I had no pain with my hernia and was not told what the chances were of it becoming strangulated. I now have a hard painful lump which radiates to my hip, whereas before I had no pain. I have many further criticisms of this hospital. For example they publish statistics showing very good outcomes for hernia surgery, but as they do not give follow up appointments how do they know? I would advise everyone to question doctors about every aspect of this surgery.

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melmer07 said on 28 June 2013

I noticed a lump in my left groin area and had been getting some pain in that region for over 6 months but the lump was a new thing.
It got that when I was walking the pain would get really intense and I literally had to stop walking and sit down to get relief.
The lump was getting bigger and pain more frequent.
I went to my GP who instantly said it was a hernia and the lump was part of my bowel sticking out.
I was given no advice at all but told it would mean an operation and refered to Hospital.
Got an appointment about 2 months later and consultant confirmed it would need operated on as there was a fair sized bit of my bowel or sack as he described it sticking our and the lump was just a small piece of it.
It will mean an epidural due to lung problems .
Can't say I am looking forward to it but I have no choice as it is causing problems with everyday life and the pain can be horrendous at times.
Should have went to GP sooner!

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lopezuk said on 16 April 2013

i just went to my doctor today,she says i have a hernia,its right above,almost in my belly button. Its a lump about the size of a ping pong ball,the doctor said just to monitor it,and if i get pain or constipation,to get to the surgery.
first she said i would need an ultrasound scan,then said,i cant have one, the lump appeared about 2 weeks ago,and was tender and bigger.a bit sore.the doctor said that they dont operate anymore on hernias because they come back out again usually. so it wouldnt be worth it. ( or is it about saving money) so thats how shes left me ,and i dont think its the correct diagnosis to tell the truth,im not sure,never had anything wrong with me before,like this.i didnt even know what a hernia was.

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eve70 said on 12 October 2012

I have gone back to a different doctor this time i took a photo with me showing when the lump comes up ,now i am being referred so i am nervous but happy

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eve70 said on 05 September 2012

i went to the doctors about a lump in my groin said how it seems to come up when i lie on my belly then turn over she explained to me it was muscle and showed as i was low weight I took a photo of it the other day and showed it to my mum she also thinks it is a hernia ,it seems to come up all of a sudden when i lie on my back i can see it rise it causes me pain but reluctant to go to drs again i think it is a inguinal hernia ,i have had to in the past lift heavy objects i am a carer i wonder if there are any tips to prevent it going worse

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Flopsy12 said on 09 June 2012

To User369800
Go back to your GP and insist that something is done, politely but firmly. Keep checking up on your GP until the surgery is arranged. Don't be put off. You owe it to yourself to do this, you only get one life!! 67 is NOT that old these days! Good luck.

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Rwthless said on 22 May 2012

I had a hemicolectomy in September 2007 for bowel cancer. Nobody warned me about heavy lifting after the wound healed. I had chemotherapy beginning November 2007, and was afraid I would become very thin so ate well at the beginning. Although I gained weight, nobody offered me a corset, or said anything about the danger of a hernia. By the end of the first year, the hernia had happened and now I have no offers of surgery to correct it. It is reasonably stable, but not very pretty. It makes me feel old and tired. Even though I am old and tired (67) I should have some quality of life.

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mike1953blue said on 24 September 2011

I recently visited my GP with regard to hip problems. They decided to examine me for hernia. The GP discovered a palpable thrill in the left groin and told me to keep an eye on it for the next month. She sent me for an X-Ray on my left hip and I am currently awaiting the result.
Should I suggest on my next visit that they refer me to the surgeon with regard to the hernia?

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