Hernia Causes, Symptoms & Risks

Have you ever laughed so hard you thought you’d give yourself a hernia? Or lifted something heavy and wondered if you pulled something “down there”? 

While hernias are the object of many jokes and comedian stand-up routines, they are no laughing matter to individuals who suffer from them. Untreated, hernias can lead to serious medical conditions.

A Franciscan Health surgeon explains what's a hernia, what causes a hernia or puts you at a higher risk, and how hernias are treated.

Key Takeaways: Hernias

• A hernia in the stomach happens when muscles in the abdomen or groin becomes weakened, thin or torn. This leads to organs like the colon or other body tissue to protrude.
• Certain activities that can strain abdominal muscles, like coughing or lifting heavy weights, can cause hernias.
• Pain and a bump or protusion are common signs of a hernia.
• Surgery is often needed to treat a hernia. Untreated, a hernia can lead to further complications.

What Is A Hernia?

If you have a hernia, a piece of intestine, fat, or other tissue is bulging through a torn or weakened abdominal muscle.
"A hernia is really a defect of the abdominal wall," said  Igor Wanko Mboumi, MD, a minimally invasive, bariatric and robotic surgeon with Franciscan Physician Network Indy Southside Surgical Indianapolis. "Think of it as a hole in the abdominal wall. Our abdominal wall is used as a defense mechanism to protect our organs and our intestines and everything that is inside within the body. So, when you have a defect in the abdominal wall, sometimes you get things that protrude through the abdominal wall, and that protrusion through a defect in your abdominal wall is essentially a hernia."

A hernia develops when muscle or tissue, usually in the abdomen or groin, weakens, becomes thin or even tears. This can allow other body tissue or an organ, sometimes the colon, to protrude through the weakened or torn tissue. This pressure and displacement can be painful.

“When a hernia is present, this means that things are out of place,” Dr. Wanko Mboumi said.  “A hernia won’t go away on its own and can even lead to much more serious, even life-threatening situations, including damage to abdominal tissue and organs.”

What Causes Hernias?

Hernias can develop painlessly over time, or occur suddenly. All it takes is increased pressure in the abdominal cavity.  Even regular exertion, such as weekend yard work, may cause a hernia.

Common causes for hernias include:

• Age-related wear and tear
• Heavy lifting
• A congenital defect
• Sustained coughing
• Obesity

Many hernias have no apparent cause.

“A common cause of a hernia is a prior surgery,” said Dr. Wanko Mboumi. “After surgery, the tissue layer is affected and heals to about 80 percent of its original strength, and this can increase your risk of developing a hernia.”

What Puts You At Risk Of Hernias?

People of any age may be at risk for developing a hernia. Sometimes the weakened tissue that allows hernias to form is present when you are born.

• Chronic coughing or sneezing
• Smoking
• Obesity or being overweight
• Pregnancy
• Chronic constipation
• Heavy lifting

Can You Prevent Hernias?

To help prevent hernias, there are a few precautions you can take:

• Be careful when lifting heavy objects. Lift with your knees rather than your back, and don't attempt to move anything too heavy for one person to manage.
• Quit smoking. Smokers often have a violent and persistent cough, which can increase the risk of hernia.
• Exercise. Getting regular exercise is an important safeguard, since strong muscles are less likely to rupture.
• Maintain a healthy weight. Being overweight strains your body and can also dangerously stretch the peritoneum, or abdominal lining.
• Get plenty of fiber. Regular bowel movements will prevent undue straining.
• Don't strain your muscles. Weight lifters, football players and golfers frequently strain or tear the muscles prone to hernia. Be sure to warm up enough before such activities, and watch out for that telltale bulge.

What Are Common Types Of Hernias?

Different kinds of hernias show up in various areas of the body. There are several types of hernias, but the most common ones are the inguinal and femoral, both located in the groin area.

Femoral hernia

A femoral hernia develops at the spot where the abdomen meets the top of the thigh.

"Another common type is femoral hernia that happens in the groin region, but it's usually underneath the region where the inguinal hernia happens," Dr. Wanko Mboumi said. "It is more common in women, especially as they get older. Again, usually it's genetics, or just bad luck. There's no known risk factor for femoral necessarily."

Hiatal hernia

Hiatal hernia occurs internally when part of the stomach pushes through the diaphragm into the chest cavity.

"Hiatal hernia is a very common hernia," Dr. Wanko Mboumi said. "It is not an abdominal wall hernia. A hiatal hernia is a hernia of the diaphragm. Just like I mentioned that the abdominal wall is the initial protection that protects your organs. The diaphragm serves as a muscle to help you breathe, but also it serves as a protection or the separation between the chest and the abdomen.

"There's one organ, the esophagus, that communicates with the abdomen that becomes the stomach as you go below the diaphragm. So, a hiatal hernia is when things that are or the stomach itself or the end part of the esophagus kind of protrudes through into the chest. So, patients have stomach parts within the chest cavity. And that's more of a hiatal hernia. You wouldn't see that necessarily on physical exam or you wouldn't feel a protrusion at all. Usually this will be diagnosed by patients who have bad heartburn or patients who have indigestion or difficulty swallowing and such things."

Incisional hernia

Incisional hernias can develop when abdominal muscles are weakened by surgery.

"Anyone who's had a prior surgery anytime you do surgery, the abdominal wall heals at about 80% of initial strength," Dr. Wanko Mboumi said. "Every time after that, it heals at 80% still, but it's 80% of the original. So, it does get strong into that 80% of what the original prior to surgery. But anytime you have an incision, you're at risk of eventually getting a hernia or just a weakness in that area."

Inguinal hernia

An inguinal hernia, a protrusion of tissue in the groin region, is usually the one people mean when they refer to a hernia.

"A body is prone to get inguinal hernias," said Dr. Wanko Mboumi, "and a lot of people will just develop it over time from just exertion or just genetics and just life."

Parastomal hernia

A parastomal hernia is a hernia in patients who have an ostomy bag.

Umbilical hernia

An umbilical hernia occurs in the navel area. 

"Patients have it when they're kids," Dr. Wanko Mboumi said. "Sometimes they people or patients develop it as they get older. As you possibly gain a little weight, there just would just wear and tear." 

Ventral hernia

A ventral hernia, or epigastric hernia occurs in the abdominal wall, but not at the umbilicus.

What Are Symptoms Of A Hernia?

Small hernias can be free of symptoms or can cause pain or discomfort. 

Hernia pain

Hernias can be either relatively painless or almost excruciating. They're frequently the cause of a dull, aching sensation that gets worse when you cough, strain your bowels, or lift something heavy. This discomfort may increase over time as more tissue pushes through the tear. Hernias that worsen quickly can cause sharp, intense pain.

"Some patients have what we call subclinical hernia, meaning that you may have an incision somewhere, or you just may have some pain around your groin, unexplained," Dr. Wanko Mboumi said. "And when you look and do an exam on yourself, for example, you may not notice a hernia, but sometimes it takes a little bit more of a trained eye to diagnose it and then to recognize it."

Bumps or protrusions from hernias

If you have a hernia, you'll probably notice a soft bump under the skin near your groin or abdomen. This bump might feel tender and squishy to the touch, and it may (or may not) disappear when you lie down. Sometimes a hernia will have no symptoms, even when a small bulge is visible.

"Most commonly patients will see a protrusion, a bulge or something either at an area of prior incision or at the umbilicus or around the groin or around above the umbilicus," Dr. Wanko Mboumi said, "or at any kind of prior incision anywhere on your body on the abdominal wall." 

Gas, bloating or problems with bowel movements

"Sometimes patients in a more extreme cases can have a bowel obstruction, meaning that sometimes the bowel itself can protrude through the defect or the hernia, and that can cause a blockage," Dr. Wanko Mboumi said. "That usually presents with not being able to pass gas and feeling bloated and not having bowel movements that that is the ultimate thing that we try to prevent by fixing these hernias."

How Are Hernias Treated?

A common myth is that limiting activities and getting plenty of rest can cure a hernia. While this will certainly alleviate symptoms, surgery is the only way to repair a hernia.

Since neglecting a hernia can have serious consequences, consult with your doctor about the best course of treatment. Surgery is the most effective treatment for a hernia, Dr. Wanko Mboumi said.

“Even if the hernia is not bothering you or getting bigger, you run the risk of it growing, causing blockage of intestines, and being harder to repair in the future,” he said.

Hernia repair can be done through open surgery or minimally invasive laparoscopic and robotic-assisted surgeries. Open surgery involves creating an incision to repair the hernia using sutures or in combination with mesh.

Robotic surgery has made surgery a much more viable treatment option for many patients, especially patients who, based on age or overall health, would have been once considered not good hernia surgery candidates. 

“While traditional hernia surgery meant a large incision in the abdomen and a long recovery time for patients, we now have the option of robotic and laparoscopic surgery that allows patients to recover much more quickly,” said Dr. Wanko Mboumi. “Patients usually leave the hospital within a day or two as opposed to five or six days with an open repair for a large hernia.”

Hernia surgery usually involves suturing the weakened tissue area or incorporating a mesh to strengthen the affected area. The robotic and laparoscopic procedure uses advanced technology, including a camera embedded in a scope, and requires only a few small incisions in the abdomen. Patients stay in the hospital overnight or go home the same day. After a couple weeks of “taking it easy” after hernia surgery, patients usually are back to their normal routines.

“The surgeons in our practice have more than 100 years of experience in repairing hernias combined,” said Dr. Wanko Mboumi. “Each patient’s condition is individually evaluated to see which repair surgery, open, laparoscopic or robotic would be best. If you’ve been told by another doctor that your hernia can’t be repaired, we may have a surgical option for you.”

What Are Risks Of Not Treating Hernias?

Not treating a hernia can carry risks, including potential of bowel obstructions happening and blood flow cutting off from the tissue, organ or intestine in the hernia, causing the affected area to die.

"Technology now has advanced to a point where sometimes living with it is a lot worse than undergoing a procedure and healing from that procedure and never having to deal with it again," Dr. Wanko Mboumi said. "Don't be afraid to ask for a referral from your primary care doctor to see a surgeon."