Key takeaways:
A hernia develops when part of an organ, soft tissue, or fat pushes through a weakened area in the body. This weak spot often occurs in muscle or connective tissue, which is supposed to be keeping things in position.
There are many different types of hernia: hiatal, umbilical, epigastric, inguinal, femoral, and incisional. The most common is an inguinal hernia (in the groin).
Many people don’t experience significant symptoms when they have a hernia. But hernias have some complications that can turn into serious medical problems.
It can be frightening to notice a new bulge on your body. One possibility is that it’s a hernia.
Hernias occur when a weakness develops in a layer of tissue. Under the skin, every person has layers of fat, muscles, and tissue (fascia). These layers help protect and contain the organs inside the body. A hernia allows the contents inside to poke through the weakness.
Hernias can happen with age, after lots of straining, or due to surgery. But sometimes there’s no obvious cause.
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In some cases, hernias don’t cause any symptoms or health problems. Other times, hernias can be painful or even cause problems for the affected organs. For example, hernias can damage your intestines and lead to a medical emergency.
Here, we’ll review the key facts to know about each type of hernia.
Types of hernias
The type of hernia depends on where it is in the body. The most common ones occur in the groin or abdomen. But there are several different types of hernia.
1. Inguinal hernia
This is the most common type of hernia. An inguinal hernias occurs in the groin when part of the intestine pushes through the inguinal canal, a weak area in the lower abdomen. It can happen on either side of the body.
Why it happens
Gravity and pressure can cause the intestine or fat tissue to slide down into the inguinal canal. Repeated straining due to constipation, carrying heavy loads, and having a chronic cough can all increase pressure in the abdomen and contribute to hernia development. People assigned male at birth are at higher risk for this type of hernia.
Symptoms
Inguinal hernias often lead to a bulge in the groin or scrotum that’s more noticeable when standing. The lump may become more apparent when someone is coughing, bending over, or during physical activity. It can often be pushed back in with your finger. Sometimes, there’s pain or discomfort — but not always.
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Treatment
Surgery is the only definitive treatment for inguinal hernias. People may opt for surgery to get rid of the appearance, or because it causes discomfort. Surgery can also prevent the risk of serious complications (more on these below).
2. Femoral hernia
Femoral hernias develop when intestines push through the femoral canal. The femoral canal is located close to the inguinal canal in the lower abdomen, near the groin. In this way, femoral hernias are similar to inguinal hernias, but they’re much less common.
Why it happens
Unlike inguinal hernias, femoral hernias are more common in people assigned female at birth due to a wider shape of the pelvis. Risk also increases with age and activities that increase pressure in the abdomen (straining from constipation, carrying heavy loads, or having a chronic cough).
Symptoms
Femoral hernias usually don’t cause a noticeable bulge. Instead, pain in the groin area often leads to a diagnosis.
Treatment
Surgery is the treatment of choice, even if the hernia doesn’t cause symptoms. This is because the risk of complications from an untreated femoral hernia is higher than other hernias.
3. Epigastric hernia
Epigastric hernias develop when soft tissue or part of your intestines push out through the muscles in the upper abdomen.
Why it happens
This type of hernia is more common in babies and young children, when the abdominal wall muscles are still developing. Experts don’t know exactly why epigastric hernias develop in adults. Some risk factors include:
Larger body size
Prior pregnancy
Smoking
Diabetes
Heavy steroid use
Lifting heavy things
Symptoms
An epigastric hernia can cause a small but noticeable bulge above the belly button, usually in the area around the stomach. It may be more noticeable when you cough or sneeze. Sometimes, epigastric hernias can cause pain.
Treatment
Smaller epigastric hernias may not require surgery. But you may need surgery for a larger one and/or if it’s causing symptoms.
4. Umbilical hernia
This type of hernia develops when the intestines bulge through the muscle that surrounds the umbilicus, also known as the belly button.
Why it happens
Umbilical hernias are common in babies. This is because the area around the belly button is weaker after birth. But people can develop them in adulthood too. Things that increase pressure in the abdomen — like pregnancy, obesity, and frequent coughing — may increase the risk.
Symptoms
It’s common to see a small bulge in the area around the belly button. It may be more noticeable when laughing, crying, or coughing — or straining to poop.
Treatment
In children, most umbilical hernias will go away on their own by the time they’re 4 or 5 years old. If they don’t, surgery may be needed to move the abdominal contents back into place and close the weakened area. This type of hernia doesn’t go away on its own in adults. So, surgery is also an option for adults, depending on how bothersome the hernia is.
5. Incisional hernia
An incisional hernia develops at the site of a previous surgery.
Why it happens
In any abdominal surgery, the surgeon cuts through the skin and underlying connective tissue. After that area heals, it may remain weaker than the surrounding abdominal wall. This can happen with both big and small incisions. An incisional hernia can happen in up to 20% of all laparoscopic surgeries.
Symptoms
Incisional hernias often cause pain and bulge at the previous site of surgery, where there may be a scar.
Treatment
Treatment depends on the size and symptoms of the hernia. If it’s small, you may not need any treatment. If the hernia causes significant pain or becomes larger, your healthcare professional may suggest surgery.
6. Hiatal hernia
Hiatal hernias are a bit different from the other types of hernias. They develop when the stomach pushes up through the diaphragm. Your diaphragm is a muscle below your lungs that separates your chest from your abdomen. There’s a hole in the center of the diaphragm, so that the esophagus can pass through and connect to the stomach. A hiatal hernia occurs when the stomach pushes through this hole.
Why it happens
If the muscle around the opening of your diaphragm weakens, the upper part of your stomach can push upward into the chest. It isn’t totally clear why certain people develop hiatal hernias or why this muscle weakens. Some experts think it’s related to age. Other risk factors may include:
Pregnancy
Obesity
Chronic constipation
Chronic obstructive pulmonary disease (COPD)
Symptoms
Someone with a hiatal hernia may never have symptoms, especially if the hernia is small. If the hernia grows, it may cause heartburn or indigestion due to acid reflux. This is when the contents of the stomach flow upward into the esophagus. Hiatal hernias are the leading cause of gastroesophageal reflux disease (GERD).
Treatment
To help with GERD symptoms, most healthcare professionals will recommend medication or dietary changes. In some cases, especially if the hernia is larger, surgery is an option to fix the hernia.
Hernias in kids: Why umbilical (belly button) hernias are most common.
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Complications
As mentioned, the only way to fix a hernia is with surgery. The decision to repair the hernia with surgery largely depends on its size and associated symptoms. In some cases, watchful waiting is fine. But hernias don’t go away on their own.
Not treating a hernia increases the risk of complications that need urgent or emergent medical attention. This is because whatever is protruding through the hernia — often the small intestines — can be damaged. If the small intestines get trapped in the hernia (called incarceration), the following can happen:
Small bowel obstruction: This is when intestinal contents can’t make their way through the intestine. This causes significant pain, nausea, and vomiting.
Bowel necrosis: The intestines’ blood supply can be cut off. This is a medical emergency.
Bowel perforation: This is when a hole develops in the intestine. It can lead to life-threatening infection and is also a medical emergency.
In these cases, emergency surgery is needed to fix the problem. Any injured portion of the intestine or other tissue may require removal.
The bottom line
Hernias develop when an organ, tissue, or fat pushes through a weakened part of muscle or connective tissue. There are many different kinds, but inguinal hernias are the most common. The only way to fix a hernia is with surgery. But whether you need surgery depends on your symptoms, its size, and your risk for complications from it. If you notice a hernia, it’s best to speak to someone about a treatment plan sooner rather than later.
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References
Brigham and Women’s Hospital. (n.d.). What is an umbilical or epigastric hernia?
Hope, W. W., et al. (2023). Incisional hernia. StatPearls.
Institute for Quality and Efficiency in Health Care. (2023). Hernias: How are inguinal and femoral hernias treated in women? InformedHealth.org.
Institute for Quality and Efficiency in Health Care. (2023). Overview: Hernias. InformedHealth.org.
Köckerling, F., et al. (2018). Current concepts of inguinal hernia repair. Visceral Medicine.
LeBlanc, K. E., et al. (2013). Inguinal hernias: Diagnosis and management. American Family Physician.
MedlinePlus. (2022). Hernia.
National Institute of Diabetes and Digestive and Kidney Disease. (2019). Inguinal hernia.
Nemours KidsHealth. (2024). Umbilical hernias.
Smith, R. E., et al. (2023). Hiatal hernia. StatPearls.
U.K. National Health Service. (2019). Hernia.
U.K. National Health Service. (2022). Femoral hernia repair.
U.K. National Health Service. (2022). Umbilical hernia repair.
