A hernia develops when part of the abdominal wall muscle or tissue weakens, tears, or develops a hole, allowing internal organs or fatty tissue to protrude outward. This occurs due to a defect in the fascia, the strong connective tissue that surrounds and supports the abdominal muscles. Hernias are relatively common conditions, affecting approximately 27% of people assigned male at birth and about 3% of people assigned female at birth over their lifetime. The most frequently diagnosed type is inguinal hernia.

Hernias often appear as visible or palpable lumps in the torso or groin area. While some hernias cause no noticeable symptoms, others can result in pain, discomfort, or progressive complications if left untreated. Fortunately, modern medicine offers multiple effective strategies for managing and repairing hernias based on their type, severity, and symptoms.

Types of Hernias

Hernias are generally classified by their anatomical location. The most common types include:

Inguinal Hernia
Accounting for approximately 73% of all hernia cases, inguinal hernias occur when part of the intestine protrudes through the inguinal canal, located between the lower abdomen and the groin. This type is significantly more common in people assigned male at birth and may extend into the scrotum.

Femoral Hernia
Femoral hernias occur when intestinal tissue or fat pushes into the upper thigh near the groin. They are less common overall but occur more frequently in people assigned female at birth and carry a higher risk of complications such as strangulation.

Umbilical Hernia
This type of ventral hernia develops near the belly button when abdominal muscles fail to close completely during development. It is common in infants but can also occur in adults, especially during pregnancy or with obesity.

Hiatal Hernia
A hiatal hernia occurs when the upper portion of the stomach pushes through the diaphragm into the chest cavity via the hiatus. Unlike other hernias, it may not cause a visible bulge but can lead to reflux-related symptoms.

Incisional (Ventral) Hernia
Incisional hernias form at the site of previous abdominal surgery when scar tissue weakens the abdominal wall, allowing tissues to protrude through the surgical incision.

Hernia Symptoms

Symptoms vary depending on the type and severity of the hernia. In many cases, the hernia causes no pain and is discovered incidentally during a physical exam.

Bulging

The most recognizable sign of a hernia is a visible or palpable bulge. This bulge may appear during activities that increase abdominal pressure, such as standing, coughing, or lifting, and may disappear when lying down. The location of the bulge corresponds to the hernia type.

Pain and Discomfort

While many hernias are painless, some cause tenderness, aching, or a dull pressure sensation at the site. Pain may worsen over time, particularly as the hernia enlarges.

Pain With Physical Activity

Activities that increase intra-abdominal pressure—such as coughing, straining during bowel movements, running, or lifting heavy objects—often exacerbate hernia-related discomfort. Increased pain during activity is a common indicator that the hernia may require treatment.

Causes of Hernias

Hernias result from increased intra-abdominal pressure combined with a weakness in the abdominal wall. Internal pressure pushes organs or tissues through the weakened area, leading to herniation. Both inherited and acquired factors contribute to hernia formation.

Common causes include:

• Heavy lifting or improper lifting techniques

• Chronic straining during bowel movements or urination

• Abdominal trauma or injury

• Surgical weakening of the abdominal wall

• Congenital defects such as gastroschisis or omphalocele

Risk Factors

Several health conditions and lifestyle factors increase the likelihood of developing a hernia. Risk varies by hernia type and biological sex.

Key risk factors include:

• Family history of hernias

• Chronic constipation or coughing

• Cystic fibrosis

• Enlarged prostate

• Obesity (BMI ≥30)

• Ascites (abdominal fluid accumulation)

• Peritoneal dialysis

• Poor nutrition

• Smoking

• Premature birth

• Undescended testicles

• Pregnancy

• Excessive physical exertion

Diagnosis

Diagnosing a hernia involves assessing its size, severity, and potential complications while ruling out other causes of abdominal or groin swelling, such as tumors, abscesses, or aneurysms.

Diagnostic methods may include:

• Physical examination: Palpation of the bulge and assessment of reducibility

• Ultrasound: Often combined with the Valsalva maneuver to increase abdominal pressure

• CT scan: Provides detailed cross-sectional imaging

• MRI: Highly sensitive, especially for detecting inguinal hernias, with accuracy rates up to 95%

Treatment Options

Not all hernias require immediate treatment. Management depends on symptom severity, hernia size, and risk of complications.

Open Surgery

Open hernia repair is typically used for larger or symptomatic hernias. Surgeons repair the defect using sutures, staples, or surgical mesh to reinforce the abdominal wall. Mesh-based repairs are associated with lower recurrence rates.

Laparoscopic Surgery

This minimally invasive approach uses small incisions and a laparoscope to guide repair. It often results in reduced pain, shorter recovery time, and smaller scars.

Robotic Surgery

Robotic-assisted hernia repair is an emerging technique that enhances surgical precision. While promising, current evidence shows no definitive advantage over conventional laparoscopy for certain hernia types.

Watchful Waiting

For asymptomatic hernias, watchful waiting may be appropriate. Patients are monitored regularly and advised on lifestyle modifications to prevent progression, such as avoiding heavy lifting and quitting smoking.

Prevention

While not all hernias can be prevented, risk can be reduced by:

• Using proper lifting techniques

• Eating a high-fiber diet and staying