What Is a Hernia?

Hernias are a common condition, but there’s a lot of confusion about what exactly they are. Get the facts here.

A hernia is a condition in which tissue or an organ bulges through a hole or a weak spot in the abdomen.  

They can occur at the navel, the diaphragm (the muscle that separates the abdominal cavity from the heart and lungs), the abdominal wall (the belly) or the groin.  

How painful or disruptive is a hernia? It depends on a range of factors, including its location, type and size. 

“Most of the time, hernias don’t cause patients severe pain but instead are more of a nuisance that can sometimes be unsightly,” says Luke R. Putnam, MD, a minimally invasive surgeon with the USC Digestive Health Institute, part of Keck Medicine of USC, who specializes in hernia treatment. However, he adds, “Sometimes smaller hernias actually hurt more than the larger ones.” 

For recently diagnosed hernia patients and their loved ones, it’s common to have questions. Dr. Putnam explains the most common types of hernias, how to recognize a hernia and how to treat a hernia. 

Ventral hernias  

A ventral (abdominal wall) hernia tends to show up as a bulge coming from within the belly, often at the navel (belly button). Patients usually feel discomfort in the area but nowhere else. 

 “Most hernias are soft. That said, there are times when the herniated contents become hard or even tender, and that’s definitely more concerning,” Dr. Putnam says.  

There are two main types: 

Umbilical hernia: This hernia shows up at the navel. It often results from a fetus’s abdominal wall not fully developing before birth. Adults, however, can get them, too.  

“An umbilical hernia can worsen with coughing, straining or crying but may shrink or appear to vanish when the patient is lying down or relaxed,” Dr. Putnam says. 

For most babies, the hernia will close by age two. If not — and in adult cases — medical attention will be necessary.  

Incisional hernia: These hernias are a potential complication of surgeries that require going through the abdominal wall to access the abdominal cavity. They can develop months or even years after the procedure and can be made worse by straining or coughing. 

Smoking, diabetes and carrying excess weight in the abdomen can increase the risk of developing an incisional hernia or having a recurrence of the hernia even after it has been repaired. 

Inguinal hernias 

Inguinal (groin) hernias happen when fat or part of the intestines pushes through a weak spot in the muscle near the groin. They often develop over time as a result of repetitive straining, and they may cause a burning or heavy sensation.  

“They most commonly appear as a bulge or swelling in the groin area, especially when standing or straining, although sometimes a bulge isn’t present and there is simply vague discomfort,” Dr. Putnam says. “Groin hernias are more common in men than in women.” 

Weight gain, coughing, straining or constipation can all increase the risk of an inguinal hernia.  

Hiatal hernias 

The diaphragm muscles separate the chest and abdominal cavities, and they assist with breathing. Between the left and right diaphragm is the hiatus, where the esophagus and aorta pass through. Together with the muscles in the lower esophagus, the diaphragm helps to create a barrier to prevent acid reflux.  

Sometimes the upper part of the stomach will push through the hiatus and into the chest cavity. The result, a hiatal hernia, can lead to heartburn, chest pain, chronic acid reflux (also known as GERD) and difficulty swallowing. Patients are encouraged to meet with both gastroenterologists and foregut surgeons to understand their medical and surgical options to address this increasingly common but very treatable condition. 

Hiatal hernias are more common among older people, but anyone can have a hiatal hernia if they were born with a larger hiatus, have certain autoimmune conditions or carry excess weight in the abdomen. 

When to see a doctor for a hernia 

“Not every hernia is dangerous, but they can definitely lead to complications and poorer quality of life,” Dr. Putnam says. “If a patient experiences intense pain, it usually means that something is stuck in the hernia and the blood supply to the fat or intestine is likely compromised.”  

If a person with a hernia experiences any of the following symptoms, it’s crucial to get them immediate medical attention. 

• Sudden onset of pain or swelling 
• Nausea or vomiting that’s not from food poisoning or a virus 
• Any changes in bowel habits  
• Skin color changes or skin thinning 

How to treat a hernia 

“The only definitive way to treat a hernia is to close it surgically,” Dr. Putnam says. 

Once the hole is closed, most repairs are reinforced with mesh. The threshold for mesh use during hernia repairs has gradually decreased. “Almost all hernia repairs should have mesh reinforcement,” he says. 

That said, even minimally invasive surgery, such as laparoscopic or robotic surgery, can come with risks and require a period of recovery. 

“Not every hernia has to be fixed,” Dr. Putnam says. “The hernia patient and their doctor should always discuss the risks and benefits of surgery.” 

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