Hernias

A hernia happens when tissue or part of an organ pushes through weak muscle. Most hernias occur in the abdomen or groin. They often look like a bulge that grows with coughing, lifting, or standing. A bulge may be constant or appear only with pressure.

A hernia forms where muscle or connective tissue is weak. Fat, intestine, or other abdominal contents can push through the weak spot. A bulge may be visible all the time or only with pressure. Important questions include where the hernia is, if it causes symptoms, and if it can be pushed back in. Small, low-risk hernias can sometimes be watched. Painful, enlarging, recurrent, or hard-to-reduce hernias need surgical evaluation.

Common types of hernias

• Inguinal hernia: Occurs in the groin near the inguinal canal; causes burning, aching, or heaviness.

• Femoral hernia: Found in the upper thigh or groin; carries a higher risk of trapping.

• Umbilical hernia: A bulge at or near the belly button that may grow with strain or pregnancy.

• Ventral hernia: A bulge along the front abdominal wall, above or below the navel.

• Incisional hernia: Forms through a scar from a prior abdominal surgery.

• Recurrent hernia: A bulge or symptoms that return in the area of a prior hernia repair.

• Hiatal hernia: An opening in the diaphragm that causes reflux or swallowing symptoms rather than an abdominal bulge.

• Visible bulge in the groin, belly button, or abdomen.

• Bulge more obvious when standing, coughing, or straining.

• Pressure, pulling, aching, burning, or heaviness at the bulge.

• Pain with coughing, lifting, bending, or exercise.

• Bulge that flattens when you lie down, called reducible.

• Scrotal swelling or testicular discomfort in some men.

• Nausea, vomiting, fever, severe pain, or inability to pass gas or stool may signal danger.

Hernias form when tissue weakness combines with increased pressure. Weakness can be present from birth or develop over time. Common contributors include prior surgery, injury, repeated strain, chronic cough, constipation, pregnancy, obesity, heavy lifting, older age, and some inherited connective tissue differences. Inguinal hernias can be indirect, related to an opening from birth, or direct, related to a later muscle weakness.

Diagnosis usually starts with medical history and physical exam. The doctor will often examine you while you stand, cough, or strain gently. Some hernias only appear under pressure. Often the exam is enough. Imaging helps when the exam is unclear, anatomy is changed by prior surgery, a recurrent hernia is suspected, or complex repair planning is needed.

Treatment depends on hernia type, symptoms, size, reducibility, prior repairs, work needs, and health. Options include watching, lifestyle changes, elective repair, or urgent surgery for complications.

Watchful waiting

Monitor the hernia and learn warning signs. This may be reasonable for selected men with small, reducible, mildly symptomatic inguinal hernias. It is generally not recommended for nonpregnant women because femoral hernias are more likely and can be risky.

Strain reduction

Avoid heavy lifting, treat constipation, manage chronic cough, and work toward a healthy weight. These steps reduce symptom triggers but do not fix the hernia.

Elective hernia repair

Surgery returns tissue to the correct spot and reinforces the weak area. Surgeons often use mesh, a synthetic patch, depending on the case. Repair is commonly considered for painful, growing, activity-limiting, recurrent, or cosmetically concerning hernias.

Minimally invasive repair

Laparoscopic or robotic surgery uses small incisions and a camera. It may offer shorter recovery and less early pain for selected patients.

Open repair

Surgery through an incision over the hernia. This may be best for certain locations, sizes, or prior operations.

Complex abdominal wall repair

Advanced planning and reconstruction for large, recurrent, or complicated defects.

Will I need mesh?

Mesh is commonly used to reinforce a hernia repair. Whether mesh is right depends on hernia type, size, location, infection risk, recurrence risk, and your health. Your surgeon will explain the reasons for or against mesh in your case.

A consultation clarifies whether a hernia is present, what type it is, and which treatment fits your goals. Dr. Colin Dunn will review your bulge location, symptom triggers, work and activity needs, and prior abdominal operations. He will also review prior hernia repairs, current medical risks, medications, and tobacco use. Bring any ultrasound, CT, or operative reports you have.

Consultation focuses

• Hernia type and location, which affect repair options and urgency.

• Whether the hernia is reducible or stuck.

• Symptoms and activity limits, to decide between observation and repair.

• Prior surgery and mesh history, for planning recurrent or incisional repairs.

• Whether imaging like ultrasound or CT is needed.

• Choosing an approach: open, laparoscopic, robotic, or complex reconstruction.

• Recovery planning: work limits, lifting restrictions, pain control, and return-to-activity timeline.

Recovery varies by surgery type, hernia size, and your health. Minimally invasive repairs often allow a quicker return to daily activities and less early pain for suitable patients. Your surgeon will discuss expected recovery, work restrictions, and pain control before surgery.