What is a Hernia? The Symptoms and Treatments Explained
According to the British Hernia Centre, one in 10 people will have a hernia in their lifetime. Indeed, hernia repair is the world’s most common surgical operation, with millions performed each year (in England alone there were more than 78,000 hernia operations performed during 2016 - 17).
A hernia is when an internal part of your body pushes through a weakness in the abdominal wall, often causing a noticeable bulge in the abdomen or groin (though in theory you can get a hernia anywhere on your body).
The abdominal wall is made up of muscle and tendons that run from the ribs down to the top of the thighs. Its job is to support the organs and tissue in the abdomen and pelvis, including the intestines – rather like a corset.
But this sheet of muscle and tendon has natural weak points, plus it can be weakened by injury, surgery or anything that puts pressure on it such as when you cough or sneeze. And when a weakness opens up in the abdominal wall, whatever is pushing against it from the inside simply bulges through.
Some hernias can be pushed back inside the abdominal wall – these are usually visible when you stand up but not when you lie down (they’re called reducible hernias). Others, meanwhile, cause a permanent bulge whether you’re standing or lying down, called non-reducible hernias.
Hernias are often associated with men, but anyone can get one – even newborn babies (see Hernias in children, below). The most common type does happen mainly in men, however. Here are some of the things that can increase your risk of developing one:
Being male (12 times more men than women develop groin hernias)
Getting older (though any age can be affected)
Having had an abdominal injury
Having had abdominal surgery in the past (appendix removal, for example)
Having constipation (straining can put pressure on the abdominal wall)
Having a chronic cough (a smoker’s cough, for example)
Having an allergy or other condition that causes constant sneezing
Lifting, carrying or pushing heavy objects
Sometimes hernias develop gradually – which means you may not even notice them to begin with (in fact some people with a hernia never have any symptoms). But it’s also possible for a hernia to come on suddenly.
And while they’re not usually painful, some people may feel an ache that gets worse after doing any activity. Over time the abdominal wall can also become even weaker, which makes the gap – and therefore the hernia itself – become bigger.
How are hernias treated?
The only way to correct a hernia is to have surgery to repair it. However, this type of surgery isn’t always appropriate, and many people with hernias aren’t offered any treatment unless they are in danger of developing complications.
A 2018 report published by the Royal College of Surgeons and the British Hernia Society that reviewed patient access to one particular type of hernia surgery in England (i) even suggests access to such operations has recently become so restricted that thousands of patients – mostly men – are being left in pain and at risk of complications.
However, if you are offered an operation you may have open surgery – which means the lump will be repaired by pushing it back into the abdomen via a single cut – or keyhole surgery, which is less invasive and involves several smaller cuts. These types of surgery are effective, but many hernias that are operated on come back.
Types of hernias
There are many different types of hernia – here are some of the most common ones:
Found in the groin, inguinal hernias are the most common type (about 70 percent of all hernias are inguinal hernias, says the British Hernia Centre). With an inguinal hernia, fatty tissue or part of the bowel bulges through into the groin at the top of the inner thigh.
According to the Men’s Health Forum, men are 12 times more likely to develop this type of hernia than women. The most common symptom is the swelling in the groin, though in men the scrotum may be enlarged too.
There are two types of inguinal hernia:
Indirect inguinal hernia (this is when part of the intestine drops down into a weakened area of the abdominal wall called the internal ring)
Direct inguinal hernia (this is found near the internal ring rather than within it)
Like inguinal hernias, these develop when fatty tissue or a part of your bowel pokes through into your groin in the area around the femoral artery (at the top of the inner thigh). This type of hernia tends to affect more women than men and is far less common than inguinal hernias.
Both inguinal and femoral hernias are thought to be caused often by ageing and repeated strain on the abdomen.
This type of hernia is found near the navel (belly button) where the abdominal wall tends to be thinner than elsewhere. It’s caused by fatty tissue or a part of the bowel poking through the abdomen.
This type of hernia can affect babies when the opening in the abdomen that lets the umbilical cord pass through doesn’t seal properly after birth. But adults can get umbilical hernias too, with repeated strain on the abdomen a likely cause.
When part of the stomach pushes up into the chest through an opening in the diaphragm – the thin sheet of muscle that separates the abdomen from the chest – it causes a hiatus hernia.
According to the NHS it’s not exactly clear what causes hiatus hernias, but it could have something to do with the diaphragm becoming weak with age or frequent pressure on the abdomen.
This type of hernia doesn’t usually cause symptoms, but some people may have heartburn as a result. Heartburn is caused when acid from your stomach flows back up into your oesophagus, causing a feeling of warmth or burning in the chest. If you have severe heartburn – or symptoms that continue for a long time – you may have a condition called gastro-oesophageal reflux disease (GORD).
Less common types of hernia include:
Epigastric hernia (when fatty tissue pokes through the upper middle section of the abdominal wall, between the navel and lower part of the breastbone, also more common in men than women).
Incisional hernia (when tissue pushes through a surgical wound in the abdomen, such as after an appendectomy).
Diaphragmatic hernia (where abdominal organs move into the chest through an opening in the diaphragm – this type can also affect babies with an under-developed diaphragm at birth).
Spigelian hernia (when part of the bowel pushes through the linea semilunaris muscle in the abdomen, causing a bulge below the navel).
Muscle hernia (when part of a muscle pokes through the abdomen or when a sports injury causes a hernia in a leg muscle).
When a hernia can be serious
Most hernias don’t develop complications, though the lumps – whether painless or causing minor discomfort – don’t usually get better on their own in adults. Some, however, can be more serious:
This means the blood supply to part of an organ or tissue trapped in the hernia has become cut off, and if the blood supply isn’t restored the trapped tissue can die. This can lead to a serious complication called septicaemia, which can be fatal.
This is when part of the bowel becomes stuck within the hernia, which means food and fluid cannot pass through.
If you have a hernia and you suddenly experience severe pain, vomiting, constipation, wind or the hernia becomes firm or tender and cannot be pushed back in, see your GP immediately or go to your nearest A&E.
Even if you don’t have any complications, see your GP when you first suspect you may have a hernia, as it may be another problem that needs medical attention. It’s also important that your GP assesses whether or not you have a non-reducible hernia, as these are the type that are most likely to become strangulated or obstructed.
Hernias in children
Babies and young children can develop hernias, with the most common types in this age group being inguinal hernias and umbilical hernias.
According to the British Hernia Centre 80 - 90 per cent of inguinal hernias in children affect boys during infancy and early childhood, and up to five per cent of babies are born with one (premature babies are more likely to be born with an inguinal hernia than full-term babies).
Inguinal hernia in boys is linked to the development and descent of the testes, where the opening in the abdominal wall that allows them to descend into the scrotum – called the inguinal canal – doesn’t close properly afterwards.
This type of hernia in a child causes a bulge or swelling in the groin (plus also in the scrotum in boys). It can often be detected by your GP, midwife or health visitor, or you may notice it when your baby cries, coughs or has a bowel movement.
The most serious complication of this type of hernia is strangulation, so take your child to a doctor immediately if they start vomiting and are generally unwell, if the lump is painful when touched or if the lump becomes hard and doesn’t disappear when they stop crying or coughing.
One in five of all children get an umbilical hernia, says the British Hernia Centre. More common in premature babies and Down’s Syndrome children, umbilical hernias cause a bulge on or near the navel that usually becomes more noticeable when a child strains their abdominal muscles (when crying, for example).
Umbilical hernias tend to correct themselves when children become older, with larger hernias taking longer to close than smaller ones. If a child develops a hernia after reaching puberty, however, it’s unlikely that it will close spontaneously. Complications such as strangulation and obstruction are rare with umbilical hernias, but if the hernia is painful, and particularly if it’s painful and your child is also vomiting or has constipation, get them to a doctor immediately.
If you think your child has any type of hernia, take them to see their doctor, as they may need surgery to repair it. The operation is very common, and children tend to recover from it very quickly.
How to help yourself
There’s no guaranteed way to prevent the muscle weakness that causes hernias, but there are some things you can do to make getting one less likely, including the following:
Maintaining a healthy weight
Eating a healthy diet with plenty of high-fibre foods
Toning your abdominal muscles by doing core-strengthening exercises (however, speak to your GP or a physiotherapist about the type of exercises you should do, as some abdominal exercises could put too much pressure on your abdominal wall and potentially cause a hernia)
Avoiding straining your abdominal wall by taking remedies to relieve constipation or allergies, or by giving up smoking if you have a smoker’s cough
Taking care when lifting heavy objects (always lift with your knees, not your back) and avoiding lifting anything that’s too heavy for you
If you’ve had successful surgery for a hernia, following the above advice could also help prevent the hernia coming back.
Meanwhile, if a hiatus hernia is giving you heartburn, there are several things you can do yourself to ease the symptoms, including the following:
Watching your weight
Avoiding big or fatty meals
Not eating late at night
Drinking less caffeine and alcohol
Avoiding carbonated drinks
Giving up smoking
Wearing loose-fitting clothing (avoid anything that’s tight)
Natural hernia support
There may not be any natural treatments proven to directly help prevent a hernia from developing, but some substances that help boost collagen – including anthocyanidins – may be helpful.
Collagen is the substance that gives the skin its structure, and it’s widely accepted that collagen production in the body slows down with age (indeed ageing is a factor in several hernia types). Studies suggest, however, that defects in the structure of collagen itself may play a role in the development of inguinal hernias (ii). There’s also some evidence to suggest a problem with collagen may be involved in the development of recurring hernias (iii).
Powerful antioxidants belonging to the flavonoids family of plant chemicals – are thought to strengthen collagen. They’re found in the skin of dark and richly coloured fruit including blueberries, blackberries, raspberries and red grapes (the flavonoids are the pigments that give these fruits their distinctive colour). You can also boost your anthocyanidin intake by taking a nutritional supplement.
Meanwhile, there are a few nutritional supplements that may help with the gastro-intestinal symptoms that often accompany a hiatus hernia, including the following:
This Indian spice is often used by natural health practitioners to treat stomach and digestive problems, including acid reflux. One study suggests heartburn and GORD may be caused by inflammation (iv), and there is evidence that curcumin – the most active ingredient in turmeric – may help reduce inflammation, with one study in particular finding that curcumin may help prevent inflammation of the oesophagus (v).
There are also some who believe curcumin may help strengthen muscle, which suggests it might help prevent the muscle weakness that causes hernias (vi).
The omega-3 fatty acids found in fish oils are also widely thought to have anti-inflammatory properties. However, some people find that taking fish oils gives them heartburn. If you do take fish oil supplements, always take them with food to reduce the risk of heartburn.
Some natural practitioners believe heartburn may be caused by an unbalance of bacteria in the gut, which makes undigested food in the stomach ferment. Foods and supplements containing live bacteria may be useful for relieving heartburn as they help manage the gut’s balance of bacteria.
Live bacteria such as acidophilus can be found in foods such as live yoghurt and other fermented foods. However, if you want to be sure you’re getting a decent level of live bacteria, a good-quality nutritional supplement may be your best option.
Royal College of Surgeons, British Hernia Society. A dangerous waiting game? A review of patient access to inguinal hernia surgery in England. Available online: https://www.rcseng.ac.uk/media/files/news-and-events/media-centre/rcs--bhs-hernia-report-june-2018.pdf
Pans, A., et al. Biochemical study of collagen in adult groin hernias. J Surg Res. (2001 Feb). ;95(2):107-13. . Available online: https://www.ncbi.nlm.nih.gov/pubmed/11162033
Klinge, U., et al. Hernia recurrence as a problem of biology and collagen. J Minim Access Surg. (2006 Sep). ;2(3): 151–154. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2999776
Yoshida, N. Inflammation and Oxidative Stress in Gastroeosophgeal Reflux Disease. J Clin Biochem Nutr. (2007 Jan). ;40(1): 13–23. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2291500
Patrick, L. (2015). Gastroesophageal Reflux Disease (GERD): A Review of Conventional and Alternative Treatments. Alternative Medicine Review, Vol 16, No 2. Available online: http://www.altmedrev.com/archive/publications/16/2/116.pdf
Aladari, N., O’Neal, P., Hasselren, P.O. Curcumin and muscle wasting – a new role for an old drug?. Nutrition. (2009 Feb). ;25(2): 125 - 129. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258441