Hernias are caused by a combination of muscle weakness and strain. Depending on its cause, a hernia can develop quickly or over a long period of time.
Common causes of muscle weakness include:
Factors that strain your body and may cause a hernia, especially if your muscles are weak, include:
The factors that increase your risk of developing a hernia include:
Conditions such as cystic fibrosis can also indirectly increase
your risk of developing a hernia. Cystic fibrosis impairs the function of the
lungs, causing a chronic cough.
The most common symptom of a hernia is a bulge or lumrp in the affected area. In the case of an inguinal hernia, you may notice a lump on either side of your pubic bone where your groin and thigh meet.
You’re more likely to feel your hernia through touch when you’re standing up, bending down, or coughing.
If your baby has a hernia, you may only be able to feel the bulge when they're crying. A bulge is typically the only symptom of an umbilical hernia.
Other common symptoms of an inguinal hernia include:
Other symptoms of a hiatal hernia include:
In some cases, hernias have no symptoms. You may not know you have a
hernia unless it shows up during a routine physical or a medical exam
for an unrelated problem.
Inguinal or incisional hernias are usually diagnosed through a physical examination. Your doctor may feel for a bulge in your abdomen or groin that gets larger when you stand, cough, or strain.
If you have a hiatal hernia, your doctor may diagnose it with a barium X-ray or endoscopy.
A barium X-ray is a series of X-ray pictures of your digestive tract. The pictures are recorded after you’ve finished drinking a liquid solution containing barium, which shows up well on the X-ray images.
An endoscopy involves threading a small camera attached to a tube down your throat and into your esophagus and stomach.
These tests both allow your doctor to see the internal location of your stomach.
If your child has an umbilical hernia, your doctor may perform an ultrasound.
An ultrasound uses high-frequency sound waves to create an image of the
structures inside the body.
For a hernia without symptoms, the usual course of action is to watch and wait, but this can be risky for certain types of hernia, such as femoral hernias.
Within 2 years of a femoral hernia being diagnosed, 40 percent result in bowel strangulation.
It remains unclear whether non-emergency surgery is worthwhile for hernia repair in cases of an inguinal hernia without symptoms that can be pushed back into the abdomen.
The American College of Surgeons and some other medical bodies consider elective surgery unnecessary in such cases, recommending instead a course of watchful waiting.
Others recommend surgical repair to remove the risk of later strangulation of the gut, a complication where blood supply is cut off to an area of tissue, which requires an emergency procedure.
These health authorities consider an earlier, routine operation preferable to a more risky emergency procedure.
Types of surgery
Although surgical options depend on individual circumstances, including the location of the hernia, there are two main types of surgical intervention for hernia:
Open surgical repair closes the hernia using sutures, mesh, or both, and the surgical wound in the skin is closed with sutures, staples, or surgical glue.
Laparoscopic repair is used for repeat operations to avoid previous scars, and while usually more expensive, is less likely to cause complications such as infection.
Surgical repair of a hernia guided by a laparoscope allows for the use of smaller incisions, enabling a faster recovery from the operation.
The hernia is repaired in the same way as in open surgery, but it is guided by a small camera and a light introduced through a tube. Surgical instruments are inserted through another small incision. The abdomen is inflated with gas to help the surgeon see better and give them space to work; the whole operation is performed under general anesthetic.
Hernia in children
Inguinal hernia is one of the most common surgical conditions in infants and children.
A 2014 systematic review of 20 years of data on conventional open hernia repair (herniorrhaphy) and laparoscopic hernia repair (herniorrhaphy) in infants and children found that laparoscopic surgery is faster than open surgery for bilateral hernias, but that there is no significant difference in operating time for unilateral inguinal hernia repair.
The rate of recurrence is similar for both types of procedure, but
complications, such as wound infection, are more likely with open surgery,
especially in infants.
You can’t always prevent the muscle weakness that allows a hernia to occur. However, you can reduce the amount of strain you place on your body. This may help you avoid a hernia or keep an existing hernia from getting worse. Prevention tips include: