Hernia: Symptoms, Causes, Treatments, and Natural Approaches

By Mercura Wang, Medically Reviewed Jimmy Almond, M.D.

A hernia occurs when a tear or weakness in muscle or tissue allows part of an internal organ or the intestines to protrude through the affected area.

The prevalence of hernias varies depending on their type and factors such as age, sex, and other individual characteristics. About 25 percent of men and 3 percent of women will experience at least one of the most common types of hernias (in the groin area) in their lives.

What Are the Types of Hernia?

Most hernias are external, creating a visible bulge as they protrude outward. In contrast, internal hernias remain inside the body without forming an external bulge. Hernias are typically classified based on their location. The most common types are as follows:

• Inguinal: Inguinal hernias are the most common type of hernia, accounting for at least 75 percent of all abdominal wall hernias. They occur in the inguinal region (i.e., the groin area), where the front of the thigh meets the lower part of the abdominal wall, wherein a loop of intestine pushes through muscle fibers. They are more common in men, especially in middle age. In men with an inguinal hernia, tissue may push into the scrotum, causing it to swell significantly (scrotal hernia). The estimated lifetime prevalence of groin hernias is 27 percent to 43 percent in males and 3 percent to 6 percent in females.
• Hiatal: In a hiatal hernia, part of the stomach pushes through an opening (the hiatus) in the diaphragm, the muscle separating the abdomen from the chest. Normally, the esophagus passes through the hiatus to connect to the stomach, but in this condition, the upper part of the stomach moves into the chest. Hiatal hernias affect about 20 percent of Americans and over half of people over 50.
• Femoral: A femoral hernia occurs high on the thigh near the groin, as intestines or fatty tissues push through a weak spot in the femoral canal (a small anatomical space in the groin area). This can lead to strangulation of the bowel, a serious complication requiring urgent medical care. Femoral hernias account for only 3 percent to 4 percent of all hernias. They occur about 10 times more often in women than men due to the broader female pelvis and are more common in adults than children.
• Umbilical: An umbilical hernia occurs when part of the gut pushes through a weak spot near the navel. It is common in newborns and overweight women or those with multiple pregnancies. Umbilical hernias in babies typically resolve on their own within the first two to six years of life, but other types of hernias don’t disappear on their own.
• Ventral: A ventral hernia occurs anywhere in the abdominal wall. One type, the epigastric hernia, occurs when tissue protrudes through a gap in the abdominal wall between the breastbone and the belly button. Epigastric hernias are usually small in size. Another type is an incisional hernia, which occurs when the site of a previous abdominal surgery becomes structurally weaker, and sometimes the intestines push through the closed incision. This type of hernia may take place years after surgery.
• Diaphragmatic: As diaphragmatic hernias are not visible from the outside, they are considered internal hernias. In severe cases, the stomach can compress chest organs, such as the lungs and heart. They can be congenital, detected in infancy or later in life, or acquired, developing as a result of trauma or as a complication arising from a medical procedure.

Despite their name, sports hernias (athletic pubalgia) are not real hernias. A sports hernia is a painful soft tissue injury in the groin, typically caused by activities involving sudden direction changes or intense twisting. While it can lead to a traditional inguinal hernia, it is a distinct injury involving a strain or tear of soft tissue (muscle, tendon, or ligament) in the lower abdomen or groin.

What Are the Symptoms and Signs of a Hernia?

The main symptoms of various hernias are as follows:

• A bulge that may decrease in size or disappear when lying down. Over time, hernias usually grow more prominent as the abdominal muscle wall weakens, allowing more tissue to bulge through.
• Burning, gurgling, or aching sensation at the bulge.
• The feeling of dragging, weakness, or pressure at the site of the bulge.
• Discomfort or sharp pain, especially when straining, lifting, coughing, or exercising, which improves with rest.
• In males, swelling or enlargement of the scrotum (with an inguinal hernia).
• Abdominal pain.
• Nausea or vomiting, which may indicate a blocked intestine.
• Burping, heartburn, or indigestion (with a hiatal hernia).
• Bloating.
• Constipation.

Some diaphragmatic hernias may be asymptomatic. In newborns, poor diaphragm movement, lung tissue crowding, and underdeveloped lung tissue and blood vessels may affect breathing and oxygen levels. Therefore, when symptoms appear, they may include:

• Difficulty breathing
• Rapid breathing
• Increased heart rate
• Loss of appetite
• Skin with a bluish tint due to low oxygen levels

What Causes a Hernia?

Different types of hernias may have various causes. Generally speaking, a hernia forms when pressure on an organ or the intestines forces it against an area with weakened muscle or tissue. Muscle weakness can be caused by factors such as a congenital defect, aging, chronic coughing, or previous injury or surgery.

Hernias can also result from increased internal pressure in the body due to lifting heavy objects, constipation, pregnancy, coughing or sneezing, sudden weight gain, or fluid buildup in the abdomen.

Who Is More Likely to Develop a Hernia?

The following factors heighten a person’s risk of developing a hernia:

• Sex: Men are eight to 10 times more likely than women to develop inguinal hernias.
• Pregnancy or Childbirth.
• Injury or Trauma: For instance, diaphragmatic injuries may initially cause no symptoms, but over time, the defect can grow, leading to significant herniation of abdominal organs.
• Surgery: Incisional hernias occur when the abdominal wall is weakened by surgery or an infected surgical incision. They are most likely to occur three to six months after surgery, during the tissue healing period.
• Age: The likelihood of having an inguinal hernia increases with age, with the most common occurrence in individuals aged 75 to 80.
• Obesity.
• Chronic Constipation.
• Strenuous Activity: Straining, like during weightlifting, can result in a hernia.
• Smoking.
• Underlying Conditions: These may include diabetes, connective tissue disorders, enlarged prostate, cirrhosis with ascites, and chronic obstructive pulmonary disease (COPD), which can cause a chronic cough that may lead to Spigelian hernia.
• Low Body Mass Index (BMI): In addition to obese people, those with a low BMI are more at risk of groin hernias.
• Family History of Hernia.
• Medications: Drugs that weaken immunity, steroids, and chemotherapy drugs all raise hernia risk.
• Structural Problems at Birth: Some babies may be born with a weak abdominal wall. In males, the weak spot typically forms in the inguinal canal, where the spermatic cord enters the scrotum, while in females, it can occur where connective tissue from the uterus joins the tissue around the pubic bone. In male fetuses, an inguinal hernia can occur if the abdominal wall does not fully close. While girls don’t have testicles, they also have an inguinal canal and can develop hernias, typically involving the fallopian tube and ovary protruding into the hernia sac.

How Is a Hernia Diagnosed?

To diagnose a hernia, your health care provider will review your medical history and discuss your symptoms.

During a physical exam, the health care provider will examine your abdomen and may ask you to stand, cough, or strain to check for a bulge to check for abdominal wall hernias. He or she may also gently try to push the hernia contents back into the abdomen. When diagnosing hiatal hernias, the health care provider will check for symptoms such as acid reflux, a sour taste in the throat or mouth, anemia, belching, difficulty swallowing, fatigue, and heartburn.

Tests

The doctor may order imaging tests if the diagnosis is unclear after a physical exam or to check for complications. These tests may include:

• Ultrasound: An ultrasound uses sound waves to create images of organs. It is the first-line imaging method used in diagnosing hernias. In diagnosing congenital diaphragmatic hernias, a fetal ultrasound may reveal abdominal organs within the chest cavity, and the pregnant woman may have an excessive amount of amniotic fluid.
• CT Scan: A CT scan combines X-rays and computer technology to produce images.
• MRI: An MRI uses magnetic fields to create pictures of internal organs and soft tissues without X-rays.
• X-Ray: Chest X-rays can detect hiatal hernias.

Other tests used may include:

• Valsalva Maneuver: A Valsalva maneuver involves exhaling forcefully while keeping the nose and mouth closed. It is commonly performed when straining during a bowel movement or blowing a stuffy nose. This maneuver increases abdominal pressure, making a hernia more visible clinically.
• Upper Endoscopy (EGD): A thin, lighted tube with a camera is inserted through the mouth into the esophagus, stomach, and duodenum while the patient is sedated. It allows the doctor to view the lining of these organs directly. A biopsy can be taken during an endoscopy, during which tissue samples are collected and examined in a lab to check for any issues.
• Upper GI Series (Barium Swallow): After the patient swallows a metallic fluid called barium, X-rays are taken to visualize the esophagus, stomach, and duodenum. The barium coats these organs for clearer imaging.
• Esophageal Manometry: Also known as motility testing, a small tube is inserted through the nose into the esophagus to measure the strength and pressure of esophageal muscles to assess reflux and swallowing issues.
• pH Monitoring: This test measures the level of stomach acid in the esophagus.
• Tests Measuring Blood Gases: These tests assist in evaluating lung function.

What Are the Possible Complications of a Hernia?

Complications of hernias may include:

• Incarcerated Hernia: An incarcerated hernia occurs when a loop of intestine becomes trapped in the hernia sac, potentially blocking the intestine. In the case of an incarcerated inguinal hernia, the hernia becomes stuck in the groin or scrotum and cannot be pushed back into the abdomen. This is caused by swelling and can lead to a strangulated hernia. If the hernia grows and the bowel becomes obstructed, it can cause symptoms such as nausea, vomiting, inability to pass gas or have a bowel movement, and severe pain.
• Strangulated Hernia: A strangulated hernia occurs when the intestine is trapped tightly, cutting off its blood supply. This can lead to the affected part of the intestine bursting and dying. Other symptoms include extreme tenderness and redness at the bulge, sudden worsening pain, fever, and rapid heart rate. If left untreated, it can lead to nausea, vomiting, severe infection, and even death.
• Increased Pressure on Surrounding Tissue: If left untreated, most inguinal hernias grow larger over time, increasing pressure on surrounding tissue.
• Gastroesophageal Reflux Disease (GERD): Severe GERD can be caused by hiatal hernias. Severe or chronic GERD can lead to damage to the esophageal lining.
• Increased Cancer Risk: Hiatal hernias can increase one’s risk of developing a type of esophagus cancer.
• Lung Issues or Pneumonia: Hiatal hernias can cause these problems by making stomach contents move up into the esophagus and one or both lungs.
• Congenital Problems: Congenital diaphragmatic hernias may cause other congenital problems in infants, such as developmental delays, learning disabilities, changes in the shape of the spine or chest, and hearing loss.
• Diaphragmatic Rupture: This can be caused by diaphragmatic hernias.
• Cardiac Tamponade: Cardiac tamponade is a rare medical emergency where fluid builds up around the heart, putting pressure on it and hindering its ability to pump effectively. It can be caused by diaphragmatic hernias.

What Are the Treatments for a Hernia?

Several treatment options may be available depending on the type and severity of a hernia and the individual’s general health.

Inguinal, femoral, and hiatal hernias without symptoms may not need any treatment.

If a newborn has a hernia, the doctor may suggest postponing surgery until the child is bigger and stronger. For certain hernias without symptoms, the doctor may also recommend watchful waiting.

Medications may also prove beneficial.

Medication

The following medications may be used to treat hiatal hernia symptoms:

• Antacids: Antacids can alleviate the symptoms of a hiatal hernia but do not repair any damage caused by stomach acid in the esophagus.
• H-2 Receptor Blockers: These medications reduce the production of stomach acid, thus providing longer-lasting relief from hiatal hernia symptoms.
• Proton Pump Inhibitors: These can block acid production in the stomach and promote esophageal healing.

Surgery

Surgery is the only permanent solution for a hernia, although it may be riskier for individuals with serious medical conditions. Hernias causing discomfort or those that are incarcerated typically require surgical repair to alleviate pain and prevent complications. There are several types of hernia repair surgery, depending on the severity and type of hernia, expected recovery time, medical and surgical history, and the surgeon’s expertise. Types include:

• Open Repair: During an open hernia surgery, the surgeon makes a small incision in the groin to push the protruding tissue back into the abdomen and then repairs the weakened area, sometimes using synthetic mesh for reinforcement. Open surgery can be performed under general anesthesia or with sedation or local anesthesia. While full recovery may take several weeks, starting moving as soon as possible is important to promote a healthier recovery.
• Laparoscopic Hernia Repair: This minimally invasive surgery is performed under general anesthesia and involves making small incisions in the abdomen. The abdomen is inflated with gas to improve visibility, and a laparoscope (a camera-equipped tube) is inserted to guide the surgeon. Surgical instruments are used through the other incisions to repair the hernia with mesh. This technique is particularly beneficial for individuals with recurrent or bilateral hernias, as it avoids scar tissue from prior surgeries.
• Robotic Hernia Repair: Robotic hernia repair is similar to laparoscopic surgery but uses robot-assisted technology to guide surgical tools more precisely.
• Complex Hernia Repair: Complex hernia repair involves separating the layers of the abdominal wall to create a stronger and more durable repair.
• Fundoplication Surgery: Fundoplication surgery is used to treat hiatal hernia-related GERD symptoms that aren’t well controlled with medication. During the surgery, the upper part of the stomach (fundus) is wrapped around the esophagus and sewn in place, creating a small tunnel of stomach muscle for the lower esophagus to pass through. The surgery can be done through the belly or chest, with the chest approach often preferred for overweight patients or those with a short esophagus. It is typically performed using laparoscopic techniques.
• Plastic Surgery: Some hernia patients may require plastic surgery for soft tissue reconstruction, internal structure repair, or excess skin removal to prevent infection and improve function and appearance.

A synthetic patch or mesh is commonly used to repair hernias in adults. It helps strengthen the abdominal wall, reduce postoperative discomfort, and reduce the likelihood of recurring hernia.

Urgent surgical repair is necessary for any incarcerated or strangulated hernia.

Lifestyle Adjustments

Certain symptoms of hiatal hernias can be controlled with lifestyle changes, such as:

• Eating at least three hours before lying down.
• Eating smaller food portions.
• Restricting fatty, acidic (e.g., citrus), and caffeinated foods, as well as chocolate, peppermint, and alcohol.
• Maintaining a healthy weight or losing weight, if necessary.
• Sleeping in a slightly elevated position.
• Avoiding smoking.
• Not bending over right after eating.
• Wearing supportive undergarments. In some cases, wearing a truss, a supportive undergarment, can help alleviate hernia symptoms by keeping the hernia in place.
• Exercising. Exercise can help strengthen the muscles around the hernia and promote weight loss, which may reduce some symptoms.

The prognosis for most hernias is generally favorable with treatment, and recurrence is rare. However, incisional hernias are more likely to return. Contrastingly, the likelihood of a femoral hernia recurrence after surgery is low.

How Does Mindset Affect a Hernia?

Although mindset doesn’t directly cause or cure hernias, it can influence them in various ways. A negative mindset can lead to poor lifestyle choices, such as overeating or overexertion, which may increase the risk of developing a hernia. Chronic stress can also weaken the immune system and slow hernia recovery.

A positive, health-conscious mindset encourages better habits, such as eating a balanced diet and avoiding heavy lifting without proper technique. This can help reduce the risk of developing a hernia and promote overall well-being. On the other hand, a lack of motivation may lead to ignoring symptoms or engaging in harmful activities.

When it comes to pain, a positive mindset can help patients tolerate discomfort better and use pain management techniques effectively. After surgery, an optimistic outlook can speed up recovery by encouraging adherence to postoperative care and reducing the risk of complications.

Finally, mindset affects treatment adherence. Those with a positive attitude are more likely to follow medical advice and stay on track with treatments, while a negative mindset might delay treatment and worsen the condition.

What Are the Natural Approaches to a Hernia?

As the following natural approaches require further research, please consult a health care provider before trying them.

1. Yoga

In a 2012 study, 19 adult males practiced selected yoga poses (e.g., vajrasana or “diamond pose”) for three months to see how it affected their inguinal hernia symptoms. They completed a questionnaire that focused on pain, factors that made their symptoms worse, and what helped relieve them before and after the yoga therapy. The results showed a significant improvement, with a major reduction in pain, how often symptoms occurred, and aggravating factors. The researchers concluded that yoga therapy was effective in treating reversible inguinal hernia.

2. Osteopathic Manipulation Therapy

Osteopathic manipulative treatment is a hands-on therapy used by osteopathic physicians to diagnose, treat, and prevent illnesses or injuries while improving overall function. In addition to training in traditional medicine, osteopathic physicians receive special training in the musculoskeletal system and use various techniques to restore health and stimulate the body’s natural healing abilities.

In a 2022 case study, a patient with a 3-centimeter hiatal hernia received osteopathic manipulative treatment to improve gastrointestinal function and reposition the gastroesophageal junction. After treatment, the patient’s symptoms improved, with no signs of the hernia or somatic dysfunctions remaining. This case study suggests that osteopathic manipulation therapy can be an effective treatment for relieving symptoms of hiatal hernias and may even help cure them.

3. Chinese Hawthorn

Chinese hawthorn (Crataegus pinnatifida) is a member of the rose family. Its berries have been used for over a millennia in traditional Chinese medicine (TCM), mainly to prevent and treat cardiovascular diseases and indigestion. The systematic encyclopedia of TCM, Compendium of Materia Medica (Bencao Gangmu), renowned as one of the most complete and comprehensive herbal guides, highlights dried hawthorn berries for their therapeutic benefits, including treating hernia. However, outside of its historical use in TCM, research on its efficacy for hernia is lacking.

How Can I Prevent a Hernia?

It is impossible to prevent hernias due to birth defects, such as indirect inguinal hernia and congenital diaphragmatic hernia. Genetic counseling may be helpful to couples with a family history of such hernias who are trying to conceive.

The following precautions may help prevent or decrease the risk of the types of hernias acquired later in life:

• Learn the correct way to lift heavy objects, lifting with your legs and not your back.
• Prevent and manage constipation to avoid straining during bowel movements.
• Seek treatment for a persistent cough.
• If you have an enlarged prostate and strain to urinate, seek medical treatment.
• Lose excess weight if you are overweight.
• Maintain a balanced diet to obtain adequate nutrition.
• Exercise regularly.
• Avoid smoking.
• Eat smaller portions and avoid lying down or bending over right after eating.
• Be careful when squatting and lifting, especially with added weights, as they can increase intra-abdominal pressure.