Hernia

Symptoms of a hernia

The main sign of a hernia is a lump or bulge, which:

• appears or gets bigger when you cough, strain, lift something heavy, laugh or stand up
• gets smaller or disappears when you lie down
• may feel like pressure, a dull ache, or a dragging or pinching sensation.

Some hernias don't cause a visible lump at all. A hiatus hernia, for example, sits too deep to see or feel, and instead tends to cause heartburn, indigestion, or a burning feeling in your chest. In men, a groin hernia can sometimes slip down into the scrotum, causing swelling there.

Causes and risk factors

A hernia happens when a weak spot or opening in your muscle or connective tissue, sometimes present from birth and sometimes developing later, allows tissue to push through. This weakness is usually made worse by ongoing pressure in your abdomen, which is more likely if you have:

• a job involving heavy lifting or long hours of standing
• a chronic cough, or sneezing from allergies
• chronic constipation, or straining to pee or poo
• a history of abdominal or pelvic surgery, which can weaken the area
• pregnancy, especially repeat pregnancies
• being very overweight (a BMI over 30)
• smoking, which weakens connective tissue.

Babies can be born with a hernia if an opening doesn't close properly before birth. This is more likely if they're born prematurely, or have cystic fibrosis, a connective tissue disorder, hip dysplasia, undescended testicles, or another problem affecting their reproductive or urinary system.

Types of hernia

Hernias are usually named after where they occur:

• An inguinal hernia found in the groin is the most common type, making up around 3 in 4 hernias and mostly affecting men.
• A femoral hernia, in the upper thigh near the groin is more common in women.
• An umbilical hernia, under or near the belly button is common in babies and often closes on its own by around age 5.
• A hiatus hernia, in the chest occurs where part of the stomach pushes up through the diaphragm.
• An incisional hernia is through a scar from previous abdominal surgery.
• An epigastric hernia is between the belly button and breastbone.

Rarer types include lumbar hernias, near the spine, and stoma hernias, which develop near a surgical opening (stoma) in the abdomen.

Diagnosing a hernia

A physical examination is often enough to diagnose a hernia. Your doctor will look and feel for a bulge, and may ask you to cough, stand up or strain so they can see it more clearly. They'll also check whether they can gently push the bulge back in, which helps them judge how serious it is.

Sometimes, particularly for hernias that are too deep to see or feel, your doctor may also arrange an ultrasound, CT scan or MRI scan to confirm the diagnosis and check its size and exact location.

Treatment for a hernia

Hernias don't usually go away by themselves, except some umbilical hernias in babies, which often close naturally by around age 5. If they do not, they may eventually need surgical repair if they get bigger or cause symptoms. If your hernia is small and isn't causing symptoms, your doctor may suggest watchful waiting, checking it periodically rather than operating straight away.

In the meantime, wearing a supportive undergarment called a truss or binder can ease discomfort by holding the hernia in place, though this only manages symptoms and doesn't fix the underlying weakness. If you have a hiatus hernia specifically, medicines that reduce stomach acid, such as antacids, can help control the heartburn it causes.

Surgical repair involves pushing the herniated tissue back into place and strengthening the weakened area, usually with stitches or a supportive mesh. This can be done as:

1. Open surgery, where the surgeon makes a single cut to access and repair the hernia directly.
2. Laparoscopic (keyhole) surgery, using several small cuts and a camera, which usually means less pain and a faster recovery.
3. Robotic surgery, similar to laparoscopic surgery, but with the surgeon guiding robotic arms from a console.

Most hernia surgery is a straightforward day case, performed under general anaesthetic, and you can typically return to light activity within a few days and normal duties within 1–2 weeks, though it may be longer before you can safely lift heavy objects again.

When to see a doctor

See your GP if you think you have a hernia, even if it isn't causing you pain, so it can be properly assessed and monitored. Get emergency medical help, call 999 or go to A&E, if you have a hernia and:

• you can no longer push it back in, or it becomes firm, red, purple or dark
• you have sudden pain that quickly gets worse
• you feel sick, are being sick, or have a swollen tummy
• you're unable to poo or pass wind.

These can be signs that the hernia has become trapped (incarcerated) or that its blood supply has been cut off (strangulated), both of which need urgent treatment.