What Is a Hernia? Inguinal, Incisional, Umbilical, Hiatal, and Femoral Hernias

Written by WebMD Editorial Contributors

• What Is a Hernia?
• Hernia Causes
• Types of Hernias

A hernia happens when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue called fascia. They often occur where the abdominal wall is weaker, such as in the abdomen (belly area) or groin, and can have various causes. 

Hernias can be painful. In some cases, they need emergency treatment. Call 911 right away if:

• Your hernia is extremely painful, growing quickly, swollen, or red.
• You vomit or feel nauseous.
• You have constipation or bloating.
• You have a fever.

In a reducible hernia, the lump can be pushed back through the abdominal wall. If not, it’s an irreducible hernia, which is more likely to have serious complications.

A hernia is an emergency if it is “incarcerated. ” In an incarcerated hernia, tissue (such as from the bowel) has slipped through the hernia and gotten stuck there. Stool may not be able to get through normally, which can cause pain, nausea, vomiting, and even tear the bowel wall. If an incarcerated hernia becomes “strangulated,” the bowel tissue has started to die and needs emergency surgery. 

Ultimately, all hernias are caused by a combination of pressure and an opening or weakness of muscle or fascia. The pressure pushes an organ or tissue through the opening or weak spot. Sometimes the muscle weakness is present at birth. But more often, it happens later in life.

Anything that causes an increase in pressure in the abdomen can cause a hernia, including:

• Lifting heavy objects without stabilizing the abdominal muscles
• Diarrhea or constipation
• Persistent coughing or sneezing

In addition, obesity, poor nutrition, and smoking can weaken muscles and make hernias more likely.

The most common types of hernia are inguinal (inner groin), incisional (resulting from a surgical cut, or incision), femoral (outer groin), umbilical (belly button), and hiatal (upper stomach).

Groin hernias

About 3 out of every 4 hernias are in the groin. There are two types: inguinal and femoral.

Almost all groin hernias are inguinal. You get them when part of your intestine pushes through a weakness in the lower belly and affects an area of the groin called the inguinal canal.

There are two kinds of this hernia:

• Indirect. The more common type; it enters the inguinal canal.
• Direct. It does not enter the inguinal canal but goes straight through the bowell wall.

They’re much more common in men than women, but they’re not limited to adults. 

With an inguinal hernia, you’ll probably see a lump where your thigh and groin come together. It may seem to go away when lying down, but you see it clearly when you cough, stand, or strain.  

Generally, these hernias aren’t dangerous. Your doctor may consider watchful waiting, or monitoring the hernia. 

Femoral hernias account for only a few out of every 100. They’re more common in older women. They are often mistaken for inguinal hernias.

Femoral hernias bulge into a different area of the groin called the femoral canal. You might see a lump right around the crease of the groin or just into the upper thigh.Your doctor will likely recommend that you get surgery for a femoral hernia instead of watchful waiting, since they are more likely to get stuck without being reducible.

Umbilical hernias

This is the second most common type of hernia. Umbilical hernias happen when fat or part of the intestine pushes through muscle near the belly button. They’re more common in newborns, especially in those born earlier than expected and babies under 6 months old. But adults can get them, too.

Women are more likely than men to get an umbilical hernia.  Your chances are also higher if you:

• Are overweight
• Have been pregnant more than once
• Have a lot of belly fluid (a condition called ascites)
• Have a long-term cough
• Have trouble peeing because of an enlarged prostate
• Are constipated for long periods of time
• Vomit repeatedly

What all of these risk factors have in common is increased pressure in the abdomen that pushes the hernia out.

Incisional hernias

If you have surgery in which a doctor makes an opening through your belly, you might get an incisional hernia later. Tissue can poke through where the skin has been weakened by a scar left after surgery. Like groin hernias, they can lead to more serious problems if they’re not repaired. 

Incisional hernias are common in people who have had an operation, especially emergency surgery. You can be more likely to get one if you do any of these things before your incision heals completely:

• Gain a lot of weight
• Exercise too soon or too heavily
• Get pregnant

Your chances are also higher if the wound gets infected or if you:

• Are a man over 60
• Are obese
• Have long-term lung disease
• Have diabetes or kidney failure
• Smoke
• Take long-term medications like steroids or drugs that affect your immune system

These are a little different from the other types of hernias because of where they happen.  

Hiatal hernias involve your diaphragm, the sheet of muscle that separates your chest from your belly. Your esophagus runs from your throat to your stomach and passes through an opening in the diaphragm.

With a hiatal hernia, part of the stomach bulges up through this opening and into the chest. You won’t see any lump, but you might get heartburn or chest pain and notice a sour taste in your mouth.

Although they’re the most common hernias seen in pregnant women, this type of hernia is most often found in people over age 50.

Other types of hernias

Less common types of hernias include:

• Epigastric hernia. This is when fat pushes through the belly somewhere between the belly button and lower part of the breastbone. These show up in men more often than women.
• Giant abdominal wall hernia. You might get one of these if you have an incisional hernia or some other kind that’s hard to treat and keeps coming back.  
• Spigelian hernia. You get this type when fat tissue pushes through muscle below your belly button along the bottom edge of where your six-pack might be.

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Inguinal Hernia | Johns Hopkins Medicine

An inguinal hernia is a bulge that occurs in your groin region, the
area between the lower part of your abdomen and your thigh. Inguinal
hernias occur because of a weakening of the muscles in the lower
abdomen.

Three layers protect the intestines inside the lower abdomen. The first
is a thin membrane called the peritoneum. The second is made up of the
abdominal muscles, and the third is your skin.

An inguinal hernia forms when your intestines and the peritoneum push
through the muscles and appear as a bulge under your skin. Inguinal
hernias are dangerous because they tend to keep getting larger and your
intestine can get trapped inside the bulge and lose its blood supply.
This is called a strangulated inguinal hernia, and surgery may be
needed to correct the problem.

Facts about inguinal hernia

Inguinal hernias may occur on one or both sides of the body and are
much more common in men than women. An inguinal hernia can appear at
any age. Infants may be born with one that doesn’t show up until they
become adults. About five out of every 100 children are born with the
condition.

An inguinal hernia can also develop over time if you increase pressure
on the walls of your abdominal muscles through activities like
straining to go to the bathroom, coughing over a long period, being
overweight, or lifting heavy weights. If you have a family history of
inguinal hernia, you may be at a higher risk for one. Infants born
before their due date are also at higher risk.

Types of inguinal hernia

Inguinal hernias come in two types:

• Indirect inguinal hernia.
  This is the most common type, and a type of hernia that you may
  be born with. Although it can occur in men and women, it is
  much more common in men. This is because the male testicle
  starts inside the abdomen and has to go down through an opening
  in the groin area to reach the scrotum (the sac that holds the
  testicles). If this opening does not close at birth, a hernia
  develops. In women, this type of hernia can occur if
  reproductive organs or the small intestine slides into the
  groin area because of a weakness in the abdominal muscles.

• Direct inguinal hernia.
  This type of hernia is caused by weakening of your abdominal
  muscles over time and is more likely to be seen in adults.
  Direct inguinal hernias occur only in men.

Symptoms

The main symptom is a visible bulge in your groin area. In men, an
inguinal hernia may extend down into the scrotum and cause an enlarged
scrotum. Small hernias may slide back and forth through the opening in
the abdomen and not cause any symptoms. Larger hernias may be massaged
back into the abdomen. Symptoms of hernias that go back and forth
include:

• A bulge that increases in size when you strain and disappears
  when you lie down

• Sudden pain in your groin or scrotum when exercising or
  straining

• A feeling of weakness, pressure, burning, or aching in your
  groin or scrotum

An inguinal hernia that can’t be moved back into the abdomen is called
an incarcerated hernia. This is a dangerous situation because the part
of your intestine inside the hernia can become strangulated, which is a
medical emergency. Symptoms of a strangulated inguinal hernia include:

Diagnosis

Inguinal hernia is most often diagnosed through a medical history and
physical examination. Your doctor will ask you questions about hernia
symptoms. During the exam, he or she will look for and feel for a bulge
in your groin or scrotal area. You may be asked to stand and cough to
make the hernia appear. Inguinal hernias in children may only be seen
or felt when the child cries.

Inguinal Hernias in Children | Q&A with Dr. Clint Cappiello

Treatment

The way to repair an inguinal hernia is usually with a surgical
procedure. In adults with small hernias that don’t cause symptoms,
treatment may only be to watch it. Adults with symptoms and most
children usually have surgery to prevent the possible complication of a
strangulated hernia in the future. An incarcerated or strangulated
hernia may need emergency surgery.

There are two main types of surgery for inguinal hernia:

• Open repair.
  An incision is made through the skin in the groin area. The
  surgeon moves the hernia back inside the abdomen and closes the
  abdominal wall with stitches. Mesh placement may be used to strengthen the closure and reduce the risk of recurrence of the hernia.   

• Laparoscopy or robotic-assisted repair.
  This type of surgery uses a few small incisions and a thin
  scope with a tiny camera. The surgeon works through the scope
  to repair the hernia, sometimes operating from a console maneuvering robotic arms. Mesh is typically used for these repairs. Recovery is shorter and pain is less severe after these minimally invasive approaches than with open repair.

Prevention

There is nothing you can do to prevent an indirect inguinal hernia, the
type you are born with. Direct hernias that occur over time may be
prevented with these precautions:

• Learn how to lift heavy objects properly.

• Avoid and, when needed, treat constipation to prevent straining
  when having a bowel movement.

• Get treatment for any persistent cough.

• If you are a man with an enlarged prostate and you strain to
  pass urine, get treated.

• If you are overweight, lose the extra pounds.

Managing inguinal hernia

If you have had surgery for inguinal hernia, it is important to follow
all your doctor’s instructions and keep your follow-up appointments.
Getting out of bed and walking is an important part of recovery and
helps prevent complications. You can help to keep an inguinal hernia
from coming back after surgery by avoiding heavy lifting and other
strenuous activity. Ask your doctor what types of activities are safe
and when you can return to work.

If you have a small hernia that is being watched or a repaired hernia,
take steps to avoid becoming constipated. Eat lots of fiber, drink
plenty of fluids, exercise, and go to the bathroom when you feel the
urge.

Call your doctor if your inguinal hernia symptoms get worse, and always
call right away if:

• You have a painful bulge that can’t be pushed back inside.

• You have increasing pain, swelling, or redness.

• You have nausea, fever, or vomiting along with hernia pain.

Hernia – cause and treatment – health articles

11/10/2022

Hernia — protrusion of the viscera along with the parietal sheet of the peritoneum through a defect in the muscle layer of the abdominal wall under the skin.

A disease may be classified according to its location. Hence the name of the hernia: umbilical, inguinal, intervertebral, dorsal, lumbar, hernia of the white line of the abdomen, subumbilical.

There are also other forms of hernia, more rare – postoperative, lateral, ischial, obturator, perineal, hernia of the obvious process of the sternum.

Causes of hernia

There can be several reasons for this disease:

• weakening of the anterior abdominal wall that occurs during pregnancy, after childbirth in women or in people leading an inactive life;
• a sharp increase in pressure in the abdomen, for example, when a person lifts weights or when straining while going to the toilet;
• overweight;
• features in the structure of the body;
• Chronic cough or allergy with frequent cough.

A hernia can be caused by a person’s age, recent trauma, or surgery that weakens the muscles. Of course, a hernia can also be hereditary, then the cause is varicose veins, scoliosis, and even flat feet.

Symptoms of a hernia

The most sure sign of the manifestation of the disease is unusual protrusions in the abdominal region. Bulging may appear in the groin, in the navel, or in the scar area if you have recently had surgery. It all depends on the type of hernia.

But not only outwardly it is possible to suspect a disease, symptoms are also such indicators as pain in the abdomen and groin during prolonged standing, during physical exertion, and when lifting weights. A person observes pain when sneezing, coughing, straining.

Umbilical hernia is most common in babies. Usually it passes by half a year, when the child begins to sit and move actively, thereby straining and strengthening the abdominal walls. But if it occurs in children much later, then you need to see a doctor. The disease can appear with frequent constipation, lack of activity, or with a constant cough. If a child complains of pain in the navel and he has protrusions in the same place in a standing position, then this is a sure sign of the appearance of an umbilical hernia. Also, the child may become lethargic, his appetite decreases and apathy occurs.

Inguinal hernia is more common in men and also in boys, especially in infancy. Symptoms are protrusions in the corresponding area, an increase in the scrotum, pain in the lower back, genitals, and when urinating.

A herniated disc causes pain in the legs or in the area of ​​the spine after physical exertion, heavy lifting, bending over, or as a result of an uncomfortable position during sleep or work. There are protrusions in the side of the spinal cord or in the lower back.

Spinal hernia occurs in the lumbar region, neck and chest. Symptoms of such a disease are pain in the corresponding area, weakness in the arms and legs, and sensitivity disorders.

In lumbar hernia, bulges appear on the side or back of the abdomen. This type of disease can be found in a supine position on a sore side – protrusions are visible, but when a person turns over to a healthy side, it disappears.

A hernia of the linea alba is a disease in which preperitoneal fat passes through cracks and holes. With such a hernia, a person may not complain of pain or have it in the epigastric region.

How to identify a hernia

Instrumental methods of examination include a method such as diaphanoscopy, used to distinguish between scrotal hernia and dropsy. It involves examining the scrotum area with a light element.

Physical examination methods: after examining the protrusion, the doctor feels it, determines its density, whether it is reduced into the cavity, and also notes the condition of the natural canals and openings (whether they are enlarged, for example, by inserting a fingertip into the inguinal canal, it is noted that it is not enlarged whether he).

Another examination method is an ultrasound examination.

Treatment

Hernia is treated by two methods – conservative and surgical. Conservative treatment includes:

• motor technique, exercise therapy;
• a manual technique that helps to change the tension of the muscles of the spine, is used when a person has a herniated disc;
• physiotherapy technique – massage, reflexology, mechanical traction, magnetic and ultrasonic treatment.

But all these methods are rarely used, very often they cannot save a person from a hernia, if only in isolated, unique cases. Conservative treatment is designed to reduce pain and reduce protrusions. The most commonly used surgical method of treatment is the removal of a hernia permanently.

Hernia surgery can be performed under local anesthesia, the procedure takes from 30 minutes to several hours, depending on the severity and type of disease.

Why does a hernia occur and how can it be cured?

It is commonly believed that hernias are caused by exercising too intensely or by lifting weights. In this article, we will understand what a hernia is and what factors actually provoke its appearance.

Contents

• What is a hernia?
• Hernia symptoms
• Causes of hernia
• Diagnostics
• Treatment

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What is a hernia?

A hernia is a protrusion through a hole in the tissues of an internal organ from a cavity that it normally occupies.

The organ may protrude under the skin, into spaces between muscles, or into body cavities.

Source: wikipedia

There are many types of hernias. They are classified depending on the location. The following are most common:

1. Inguinal hernia is a protrusion of the peritoneum (the thin membrane covering the inner walls of the abdominal cavity) into the region of the inguinal canal. In this case, the peritoneum forms the so-called “hernial sac”, into which organs from the abdominal cavity can enter. Inguinal hernia is much more common in men (27% risk), but women can also be affected (3% risk).
2. Femoral hernia , unlike inguinal hernia, is more common in women, especially pregnant or obese patients. The main difference between a femoral hernia and an inguinal hernia is its location. It is located below the inguinal ligament, in the area of ​​the femoro-inguinal fold. Inguinal hernia, on the contrary, is located above the inguinal ligament.
3. Umbilical hernia – protrusion of part of the small intestine through the structures of the umbilical ring. This hernia is common in infants, but also affects overweight women or those who have had multiple pregnancies.
4. Hiatal hernia or hiatal hernia. In this case, part of the stomach exits through a hole in the diaphragm, the thin layer of muscle that separates the chest from the abdomen.
5. Herniated disc is a protrusion of the nucleus of the intervertebral disc into the spinal canal. The intervertebral disc consists of an inner part – the nucleus of a gelatinous consistency – and an outer part – a dense fibrous ring. With a hernia of the spine, the integrity of the fibrous ring is violated, due to which part of the nucleus comes out.

The most common types of hernias are listed above, but there are others : postoperative, epigastric (when organs protrude between the sternum and navel), hernias of the Spigelian line of the abdomen (protrusion of organs just below the navel, to the right and left of it), muscular hernias .

Symptoms of a hernia

As a rule, a hernia is clearly visible : it is a bump or “bump” on the body, and sometimes it can be “set”, that is, pressed back, and in some cases it can disappear when the patient lies down .

Hernia reappears with coughing, laughing, straining to have a bowel movement or physical activity.

Other symptoms of a hernia include:

• swelling (for example, in an inguinal hernia – in the groin or scrotum),
• constant pain at the site of the protrusion,
• pain when lifting weights,
• feeling full stomach or bowel obstruction.

It is important to note that hiatal hernia (hiatal) may not be visible externally – there are no “bumps” or bulges on the body. Instead, symptoms may include heartburn, indigestion, difficulty swallowing, belching, or chest pain.

In the case of a herniated disc, the main symptom is pain .

Hernia pain usually occurs in the cervical or lumbar spine, and only on one side of the body. The pain may radiate to the leg (up to the foot) or to the shoulder and arm.

Also possible numbness and tingling in the hands and feet, as well as loss of physical strength (up to the point that a person may start to stumble).

In addition, a hernia may be accompanied by a complication – pinched . This is a compression of the internal organ in the hole through which it protruded.

Pinching can lead to impaired blood circulation and, as a result, tissue necrosis. This complication requires urgent surgical intervention.

Symptoms of strangulation:

• sharp and rapidly increasing pain,
• nausea,
• vomiting,
• inability to empty the bowels.

The hernia itself can become hard. These symptoms are a reason for immediate medical attention.

Causes of hernias

Due to the variety of types of hernias, it is impossible to form a single list of causes of their occurrence. In general, the appearance of a hernia requires the presence of predisposing factors and conditions that directly lead to rupture of muscles and tissues and, as a result, protrusion of the organ.

Predisposing factors include:

1) Genetics . Scientists have found that the predisposition to certain types of hernias is inherited. These include, for example, an inguinal hernia or a hernia of the spine.

Genetic variants in the WT1, EFEMP1, EBF2 and ADAMTS6 genes are associated with the risk of inguinal hernia.

The WT1 and EFEMP1 genes regulate the work of enzymes that break down collagen and elastin, the main components of connective tissue that provide its strength and elasticity.

A gene ADAMTS6 promotes the formation of collagen from its precursor procollagen.

The Atlas Genetic Test can identify combinations of gene variants that increase the risk of inguinal hernia.

Mutations in the ZFPM2, SOX7, GATA6, MYRF, NR2F2, KIF7, GLI3, PBX1, SLIT3, ROBO1, GPC3, NDST1, FREM1, FRAS1, FREM2 genes are associated with the risk of diaphragmatic hernia.

2) Increased physical activity . We are talking about regular intense sports or physical labor, which damage and weaken muscles, accelerate the destruction of intervertebral discs.

3) Age . Although a hernia can appear at any age (for example, umbilical hernias are common in infants), the risk of developing some types of hernia increases as a person ages.

For example, inguinal hernias most often appear either before the age of one or after the age of 55.

In general, the older a person, the weaker his muscles, and therefore, the higher the likelihood of damage and rupture.

4) Overweight or underweight .

5) Adverse lifestyle factors : smoking, alcohol abuse.

However, there are not enough predisposing factors to cause a hernia. In order for a gap to appear in a muscle or other tissue (already weakened for the reasons listed), a certain “push” is needed.

Such an event could be a sudden increase in load or pressure on the affected organ, such as heavy lifting, prolonged diarrhea or severe coughing.

Diagnosis

Usually a doctor can make a diagnosis based on the examination of the patient.

If necessary, to confirm the diagnosis or to better understand the condition of the hernia, the specialist may prescribe additional examinations:

• ultrasound,
• computed tomography,
• magnetic resonance imaging (in case of a herniated disc).

Hernia treatment

A hernia cannot disappear on its own, so the only way to get rid of it is surgical treatment.