What is a hernia and how is it treated?

A hernia is a common problem, particularly among men. In fact, there are around 100,000 people undergoing treatment for hernias every year in the UK.

A hernia occurs when an internal part of your body pushes through a weak spot in the muscle or tissue wall. Your organs are usually held in place by tight, strong muscles, but if there are any weaknesses then a part of the bowel may protrude.

You can usually feel this as a bulge or swelling under your skin and you may experience pain and a feeling of pressure.

But did you know that there are different types of hernias? Here are four of the most common types:

1. Inguinal hernias

Inguinal hernias occur in the groin and are the most common type, accounting for around 70% of all hernias.

An inguinal hernia occurs when part of your bowel pokes through into your groin. It is far more common in men, though it can affect women too.

2. Femoral hernias

Like inguinal hernias, femoral hernias also occur when fat or part of the bowel pokes through into the groin. However, femoral hernias are far less common and tend to be found in women more than men.

3. Umbilical hernias

Umbilical hernias occur when fatty tissue or part of the bowel pokes through your abdomen near your belly button. They can happen in babies when the umbilical opening doesn't seal properly, or in adults as a result of significant weight gain and stretching of the abdominal wall.

4. Hiatus hernias

A hiatus hernia can occur if part of the stomach pushes through an opening in your diaphragm and into your chest. Since this is an internal hernia it can exist without noticeable symptoms, though it can cause heartburn.

Causes of a hernia

Hernias are caused by a combination of muscle weakness and strain. Some parts of the body are more prone to muscle weakness such as the groin. While you can't prevent hernias completely, there are a number of lifestyle changes that can reduce your chance of developing a hernia.

Common causes of strain on the abdomen include chronic coughing or sneezing, constipation and straining during bowel movements, or lifting heavy weights. Other causes include rapid or sudden weight gain and pregnancy.

Some of the main risk factors for hernias are:

1. Age

Hernias become more likely as you get older because the muscles in your abdomen become weaker with age. Keeping fit as you get older is essential.

2. Damage from injury or surgery

Hernias can occur in areas where you have previously sustained injury or undergone surgery. These factors can both lead to weakness in the abdominal wall. Appropriate exercises or physiotherapy following injury or surgery is highly recommended.

3. Repeated strain on the abdomen

If your muscles are already weakened, putting excessive strain on your abdomen can lead to hernias.

If you are planning to start a new job involving heavy lifting you should receive appropriate training to avoid injury. Similarly if you are starting a new exercise regimen it is wise to obtain the correct advice.

Diagnosing a hernia

The most common symptom of a hernia is a swelling or lump in your tummy or groin. This may be more obvious when you're standing, bending down or coughing, and can disappear when lying down. You may also experience some pain or discomfort.

A consultant's view

Consultant Colorectal and Laparoscopic Surgeon, Mr Joseph Ellul offers his advice on hernias.

At what age is a hernia likely to develop?

Hernias may develop at any age. They are sometimes noticed after heavy straining or lifting, but most would have occurred anyway at some time due to a pre-existing muscle weakness.

Typically, hernias are more noticeable if you are standing or walking and disappear overnight or while you are lying down.

Most hernias can be diagnosed with an examination by your doctor, but in some cases an ultrasound or MRI scan may be needed to confirm the diagnosis.

Can a hernia go away on its own?

Unfortunately, hernias never heal in adults and no amount of exercise will improve them. In fact, most hernias will progressively enlarge over time, especially in active people.

Eventually, hernias may cause problems such as strangulation (where part of the bowel becomes trapped in the hernia), which requires emergency surgery.

In view of this, most patients who suffer with a hernia should be offered surgery.

This can be performed either using open surgery, where a cut is made over the hernia, or by laparoscopic surgery, also known as keyhole surgery. There are pros and cons for both methods but generally patients recover more quickly from laparoscopic surgery.

Treating a hernia

The operation itself involves pushing the protruding tissue back into place and strengthening the weakened muscles that allowed the hernia to happen. 

This can be done either via open surgery or keyhole surgery. The operation you have will depend on the type of hernia and the experience of the surgeon.

After hernia surgery, you should be able to go home the same day or the day after. Your doctor will give you detailed instructions on how to take care of yourself while you recover, including what to eat and drink and how soon you can return to day-to-day activities. Most people are able to return to work after a week or two.

Hernias can cause complications. The most common are:

Obstruction: blockage of the bowel occurs when the bowel becomes stuck in the hernia and causes stomach pain, nausea and vomiting.

Strangulation: if a section of the bowel becomes trapped and the blood supply is cut off, emergency surgery is required within hours to restore blood supply, release the bowel and repair the hernia

Read more about recovering from a hernia operation

A hernia operation is a safe, routine operation, however there is a small risk of complications. These can include but are not limited to:

• Infection (rare)
• A build-up of blood or fluid in the space (seroma) left by the hernia, which resolves itself without treatment
• Pain or swelling in the testicles, base of the penis or the groin area (in inguinal hernias)
• Damage to the nerves or blood supply or to the vas deferens, the tube which carries sperm to the testicles (in inguinal hernias)
• There is also a small chance your hernia could come back after surgery, however your consultant will be able to discuss this with you.