Hernia: Symptoms, Causes & Which Doctor to See

What is a hernia and what causes it?

The abdominal wall is a layered sheet of muscle and tough connective tissue. Where it is naturally weaker, such as the groin canal or the belly button, or where it has been cut during an earlier operation, increased pressure inside the abdomen can push tissue outwards. The bulge is the hernia; the gap it passes through is the defect.

Inguinal hernias in the groin are the most common type and occur far more often in men. Femoral hernias, lower in the groin, are more common in women and have a higher risk of getting trapped. Umbilical and paraumbilical hernias appear around the navel, often after pregnancy or weight gain. Incisional hernias develop through an old surgical scar. A hiatus hernia is different: part of the stomach slides into the chest and usually causes reflux rather than a visible lump.

• Heavy lifting and straining
• Chronic cough from smoking or lung disease
• Constipation and straining on the toilet
• Straining to pass urine due to an enlarged prostate
• Pregnancy and obesity
• Previous abdominal surgery or wound infection
• Family history and connective tissue weakness

What are the symptoms of a hernia?

The typical sign is a soft lump that appears when you stand, cough or strain and shrinks or disappears when you lie down. Many people feel a dragging ache or heaviness in the groin, especially by the end of the day or after lifting. In men, an inguinal hernia can extend into the scrotum.

Some hernias are painless and found during a routine check. Small hernias can paradoxically be more painful than large ones. Groin pain without a lump can also come from muscle strain, the hip or the spine, so examination is needed before assuming it is a hernia.

• A lump in the groin or near the belly button
• The lump grows on coughing and goes back on lying down
• Aching, burning or dragging in the groin
• Heaviness by the end of the day
• Swelling in the scrotum
• A bulge along an old surgical scar

When is a hernia an emergency?

A hernia becomes dangerous when the contents get trapped (incarcerated) and the blood supply is cut off (strangulated). A strangulated hernia needs emergency surgery, usually within hours. If you have any of the following, go to the nearest emergency department or call 112 or 108.

Do not try to force a hard, painful lump back in, and avoid eating or drinking until you have been assessed, because you may need an anaesthetic.

• A hernia that suddenly becomes hard, tender and cannot be pushed back
• Severe pain at the hernia site
• Red, purple or dark skin over the lump
• Vomiting or nausea with a painful lump
• A swollen tummy and not passing wind or stool
• Fever or feeling very unwell with a painful hernia

Which doctor should I see for a hernia?

A general and laparoscopic surgeon diagnoses and repairs hernias. At Lotus, the general and laparoscopic surgery team assesses groin, umbilical and incisional hernias and discusses whether open or keyhole repair suits you. For hiatus hernia with reflux, a gastroenterologist or surgeon may be involved depending on symptoms.

Book an appointment soon after you notice a new lump, even if it is painless, so the type can be confirmed. Femoral hernias and hernias that are increasingly painful or difficult to push back should be seen promptly because their risk of complications is higher.

• Any new lump in the groin or near the navel
• A hernia that is getting bigger or more painful
• A lump that is harder to push back
• Groin lump in a woman (possible femoral hernia)
• Bulge in an old surgical scar

What happens at a hernia consultation?

The surgeon asks when you noticed the lump, whether it goes back, how much it bothers you, your work and lifting, cough, bowel and urinary habits, and previous surgery. You will be examined standing and lying down, and asked to cough so the surgeon can feel the defect.

If surgery is suggested, the surgeon explains the options, the type of anaesthesia, recovery time, risks such as recurrence and chronic groin pain, and what happens if you choose to wait. Bring a list of medicines, especially blood thinners and diabetes medicines, which may need adjusting before surgery.

• Describe your work and lifting demands
• Mention cough, constipation or urinary straining
• Bring reports of any previous abdominal surgery
• Ask about open versus laparoscopic repair
• Ask when you can return to work and driving

Which tests are needed for a hernia?

Most groin and umbilical hernias are diagnosed by examination alone. An ultrasound helps when the diagnosis is uncertain, for example a small hernia in a person with groin pain but no clear lump. A CT scan is useful for incisional, recurrent or complex hernias to plan surgery.

Before an operation, routine tests depend on your age and health and typically include blood counts, blood sugar, kidney function and an ECG, with others as needed.

If you have an incisional hernia after previous surgery, bring the operation notes if available, because they help the surgeon plan the repair.

• Clinical examination standing and lying
• Ultrasound of the groin or abdominal wall
• CT scan for complex or incisional hernias
• Pre-operative blood tests and ECG

How is a hernia treated?

For a small inguinal hernia in a man with few symptoms, careful watching is a reasonable option after discussion, because the short-term risk of strangulation is low. Many such hernias become symptomatic over time and are repaired later. Femoral hernias are usually repaired promptly. Hernia belts or trusses may give short-term comfort but do not fix the defect and are not a long-term solution.

Repair usually involves placing a mesh to reinforce the weak area. Open repair is done through a cut over the hernia, often under regional or local anaesthesia. Laparoscopic (keyhole) repair uses small incisions under general anaesthesia and may suit hernias on both sides or recurrent hernias. Your surgeon will discuss which approach fits your hernia, health and preferences.

Before surgery, it helps to stop smoking, control blood sugar and treat any persistent cough or constipation, because these affect healing and recurrence. In people with significant medical conditions, repair is planned carefully with the anaesthetist, and your surgeon will discuss the balance of risks and benefits if you are older or frail.

• Watchful waiting for selected small, painless inguinal hernias
• Open mesh repair
• Laparoscopic repair (TEP or TAPP techniques)
• Repair of umbilical and incisional hernias, open or keyhole
• Emergency surgery for strangulation
• Treatment of cough, constipation or prostate problems that raise pressure

How can I prevent a hernia or a recurrence?

You cannot change anatomy, but you can reduce strain. Lift with your knees bent and the load close to the body, and get help with heavy items such as water cans and gas cylinders. Treat constipation with fibre, fluids and activity. Stop smoking, which causes chronic cough and weakens tissue healing.

A healthy weight reduces pressure on the abdominal wall and lowers the risk of incisional hernia after surgery. Men who strain to pass urine should have their prostate checked.

• Use safe lifting technique
• Prevent constipation
• Stop smoking
• Keep a healthy weight
• Get a persistent cough assessed
• Follow lifting restrictions after any abdominal surgery

What is recovery like and when should I follow up?

After an uncomplicated repair, most people walk the same day and go home the same or next day. Desk-based work is often possible within one to two weeks, while heavy lifting is usually avoided for several weeks; follow your surgeon’s specific advice.

Seek prompt review for increasing pain, swelling, wound redness or discharge, fever, or difficulty passing urine. A follow-up visit checks the wound and recovery, and you should return if a lump reappears.

• Walk regularly from the first day
• Avoid heavy lifting as advised
• Wound check at the follow-up visit
• Return if a lump reappears or pain persists