Understanding Hernias: the Basics

Medically Reviewed by Jabeen Begum, MD on May 16, 2024
Written by Deanna Altomara
13 min read

You get a hernia when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue called fascia. Hernias often happen where the belly wall is weaker, such as in the belly area or groin. They can have various causes. 

Hernias can be painful. In some cases, they need emergency treatment. Call 911 right away if you your hernia:

  • Is extremely painful, growing quickly, swollen, or red
  • Makes you feel nauseated
  • Brings on constipation or bloating
  • Comes with a fever

In a reducible hernia, the lump can be pushed back through the belly wall. If not, it's an irreducible hernia, which is more likely to have serious complications.

A hernia is an emergency if it's “incarcerated.” In an incarcerated hernia, tissue (such as from the bowel) has slipped through the hernia and gotten stuck there. Stool may not be able to get through normally, which can cause pain, nausea, vomiting, and even a tear in the the bowel wall. If an incarcerated hernia becomes “strangulated,” the bowel tissue has started to die and needs emergency surgery. 

Ultimately, hernias are caused by a combination of pressure and an opening or weakness in the muscle or fascia. The pressure pushes an organ or tissue through the weak spot. Sometimes the muscle weakness is present at birth. But more often, it develops later in life.

Common sources of belly pressure include:

  • Lifting heavy objects without proper form (in other words, without stabilizing the belly muscles)
  • Diarrhea or constipation
  • Persistent coughing or sneezing
  • Pregnancy
  • Pelvic or abdominal (belly) surgery

Some people are born with a hernia. This is called a congenital hernia. It’s more common in people who:

  • Are born early
  • Have certain conditions (such as cystic fibrosis, connective tissue disorders, hip dysplasia, and some urinary or reproductive tract problems)
  • Have undescended testicles (in people who are assigned male at birth)

The most common types of hernias are inguinal (inner groin), femoral (outer groin), umbilical (bellybutton), incisional (resulting from a surgical cut, or incision), and hiatal (upper stomach).

Groin hernias

About 3 out of every 4 hernias are in the groin. There are two types: inguinal and femoral.

Almost all groin hernias are inguinal. They’re much more common in men than women. About 1 in 4 men and people assigned male at birth get inguinal hernias.

  1. Inguinal hernia

    They form when part of your intestine pushes through a weakness in the lower belly. This causes a bulge in an area of the groin called the inguinal canal.

    There are two kinds of inguinal hernia:

    • Indirect. The intestine enters the inguinal canal. This is the more common type.
    • Direct. The intestine does not enter the inguinal canal but goes straight through the bowel wall.

    With an inguinal hernia, you’ll probably see a lump where your thigh and groin come together. It may seem to go away when lying down, but you see it clearly when you cough, stand, or strain. 

    Generally, these hernias aren’t dangerous. Your doctor may consider watchful waiting, or keeping an eye on it.

  2. Femoral hernia

    Femoral hernias account for only a few out of every 100 hernias. They’re more common in older women and are often mistaken for inguinal hernias.

    Femoral hernias bulge into a different area of the groin called the femoral canal. This canal is right beneath the inguinal canal. You might see a lump right around the crease of the groin or just into the upper thigh. Your doctor will probably suggest surgery for a femoral hernia  because they are more likely to get stuck  than inguinal hernias.

Umbilical hernia

About 15% of babies have a congenital hernia, usually umbilical. Umbilical hernias happen when fat or part of the intestine pushes through muscle near the bellybutton. It’s a type of ventral hernia, which means that it affects the muscles of your abdominal (belly) wall.

They’re more common in newborns, especially in those born too early. But adults can get them, too. 

Women are more likely than men to get an umbilical hernia. Your chances are also higher if you:

  • Are overweight
  • Have been pregnant more than once
  • Have a lot of belly fluid (a condition called ascites)
  • Have a long-term cough
  • Have trouble peeing because of an enlarged prostate
  • Are constipated for long periods of time
  • Vomit repeatedly

What all of these risk factors have in common is increased pressure in the belly area, or abdomen, that pushes the hernia out.

Incisional hernia

About 1 in 10 hernias are incisional. This means that they form where you had a previous surgery. The surgery might have weakened the abdominal wall muscles, making them vulnerable to tearing. If a hole forms, tissue can poke through. Because they affect the abdominal wall, they’re considered a type of ventral hernia. Like groin hernias, they can lead to more serious problems if they’re not repaired. 

Incisional hernias are common in people who have had an operation, especially emergency surgery. You're more likely to get one if you do any of these things before your surgery cut heals completely:

  • Gain a lot of weight
  • Exercise too soon or too heavily
  • Get pregnant

Your chances are also higher if the wound gets infected or if you:

  • Are a man over 60
  • Are obese
  • Have long-term lung disease
  • Have diabetes or kidney failure
  • Smoke
  • Take long-term medications like steroids or drugs that affect your immune system

Hiatal hernia

About 1 in 5 people get a hiatal hernia, half of whom are over 50. This is also the most common type of hernia among pregnant people.

Unlike many other hernia types, a hiatal hernia doesn’t affect your abdominal wall. Instead, it affects your diaphragm. This is the sheet of muscle that separates your chest from your belly. 

Your esophagus runs from your throat to your stomach and passes through an opening in the diaphragm.

With a hiatal hernia, part of the stomach bulges up through this opening and into the chest. You won’t see any lump, but you might get heartburn or chest pain and notice a sour taste in your mouth.

Epigastric hernia

Less than 4% of abdominal hernias are epigastric. They’re more common in men and people assigned male at birth as well as people ages 20-50. 

An epigastric hernia forms at the midpoint between your sternum (breastbone) and bellybutton. It happens when fat pushes through a hole in your abdominal wall muscles, causing a painful bulge.

Spigelian hernia

This kind of hernia is rare, making up less than 2% of all abdominal wall hernias. They’re most common in women and people assigned female at birth, as well as people over 60. 

They form when abdominal tissue pushes through a hole in an area of connective tissue called the Spigelian fascia. You might not notice a lump. These hernias are particularly likely to get incarcerated (stuck).

Perineal hernia

This hernia is also rare. It happens when abdominal tissue pokes through a hole in the pelvic floor. This can be caused by surgery, injury, or pregnancy. It affects less than 7% of people who have pelvic surgery. It’s more common in women and people assigned female at birth.

Congenital diaphragmatic hernia

This is a dangerous birth defect that affects up to 1 in 2,500 babies. It happens when the diaphragm (the wall of muscle that separates your chest and belly) has a hole. The baby’s still-growing organs can slip through the hole and crowd the lungs.

It’s not clear what causes this type of hernia, although genetic conditions and exposure to toxins might play a role.

The most obvious symptom is a visible lump. It might be tender and can sometimes disappear when you lie down. But some people don’t have a lump or any other symptoms.

Common symptoms of inguinal, femoral, umbilical, and incisional hernias are:

  • Visible swelling in your abdomen or groin.
  • A heavy feeling in the abdomen, sometimes with constipation or blood in your poop
  • Discomfort in the abdomen or groin when lifting or bending over
  • A burning or aching sensation at the bulge
  • Weakness or pressure in your groin
  • Heartburn
  • A hard time swallowing
  • Shooting pain
  • Vomiting
  • Constipation
  • Pain and swelling around the testicles

On the other hand, a hiatal hernia is likely to cause heartburn and upper abdominal pain.

Strangulated hernia symptoms

Usually, you can push a hernia back in. But sometimes, you can’t. It can get stuck in your abdomen. If the trapped part gets cut off from blood flow, it’s a serious situation and can be life-threatening. This is called strangulation.

Call your doctor right away if you have any of the symptoms of a strangulated hernia, including:

  • Nausea, vomiting, or both
  • Fever
  • Sudden pain that gets worse quickly
  • A hernia bulge that turns red, purple, or dark
  • Not being able to poop or pass gas

When to worry about hernia pain

If you think you have a hernia, make an appointment with your doctor. They can make sure you get the right diagnosis, especially because other conditions can look like hernias. They also will help you get treatment before the hernia becomes serious.

Get emergency help if:

  • Your hernia changes color.
  • Your hernia becomes numb.
  • You have a fever, nausea, or vomiting.

Hernia signs and symptoms in children

Hernias are common in kids, especially babies. They can happen when part of their abdominal wall is weak at birth. If your child has one, you’ll usually notice a bulge in their groin area or around their bellybutton. Your baby may also cry a lot and refuse to eat. Hernias often bulge when your child cries, coughs, or strains to poop. You may also notice that their belly is tender to the touch.

You should see a doctor if you:

  • Suspect that you have a hernia
  • Can't get a hernia to go back in or it goes soft. Seek medical care right away, as this is an incarcerated hernia and can lead to organ strangulation.
  • Have a painful or noticeable bulge in your groin on either side of your pubic bone
  • Know you have a hernia, and have symptoms of a strangulated hernia. Seek medical care right away.

Most bulging hernias can be diagnosed with a physical exam. Your doctor may look at your hernia and feel it. They might also ask you to cough or change your position. Sometimes, they will push it back in. This helps them get a better idea of how serious it is.

Occasionally, they may need to get a better look with a CT scan or other imaging test.

Hernias usually don’t get better on their own. They tend to get bigger. In rare cases, they can lead to life-threatening complications. That’s why doctors often suggest surgery. But not every hernia needs treatment right away. It depends on the size and symptoms. If it doesn't have symptoms, it may not need treatment at all.

A surgical hernia repair involves pushing the bulge back inside the body part that should contain it using mesh, and keeping it there.

Nonsurgical hernia treatments

Your doctor may suggest that you wear a corset, binder, or truss. These supportive undergarments apply gentle pressure on the hernia and keep it in place. They also may ease discomfort or pain. You use them if you can't have surgery or for temporary relief before your procedure. Only use these garments under your doctor’s care.

Most hernias eventually need surgical repair. It may be time for surgery if:

  • Tissue (such as the intestine) becomes trapped in the abdominal wall. This is called incarceration. If left untreated, it may lead to strangulation. 
  • The hernia becomes strangulated. This is when it loses blood flow. Strangulated organs, usually your intestines, will die. If they're not removed quickly, you can become seriously ill. Signs include fever or nausea, sudden pain that gets worse, or a hernia that turns red, purple, or dark.
  • The hernia causes pain or discomfort, or it’s growing larger.

You may be able to wait to have surgery if:

  • Your hernia goes away when you lie down, or you can push it back into your belly. This is called a reducible hernia.
  • It’s small and causes few – or no – symptoms (These may never need surgery.)

Talk to your doctor. They’ll watch for changes to your hernia during your yearly physical.

Nearly all children and adults can have hernia surgery. If you’re seriously ill or very frail, you may choose not to have an operation. Your doctor can help you weigh the benefits of the procedure against your ability to recover.

Types of hernia surgery

What kind of surgery you’ll need often depends on the size, type, and location of your hernia. Your doctor will also consider your lifestyle, health, and age. Regardless of the type you get, the surgery can be done at a hospital or outpatient surgery center and will require general anesthesia.

Open surgery. The surgeon makes a cut (incision) to open your skin. They’ll gently push the hernia back into place, tie it off, or remove it. Then they’ll close the weak area of the muscle – where the hernia pushed through – with stitches. For larger hernias, your surgeon may add a piece of flexible mesh for extra support. It’ll help keep the hernia from coming back.

Laparoscopic surgery. In this surgery, your abdomen is inflated with a harmless gas. This gives the surgeon a better look at your organs. They’ll make a few small cuts near the hernia. They’ll insert a thin tube with a tiny camera on the end (laparoscope). The surgeon uses images from the laparoscope as a guide to repair the hernia with mesh.

You'll usually get better faster with laparoscopic surgery. On average, you're back to your normal routine a week sooner than with open surgery.

Minimally invasive robotic surgery. This technique is similar to laparoscopic surgery, but your surgeon will use a computer to control robotic arms. 

Nissen fundoplication for hiatal hernia. In this surgery, the surgeon stitches together your upper stomach and lower esophagus.

Hernia surgery cost

The cost depends on where you live, what kind of surgery you need, and what kind of insurance you have.

According to Medicare.gov in May 2024, surgery for a mild hernia (one less than 3 centimeters and that can be easily pushed back in) cost $1,956 at an outpatient surgery center or $3,631 at a hospital. On average, a Medicare patient was responsible for $391 of the outpatient procedure costs or $726 of the hospital costs.

A laparoscopic surgery was more expensive. An inguinal hernia repair cost $3,134 at an outpatient surgery center or $5,926 at a hospital. On average, a Medicare patient paid $626 of the outpatient procedure costs or $1,184 of hospital costs.

But every insurance plan has different rules. So check with your insurance company about what they will cover and whether you need preauthorization. Also, these cost estimates don’t include doctor fees, extra procedures, or other services. 

Hernia surgery recovery time

How long it takes to recover depends on what kind of hernia you have and your overall health. You usually don’t need to stay overnight in the hospital. 

Most people can get up and move around within a few days. You may even be able to do some light walking the day after your procedure. Start off at a gentle pace. Over time, you can slowly raise your activity levels. Generally, you can return to work in 1-2 weeks, depending on your job.

It will probably be another few weeks before you can do more intense activities, like lifting heavy objects.

Hernia surgery complications

This type of operation is normally very safe. But like all surgeries, having your hernia removed comes with some risks. They include:

  • Infection
  • Blood clots
  • Temporary trouble peeing
  • Pain

In most cases, the area will be sore as you heal. But some people develop long-lasting pain at the site. Experts think this might be because the procedure could damage certain nerves. Laparoscopic surgery may cause less pain than an open procedure.

Call your doctor if you have any of the following signs:

  • Fever or chills
  • A hard time pooping or passing gas
  • Pain, swelling, warmth, redness, or pus at the surgery site
  • Bleeding (enough to soak through your bandage)

Call 911 if you have signs of:

  • A blood clot: sudden pain, swelling, warmth, or redness in your leg or groin
  • Sepsis: fever or chills, a fast heartbeat, high blood pressure, sweaty or clammy skin, or trouble breathing

These are rare but life-threatening emergencies.

There’s a small chance the hernia could come back after the surgery. But your risk can be lowered if your surgeon uses mesh. 

A hernia forms when tissue pokes through a weak spot in the muscle. This can cause a visible bulge. Hernias usually don’t cause danger right away. But if left untreated, the tissue can become stuck or lose blood flow. Most hernias eventually need surgical repair.

What does a hernia feel like?

It depends. You might notice a bulging spot with some discomfort, pressure, achiness, or pain. Or you might not see or feel anything at all. Some hernias also can cause acid reflux.

How serious is a hernia?

Hernias usually don’t start out as serious, but they get worse over time. Eventually, most people need surgery. If left untreated, a hernia might get stuck in the hole of the muscle wall. This could cause pain and prevent blood from reaching the affected tissue, leading to cell death. 

What happens to a hernia if left untreated?

Sometimes, a hernia can get stuck in the hole in the wall of muscle or connective tissue. This is called incarceration. In severe cases, this can cut off blood flow, leading to cell death. If your bowels get stuck in the hernia, it could also prevent food and gas from passing through the digestive system.

How do you know if you have a hernia?

The most obvious sign of a hernia is a lump or bulge in your belly area. The lump may appear or disappear when you lift heavy objects, laugh, or cough. You may also notice a pinching or pressure at the site. But some hernias don’t cause a visible lump.