HERNIA: COMMON AND RARE TYPES, CAUSES, SYMPTOMS, NEW REPAIR TECHNIQUES

Medically Reviewed by Dr. Sony Sherpa (MBBS) - August 23, 2024

When an organ or tissue bulges through a ruptured weak spot or opening in the muscle or tissue that typically holds it in place, it leads to a hernia.^[1] It can occur in different parts of the body, such as the abdomen, groin, chest, thigh, or leg.

Hernias are very common, affecting about 5% of the population at some point in their lives. Both men and women can be affected, although some types are more common in one gender than the other. Hernias often cause pain, discomfort, and sometimes serious complications if left untreated. Therefore, it is important to recognize the symptoms of a hernia and seek medical attention as soon as possible.

In this blog, we will cover the signs and symptoms, different types of hernia, as well as diagnosis, prevention, and treatment options, including hernia repair surgery.

Hernia Symptoms

The most common symptom of a hernia is a visible or palpable lump or bulge under the skin where the hernia is located. The lump may appear or become more noticeable when you cough, sneeze, strain, or stand up. It may also disappear or reduce in size when you lie down or push it back in. Some hernias may not cause any symptoms, especially if they are small or in an area that is not easily seen or felt.

Other symptoms of a hernia may include:

• While lifting, bending, or exercising, pain or discomfort in the affected area
• A feeling of heaviness, pressure, or fullness in the abdomen or groin
• Difficulty passing stool or gas or constipation
• Nausea, vomiting, or loss of appetite
• Fever, chills, or sweating
• A change in the color or texture of the skin over the hernia
• Heartburn or acid reflux

Some of these symptoms may indicate a serious complication of a hernia, such as obstruction or strangulation. Obstruction occurs when a part of the intestine or other tissue gets stuck in the hernia and blocks the passage of food or waste. Symptoms of obstruction can last until the blockage clears.

Emergency Signs of a Strangulated Hernia

Strangulation occurs when the blood supply to the trapped tissue is cut off, causing tissue death and infection. These complications can be life-threatening and require emergency surgery.

If you have any of the following signs of a strangulated hernia, you should seek immediate medical help:

• Sudden, severe pain in the hernia site that does not go away or gets worse
• A hard, tender, or swollen lump that cannot be pushed back in
• A red, purple, or dark color of the skin over the hernia
• Frequent fever, chills, or sweating
• Recurrent nausea, vomiting, or loss of appetite
• Inability to pass stool or gas, despite the urge

What Are the Different Types of Hernias?

There are many different types of hernias, depending on where they occur in the body and what causes them. Some of the most common types of hernias are^[2]:

Inguinal hernia: This is the most common type of hernia, accounting for about 75% of all hernias. It happens when a part of the intestine or other tissue, usually from the inguinal canal, pushes through a weak area in the lower abdomen wall. The inguinal canal is a passage in the groin area that contains blood vessels and nerves in both genders and the spermatic cord in men or the round ligament in women. Men are more likely than women to have inguinal hernias (9:1), which can affect one or both sides of the groin.^[3]

Femoral hernia: A weak point in the femoral canal allows a portion of the intestine or other tissue to press through, resulting in a less common variety of groin hernia. The femoral canal is a space near the groin that contains blood vessels and nerves that supply the leg. Femoral hernias are more common in women than in men, and they are more likely to become strangulated than inguinal hernias.

Ventral hernia: This is a general term for any hernia that occurs in the front wall of the abdomen, excluding the groin area. It includes umbilical hernias, incisional hernias, and other less common types, such as:

• Epigastric hernias - A portion of the intestine or other tissue can protrude through a weak point in the upper abdomen, which is located between the belly button and the breastbone, to cause an epigastric hernia.  
• Spigelian hernias - Usually beneath the belly button, a weak area in the side of the abdominal wall allows a portion of the intestine or other tissue to push through, resulting in a spigelian hernia.

Umbilical hernia: When a section of the intestine or another tissue pushes through a weak area in the abdominal wall close to the belly button, it can cause this kind of hernia. Umbilical hernias are common in babies and children, and they usually close on their own by the age of 4. Adults can also develop umbilical hernias, especially if they are overweight, pregnant, or have a lot of abdominal pressure.

Hiatal hernia: This kind of hernia happens when the diaphragm, the muscle that divides the chest from the abdomen, has an opening that allows a portion of the stomach to push upward. The esophagus travels through this aperture, known as the hiatus, to join the stomach. Older adults and those who smoke, are overweight, or have a persistent cough are more likely to develop hiatal hernias. Hiatal hernias can cause heartburn, acid reflux, difficulty swallowing, and chest pain.

Incisional hernia: This kind of hernia happens when a portion of the intestine or other tissues pushes through a weak area in the abdominal wall that was caused by an earlier surgical procedure. Incisional hernias can happen after any abdominal surgery, but they are more common after large or multiple operations. They can occur soon after surgery or years later.

Perineal hernia^[4]: This is a rare type of hernia that happens when an organ or tissue pushes through a weak spot in the fascia or pelvic floor muscles, which support the perineum. Perineal hernias can affect both men and women, but they are more common in women. They can be caused by pelvic surgery, injury, illness, or pregnancy and lead to pain, swelling, or obstruction in the abdominal cavity.

What Are the Causes of Hernias?

Weakness and pressure work together to develop hernias. An organ or tissue that is held in place by a muscle or tissue weak point is forced through by pressure.

The pressure that causes a hernia can come from various sources, such as:

• Coughing, sneezing, or straining
• Lifting, pushing, or pulling heavy objects
• Pregnancy or childbirth
• Obesity or weight gain
• Constipation or diarrhea
• Ascites or fluid buildup in the abdomen
• Enlarged prostate or bladder problems

Hernia Risk Factors

The weakness can be present at birth or develop later in life^[5]. Some factors that can contribute to weakness include:

• Aging or loss of muscle tone
• Previous surgery or injury
• Chronic diseases or conditions that affect the connective tissue, such as Ehlers-Danlos syndrome and Marfan syndrome
• Rectus abdominis diastasis (unusual parting of the abdominal muscles)^[6]
• Smoking
• Family history or genetics

How Is Hernia Diagnosed?

A hernia is usually diagnosed by a physical exam. Your doctor will check for a bulge or lump in the affected area and ask you to cough, stand, or strain to make it more visible or palpable. Your doctor may also feel the hernia and try to push it back in. Sometimes, your doctor may order imaging tests, such as ultrasound, CT scan, or MRI, to confirm the diagnosis or to check for complications.^[7]

Hernia Treatment

The size, location, symptoms, and complications of a hernia determine how it should be treated. Some hernias may not require any treatment, especially if they are small and do not cause any discomfort. Your doctor may recommend watchful waiting, which means monitoring the hernia for any changes or signs of complications. You may also be advised to wear a supportive device, such as a truss or a belt, to keep the hernia in place and reduce pain. However, these devices are not a permanent solution and may cause skin irritation or infection.

The only way to permanently fix a hernia is by surgery. Surgery may be recommended if the hernia is:

• Large, painful, or bothersome
• Growing or changing
• Causing complications, such as obstruction or strangulation
• Affecting your quality of life or daily activities

Surgical Procedures for Treating a Hernia

Hernia surgery can be classified into two categories: open repair and minimally invasive repair.^[8]

Open hernia repair: This is the most conventional method of hernia repair. In this procedure, the surgeon makes a cut in the skin over the hernia and pushes the protruding organ or tissue back into place. The surgeon then repairs the weak spot or opening in the muscle or tissue, often using a synthetic mesh to reinforce it. The cut is then closed with stitches, staples, or glue.

Minimally-invasive hernia repair: In this procedure, the surgeon makes several small cuts in the skin near the hernia and inserts a thin tube with a camera and surgical instruments. This is known as laparoscopic surgery. The surgeon uses the camera to guide the instruments and repair the hernia with mesh. The cuts are then closed with stitches, staples, or glue. Robotic-assisted hernia repair is a variation of laparoscopic surgery that makes use of a robotic system to offer enhanced precision and control.

Both types of surgery can be done under local or general anesthesia, depending on the location and size of the hernia and your preference.

The advantages and disadvantages of each type of surgery may vary depending on your individual situation. These are compared in the table below: