Is It a Hernia? Symptoms, Treatment, and What You Should Know

Inguinal Hernia

An inguinal hernia happens in the groin when tissue pushes through a weak area in the lower abdominal wall. This is the most common type of hernia. Researchers estimate that about 27% of men and 3% of women will develop one in their lifetime. In men, the bulge may extend into the scrotum. Symptoms may include:

• A bulge in the groin area
• A heavy or dragging sensation
• Discomfort or pressure, especially when lifting, coughing or bending

Femoral Hernia

A femoral hernia also occurs in the groin but slightly lower than an inguinal hernia. It is less common but more likely to lead to complications. You may notice:

• A small bulge in the upper thigh or groin
• Groin discomfort or pain

Umbilical Hernia

An umbilical hernia forms near the belly button. It can affect infants and adults. In adults, it is often linked to pressure on the abdominal wall. Symptoms may include:

• A bulge near the belly button
• Discomfort when coughing or straining

Incisional Hernia

An incisional hernia forms through a weak area in a scar from prior abdominal surgery. You may notice a bulge near the scar, especially when you cough or strain.

Hiatal Hernia

A hiatal hernia is different because it happens inside the body. Part of the stomach pushes through the diaphragm into the chest, so you usually do not see a bulge. Some people have no symptoms, while others may have:

• Acid reflux
• Chest discomfort after meals
• Heartburn
• Trouble swallowing

If your symptoms do not improve, the Acid Reflux and Hiatal Hernia Centers of Excellence at Catholic Health can help you find out what is causing them.

Hernias in Men and Women

Hernias can affect anyone, but some types are more common in men and others are more common in women.

Inguinal hernias are much more common in men. Women are more likely to have femoral hernias, which can be harder to detect and carry a higher risk of complications. Women may also develop certain abdominal wall hernias, such as umbilical hernias, after pregnancy.

“Not every hernia looks or feels the same,” said Dr. Tamesis. “In some people, a bulge is easy to see. In others, pain or pressure may be the only sign. That is why we take symptoms seriously, even when the cause is not obvious.”

Hernia Causes

A hernia usually develops when a weak spot in the muscle or tissue combines with pressure inside the abdomen. Sometimes that weak area can be present at birth. In other cases, it develops over time. You may be at risk if you experience any of the following:

• Chronic constipation and straining
• Chronic coughing
• Connective tissue weakness
• Extra weight or obesity
• Family history of hernias
• Heavy lifting
• Pregnancy
• Prior abdominal surgery
• Smoking

For hiatal hernias, the opening in the diaphragm can weaken or stretch over time. This allows part of the stomach to move into the chest. That can play a role in the risk factors for a hiatal hernia.

Hernia Diagnosis

A hernia is often diagnosed with a physical exam. Your physician may ask about your symptoms and check the area while you stand, cough or strain. If the cause is not clear, imaging tests may help confirm what is going on. These may include:

• Ultrasound
• CT scan
• MRI

Hiatal hernias may require a different evaluation because they are inside the body and are often found when checking for reflux symptoms.

Hernia symptoms can overlap with other conditions. Your physician will take the time to understand what you are feeling and use the right tests when needed to make an accurate diagnosis.

Hernia Complications

Over time, a hernia can do more than cause a bulge or discomfort. If it is not treated, it may lead to more serious problems. Complications may include:

• Incarceration — the tissue becomes trapped and cannot be pushed back in
• Strangulation — the blood supply to the trapped tissue is cut off
• Bowel obstruction — can block normal digestion

Femoral hernias carry a higher risk of these complications than many other types. Hiatal hernias can also lead to complications when reflux becomes severe, causing irritation or narrowing of the esophagus.

Hernia Treatment Options

Treatment depends on the type of hernia, your symptoms, your overall health and whether there are signs of a more serious problem.

“Hernia treatment is not the same for everyone,” said Dr. Tamesis. “We look at your symptoms, your risk for complications and what will help you recover safely and get back to your normal routine.”

The right approach may range from monitoring to surgery. Treatment options may include:

• Watchful waiting — If your hernia is small and not causing symptoms, your physician may recommend monitoring it over time. If the bulge grows, you experience more pain or the hernia does not go back in, you will need a reevaluation.
• Surgery — Many hernias require surgery. Hernia surgery places the tissue back where it belongs and repairs the weak area. Surgeons may use an open or minimally invasive approach. In some cases, surgeons use mesh to strengthen the repair.
• Emergency treatment — A hernia that becomes painful and cannot be pushed back in or one where you experience nausea, vomiting, fever or skin color changes, requires emergency surgery right away.

Hiatal hernias are treated differently. Treatment often starts with lifestyle changes and medicine to control reflux symptoms for smaller hiatal hernias. Surgery may be recommended if symptoms do not improve with optimal medical management or you begin to develop complications of uncontrolled reflux, such as Barrett’s esophagus. Surgery is also indicated for larger hiatal hernias, also known as paraesophageal hernias.

If you notice a bulge in your groin, upper thigh, belly button or near a prior surgical scar, or if your reflux symptoms do not improve with treatment, a Catholic Health physician can help you find the cause and talk through the right treatment. Our specialists diagnose and treat many types of hernias, from common cases to more complex conditions.