A hernia is a bulge or sac of intestine, another organ or fat which protrudes through a hole or weak area in the muscles of the abdominal wall. There are several types of hernias that are classified based on the severity and location of the hernia. Anyone can get a hernia, including people of all ages, races and both sexes.

Hernia Signs and Symptoms

Some patients may have no symptoms from a hernia. The most common symptom is discomfort and pain related to the hernia itself. The discomfort may be worse when you cough, stand, strain or lift heavy objects. Many people will describe an uncomfortable lump or bulge that may have gotten bigger over time.

In some hernias, intra-abdominal contents such as the small intestine may get stuck in the hernia hole (defect). This is known as an incarcerated or a strangulated hernia. This is a surgical emergency. If a piece of small intestine gets stuck in a hernia, the blood supply to this piece of intestine can become compromised. When this happens, it is a life-threatening surgical emergency.

Common Causes of Hernia

Anyone can get a hernia, including people of all ages, races and both sexes. People at higher risk for hernia are those who have had hernias before, people with genetic predispositions for getting hernias, people who are overweight and people who smoke.

Usually, there is no obvious cause of hernia. However, hernias can occur due to activities or medical problems such as:

  • Chronic constipation, straining to have bowel movements
  • Chronic cough
  • Cystic fibrosis
  • Enlarged prostate, straining to urinate
  • Extra weight
  • Fluid in the abdomen (ascites)
  • Heavy lifting
  • Peritoneal dialysis
  • Smoking
  • Overexertion
  • Undescended testicles

People who are overweight have more pressure pushing on the abdominal wall. Those who smoke, cough frequently, and have lung problems are at higher risk for forming hernias. People who have had hernias before tend to have them in other places as well.

Some patients may have a family history of hernias. Hernias may be present at birth, but the bulge may not be noticeable until later in life. They tend to occur over time due to wear and tear.

Preventing a Hernia

Hernias are difficult to prevent. The hole, or defect in the muscle, is often present at birth, and the weakness worsens with time.

Certain types of hernias can be identified and fixed at birth. This can be the case for inguinal hernias, which are located in the groin. All babies have an inguinal canal, and for boys, the canal lets the testicles descend into the scrotum (the sac that holds the testicles). If the canal doesn’t completely close, a hernia may develop. Similarly, umbilical hernias, located around the belly button, may also be identified and treated at birth.

People who have recently had abdominal surgery are at a higher risk for developing a hernia and should take the necessary recovery time. This type of hernia is called an incisional hernia because it forms where the surgical scar is located. In the months following surgery, patients should avoid strenuous activities and weight gain, which can put extra stress on healing tissues.

Some hernias are difficult to identify, and it is hard to predict if they will worsen. There are some things you can do to slow progression and keep symptoms at bay:

  • Maintain a healthy weight: Carrying additional weight can weaken and stretch the abdomen’s muscles and tissues and lead to a hernia. Staying active and lean can prevent pressure from extra body fat.
  • Eat enough fiber: Constipation leads to straining, which can increase the risk of a hernia. Fiber-rich foods can prevent constipation. According to the U.S. Department of Agriculture, daily fiber intake should be 25 grams for women and 38 grams for men.
  • Seek treatment for a persistent cough or sneezing: A chronic cough or allergies can make a hernia worse because of the strain on the abdominal muscles.
  • Quit smoking: Long-term smokers often have a dry and persistent cough. Smokers are more at risk for hernias because coughing weakens the abdominal wall.

Types of Hernias

Hernias can be divided into five main groups and are based on where they occur.

Groin Hernias (Includes Inguinal Hernias)

  • Inguinal hernias, which appear as a bulge in the groin, more commonly in men than in women, with the bulge potentially going all the way down into the scrotum.
  • Femoral hernias, which appear as a bulge in the upper thigh, just below the groin, and more commonly in women than in men.
  • Bilateral (double) hernias are any of the groin hernias that occur on both sides of the body.

Abdominal Hernias

  • Incisional hernias, which can occur through a scar if you have had abdominal surgery in the past
  • Umbilical hernias, which appear as a bulge around the belly button and occur when the tendon around the navel doesn’t close completely
  • Epigastric hernias, which develop in the mid-upper abdomen, anywhere along a line drawn from the lower point of the breastbone straight down to the umbilicus.

Stoma Hernias

Stoma hernias are those that occur around an ostomy in patients that have either a colostomy or an ileostomy.

Flank Hernias

Flank hernias are those which occur more laterally (to the side of the abdomen), typically because of trauma or previous surgery.

Complex and High-Risk Hernias

Complex hernias include those involving abdominal wall reconstruction and recurrent hernias, which include all hernias that reappear after a previous repair.

Hernias that require abdominal wall reconstruction are the most complex and, therefore, of most concern. These may be large abdominal hernias. In some patients, there may be an active infection of previously placed mesh or a fistula to the small or large intestine.

Treatment requires a team (multidisciplinary) approach to reconstructing the abdominal wall and generally involves open surgery. Sometimes, hernia surgeons work with plastic surgeons to repair more complicated reconstructions.

Diagnosing Hernias

A health care provider can confirm that you have a hernia during a physical exam. The growth may increase in size when you cough, bend, lift or strain. In some cases, an ultrasound may be needed to look for a hernia. Other imaging scans that can be helpful in diagnosing hernia or planning repair include abdominal X-rays and CT scans.

Comprehensive Treatment Options

We have a wealth of experience in treating all types of hernias. From the simple to the complex, we use a patient oriented, team approach to hernia care.

Our comprehensive team will work to properly diagnose your hernia and determine the best treatment plan based on your individual causes and symptoms, risks and needs. Whenever possible, we offer a minimally invasive hernia repair and use the latest techniques available. Learn more about the different hernia treatment options we offer.

Expert Care for All Types of Hernias

We provide expert hernia care in the Milwaukee area for simple and complex hernias. Hernia surgeons at Froedtert Hospital are also part of the Robert E. Condon, MD, Hernia Institute, a Medical College of Wisconsin Center of Excellence. Our surgeons focus on a broad range of abdominal wall defects, ranging from inguinal hernias to those that may require complex abdominal wall reconstruction.