Hernia

A hernia is an area in a layer of tissue that is weak or torn. Often when there is a hernia, other tissues that are normally held in by the damaged layer bulge or stick out through the weak or torn spot.

Hernias can happen in different parts of the body. When they happen where the thigh and body meet (called the groin), they are called inguinal or femoral hernias. Inguinal hernias are a bit higher on the groin than femoral hernias. Either type of hernia can balloon out and form a sac. In some cases, the sac holds a loop of intestine or a piece of fat that is normally tucked inside the belly.

Groin hernias are more common in men than in women.

ImageGroin hernias do not always cause symptoms. But when symptoms do occur, they can include:

• A heavy or tugging feeling in the groin area
• Dull pain that gets worse when straining, lifting, coughing, or otherwise using the muscles near the groin
• A bulge or lump at the groin

Hernias can be very painful and even dangerous if the tissue in the hernia becomes trapped and unable to slide back into the belly. When this happens, the tissue does not get enough blood, so it can get damaged or die. This is more likely with femoral hernias than with inguinal hernias.

Yes. See a doctor or nurse if you:

• Feel or see a bulge in your groin
• Feel a pulling sensation or pain in your groin even if you have no bulge

In most cases, doctors can diagnose a hernia just by doing an exam. During the exam, the doctor will ask you to cough while pressing on the bulge. This can be uncomfortable, but it is necessary to find the source of the problem.

Most of the time, the contents of the hernia can be “reduced,” or gently pushed back into the belly. Still, there are times when the hernia gets trapped and can’t be pushed back in. If that happens, the tissue that is trapped can get damaged.

If you develop pain around the bulge or feel sick, call your doctor or surgeon right away.

Not all hernias need treatment right away. But many do need to be repaired with surgery. Femoral hernias, in particular, usually need repair. They are more likely than inguinal hernias to cause tissue damage.

Surgeons can repair groin hernias in 1 of 2 ways. The 2 ways work equally well to fix the hernia. The best surgery for you will depend on your preferences and your surgeon’s experience. It will also depend on the type and size of your hernia, whether this is the first time it is getting repaired, and your overall health.

The 2 types of surgery are:

• Open surgery – During an open surgery, the surgeon makes one incision near the hernia. Then they gently push the bulging tissue back into place. Next, the surgeon sews the weak tissue layer back together, so that nothing can bulge through. In most cases, surgeons will also patch the area with a piece of mesh. Mesh takes the strain off the tissue wall. That way the hernia is not likely to happen again.
• Minimally invasive surgery – During laparoscopic surgery, the surgeon makes several small incisions. Then they insert long thin tools into the area near the hernia. One of the tools has a camera (called a “laparoscope”) on the end, which sends pictures to a TV screen. The surgeon can look at the picture on the screen to guide his or her movements. Then they use the long tools to repair the hernia with mesh. “Robotic repair” is done in a similar way, but with the help of a machine called a surgical robot.

If your hernia has reduced the blood supply to a loop of intestine, your doctor might need to remove that piece of intestine and sew the 2 ends back together. To do this, they might need to make a separate, bigger incision in your belly.

Your internal organs and tissues are held in place by a tough outer wall of tissue called the “abdominal wall.” An abdominal hernia is an area in that wall that is weak or torn. Often when there is a hernia, organs or tissues that are normally held in place by the abdominal wall bulge or stick out through the weak or torn spot.

There are many different kinds of abdominal wall hernias.

ImageAbdominal wall hernias can happen in different parts of the torso:

• Incisional hernias happen along incisions from surgery
• Umbical hernias happen at the belly button
• Epigastric hernias happen in the midline above the belly button
• Spigelian hernias happen to the left or right of midline, where 2 layers of muscle meet
• Lumbar hernias (not shown) happen at the back
• Inguinal hernias happen in the groin region
• Femoral hernias happen where the thigh joins the torso

Abdominal wall hernias do not always cause symptoms. When they do, they can cause some or all of these symptoms:

• A bulge somewhere on the trunk of the body – This bulge can be so small that you don’t even realize it’s there.
• Pain, especially when coughing, straining, or using nearby muscles
• A pulling sensation around the bulge
• Nausea or vomiting if part of your intestine is blocked in the hernia

Abdominal wall hernias can balloon out and form a sac. That sac can end up holding a loop of intestine or a piece of fat that should normally be tucked inside the belly. This can be painful and even dangerous if the tissue in the hernia gets trapped and unable to slide back into the belly. When this happens, the tissue does not get enough blood, so it can become swollen or even die.

Yes. See a doctor or nurse if you have any of the symptoms of a hernia. In most cases, doctors can diagnose a hernia just by doing an exam. During the exam, the doctor might ask you to cough or bear down while pressing on your hernia. This might be uncomfortable, but it is necessary to find the source of the problem.

Most of the time, the contents of the hernia can be “reduced,” or gently pushed back into the belly. Still, there are times when the hernia gets trapped and won’t go back in. If that happens, the tissue that is trapped can get damaged.

If you develop pain around a hernia bulge or feel sick, call your doctor or surgeon right away.

Not all hernias need treatment right away. But many do need to be repaired with surgery. Surgeons can repair most hernias in 1 of 3 ways. The right surgery for you will depend on the size of your hernia, where on the abdominal wall it is, whether this is the first time it is getting repaired, what your general health is like, and your surgeon’s experience. The types of surgery are:

• Open surgery – During an open surgery, the surgeon makes an incision near the hernia. Then they look at the tissue that is stuck in the hernia, and if it is healthy, gently pushes it back into place. Sometimes a piece of tissue needs to be removed. Next, the surgeon sews the layers of the abdominal wall back together, so that nothing can bulge through. In some cases, surgeons will also patch the area with a piece of mesh. The mesh takes some of the strain off the abdominal wall. That way the hernia is less likely to happen again.
• Laparoscopic surgery – During laparoscopic surgery, the surgeon makes a few incisions that are much smaller than those used in open surgery. Then they insert long, thin tools into the area near the hernia. One of the tools has a camera (called a “laparoscope”) on the end, which sends pictures to a TV screen. The surgeon can look at the picture on the screen to guide his or her movements. Then he or she uses the long tools to repair the hernia using mesh.
• Robotic surgery – During robotic surgery, the surgeon controls a robot to move tools like the ones used in laparoscopic surgery. In robotic surgery, the tools can move more precisely and twist and turn more easily. It is also easier to sew using these tools. Mesh is also used for robotic repair of abdominal wall hernias.

If your hernia has reduced the blood supply to a loop of intestine, your doctor might need to remove that piece of intestine. Then most times they will sew the intestine back together. The recovery and aftercare for each type of hernia repair is different. Your doctor or nurse can tell you what to expect after your surgery.

A hiatal hernia is what doctors call it when a part of the stomach moves up into the chest area. Normally, the stomach sits below the diaphragm, the layer of muscle that separates the organs in the chest from the organs in the belly. The esophagus, the tube that carries food from the mouth to the stomach, passes through a hole in the diaphragm. In people with a hiatal hernia, the stomach pushes up through that hole, too.
There are 2 types of hiatal hernia :

• Sliding hernia – A sliding hernia happens when the top of the stomach and the lower part of the esophagus squeeze up into the space above the diaphragm. This is the most common type of hiatal hernia.
• Paraesophageal hernia – A paraesophageal hernia happens when the top of the stomach squeezes up into the space above the diaphragm. This is not very common, but it can be serious if the stomach folds up on itself. It can also cause bleeding from the stomach or trouble breathing.

Hiatal hernias do not usually cause symptoms. In some cases, though, hiatal hernias cause stomach acid to leak into the esophagus. This is called acid reflux or gastroesophageal reflux, and it can cause symptoms, including:

• Burning in the chest, known as heartburn
• Burning in the throat or an acid taste in the throat
• Stomach or chest pain
• Trouble swallowing
• A raspy voice or a sore throat
• Unexplained cough

Yes, but doctors do not usually test for hiatal hernia. Instead, most people learn they have a hiatal hernia when they are having tests to find the cause of symptoms, or for other reasons. For instance, some people find out they have a hiatal hernia when they have an X-ray. Others find out when their doctor puts a tube with a tiny camera down their throat (called an endoscopy)

People who have symptoms caused by a hiatal hernia can get treated for their symptoms. Treatment for symptoms involves taking the medicines that are used for acid reflux. People with a paraesophageal hernia, and some people with a sliding hernia, need surgery. For this surgery, the surgeon pulls the stomach back down and repairs the hole in the diaphragm so the stomach does not slide up again.

Medicine type	Medicine name examples
Antacids*	Calcium carbonate (sample brand names: Maalox, Tums)
	Aluminum hydroxide, magnesium hydroxide, and simethicone (sample brand name: Myl
Surface agents	Sucralfate (brand name: Carafate)
Histamine blockers¶	Famotidine (brand name: Pepcid)
	Cimetidine (brand name: Tagamet)
Proton pump inhibitors	Omeprazole (brand name: Prilosec)
	Esomeprazole (brand name: Nexium)
	Pantoprazole (brand name: Protonix)
	Lansoprazole (brand name: Prevacid)
	Dexlansoprazole (brand name: Dexilant)
	Rabeprazole (brand name: AcipHex)

* Some antacids contain aspirin, which can increase the risk of internal bleeding. Examples of antacids with aspirin include Alka-Seltzer, Medi-Seltzer, and Neutralin. But there are others, too, so it’s important to check labels. Talk to your doctor or nurse before taking any medicines that contain aspirin. ¶ Another histamine blocker, ranitidine (brand name: Zantac), stopped being sold in 2020. That’s because it was found to sometimes contain a substance that could increase a person’s risk of cancer if they took a lot of it over time. If you have any of this medicine in your home, you should stop taking it and throw away any that is left over. Ask your doctor or nurse about what other medicine you can use instead.