How Serious Is a Hernia?

A hernia, or a tear in muscle or connective tissue wall, nearly always needs surgical repair. How serious it is depends on the location of the hernia and which organs are nearby.

A hernia occurs when tissue or an organ protrudes through a defect in the muscles or connective tissue of the body. 

The most common types of hernias include:

• Groin hernias 
  • The most common types of hernias 
  • Inguinal: forms a canal that goes from the abdominal cavity to the scrotum in males or the vulva in females
  • Femoral: extends toward the hip bone (femur) 
• Hiatal hernia
  • Forms where the stomach meets the esophagus inside the abdominal cavity
  • In severe cases, the whole stomach can protrude into the chest cavity and cause serious problems with digestion and breathing
• Incisional hernia
  • A hernia that forms where an incision was made from a previous surgery
• Ventral hernias
  • Umbilical: forms at the navel (belly button or umbilicus)
    • Occurs 3 times more often in females than in males
  • Epigastric: forms in the upper abdominal wall 

Symptoms of hernia can vary depending on their location in the body and many hernias do not cause any symptoms. 

Groin hernias may not cause symptoms. When symptoms occur, they may include:

• Heavy or tugging feeling in the groin area
• Bulge or lump at the groin
• Dull pain that worsens when straining, lifting, coughing, or using the muscles near the groin

Most small hiatal hernias cause no symptoms. Moderate sized hiatal hernia symptoms include:

• Nausea
• Occasional vomiting or retching
• Heartburn
• Reflux of gastric acid or recently eaten food
• Abdominal cramps

Large hiatal hernias can become life-threatening emergencies if they twist or become obstructed.

In incisional hernia symptoms include a bulge at the incision site. 

Ventral hernia symptoms may include:

• Pain and discomfort that may be aggravated with coughing or straining 
• A bulge in the abdominal wall 
• Pressure on the overlying skin leading to areas of redness, decreased blood flow, or ulcers

Weak connective tissue or musculature can cause a hernia to develop. 

Increased pressure inside the abdominal cavity can make a hernia worse or cause more symptoms. Pressure in the abdomen may be increased by:

• Pregnancy
• Chronic constipation and straining during bowel movements
• Forceful coughing
• Heavy lifting
• Liver disease and fluid in the abdominal cavity (ascites)

Hernias are diagnosed with a patient history and physical examination, along with tests such as: 

• Ultrasound
• Computerized tomography (CT) scan
• Magnetic resonance imaging (MRI) scan
• Barium X-ray
• Endoscopy

Except for umbilical hernias in infants, hernias generally do not go away on their own. The main treatment for all types of hernias is surgical repair. 

Types of surgery to repair a hernia include: 

• Open surgery
  • An incision is made where the hernia is located
  • The protruding tissue is pushed back into place 
  • A mesh may be implanted for additional support
• Laparoscopic surgery 
  • Similar to open surgery, except small incisions are made so surgical tools can be inserted to perform the procedure
• Robotic hernia repair
  • Similar to laparoscopic surgery with small incisions 
  • A surgeon operates surgical instruments from a console

Complications of hernias include: 

• Recurrence of hernia in up to 15% of patients
• Obstruction, in which part of the intestine becomes stuck in the inguinal canal
• Strangulation, in which part of the intestine becomes trapped and the blood supply is cut off
  • This is a medical emergency that requires immediate surgery