8 Warning Signs That You May Have a Hernia

Though hernias are common and may not be serious, about 1 million Americans each year have a condition serious enough to require surgery. Hernias become more common with age — some types mainly affect people over age 50 because of weakening muscles.

A hernia occurs when tissue or an organ, like your intestines, pushes past muscle and pops out, creating a bulge. Hernias usually happen in your abdominal area or groin. The bump can emerge when your body is in certain positions or when you’re doing certain physical activities like coughing, lifting or straining.

A hernia may be painful, but some don’t cause any discomfort at all, says Stanley W. Ashley, M.D., a surgeon and professor emeritus at Harvard Medical School.

A hernia can get serious quickly if it gets stuck and can’t go back into place — what doctors call incarceration. The protruding tissue or organ can lose blood supply — that’s called a strangulation — and cause tissue damage or death. If either occurs, you may need emergency surgery, Ashley says.

“If it’s stuck out there, it can swell. And then swelling compromises blood supply,” Ashley explains.

Types of hernias

Common types of hernia include:

• Inguinal: This is the most common form of hernia and occurs in the groin area. Your chances of getting this type of hernia go up with age, especially if you’re between 75 and 80 years old.

• Hiatal: A hernia that occurs in the area of your upper stomach or diaphragm. It affects half of those over age 50.

• Femoral: Though this hernia occurs in the upper thigh or groin area, it’s less common than an inguinal hernia but more likely in women.

• Incisional: A protrusion in the area of a former incision or current scar in the abdominal area.

• Umbilical: This bulge can be visible near your belly button and is usually present from the time you’re born.

Warning signs of a hernia

Signs that you may have a hernia include:

1. Bulge

A protruding lump is one sign, but not all hernias are visible. The most common type of hernia — an inguinal hernia — occurs when part of your bowel pushes out along your inner thigh and groin area. Other types of hernias, such as femoral and hiatal, may not be visible.

2. Pain

Hernia pain may feel like a pinch when it protrudes. Hernias can also cause women to feel pain during menstruation or sex.

3. Ache/pressure

Not everyone has pain with a hernia. Some may feel pressure or a dull ache.

Signs you may need emergency care

Ashley recommends going to the emergency room if your hernia is stuck out and painful or if you have any of these more serious symptoms.

4. Nausea/vomiting

If the hernia is stuck and cutting off the blood supply to part of the organ or tissue, it can cause nausea or vomiting. Seek emergency care if this happens.

5. Constipation

Feeling constipated or unable to pass gas could indicate a serious problem. This can occur if the hernia blocks your bowel. In fact, hernias are the second most common cause of small bowel obstruction in the United States.

6. Fever

If your temperature goes above normal, it could be a sign of infection, and you may need immediate medical care.

7. Redness

Discoloration in the hernia area can mean that you have an infection and need emergency care.

8. Numbness

If the area of the hernia feels numb, this could be a sign that the blood supply is being cut off and you need to go to the emergency room.

Symptoms of serious infection also can include increased heart rate, low blood pressure and sepsis, says Maria S. Altieri, M.D., a surgeon at Penn Medicine.

“The danger of hernias is the risk of incarceration and strangulation,” Altieri says. “These two conditions are considered an emergency, and patients should seek immediate medical attention.”

Hernia causes and risk factors

Some people develop a hernia over time, while others are born with it. Surgery or repetitive stress injuries are common causes.

You may be more prone to develop a hernia if you:

• Lift heavy items or stand a lot

• Experience chronic constipation and strain to go to the bathroom

• Have had pelvic or abdominal surgery

• Are obese with a body mass index (BMI) over 30

• Have been pregnant — especially more than once

• Have a chronic cough or allergies and sneeze frequently

• Are older (especially for hiatal and inguinal hernias)

• Were born prematurely or with cystic fibrosis, a connective tissue disorder, hip dysplasia, undescended testicles or urinary or reproductive issues

Diagnosing a hernia

A physical exam can help your doctor determine if you have a hernia. The doctor will check for a bulge and may ask you to stand and cough to look for anything.

Clinicians may also use a computed tomography (CT) scan, a magnetic resonance imaging (MRI) scan or ultrasound to confirm a diagnosis.

“Initially, most patients see their primary care physician, who makes a diagnosis and then refers to a specialized surgeon for an elective repair, as hernias can either become larger or incarcerate or strangulate,” Altieri says.

Hernia treatments and complications

Hernias tend to get worse as time goes on, and most cases will require surgery at some point, Ashley says.

Between 30 and 65 percent of hernias need scheduled surgery, while 3 to 5 percent of cases will require emergency surgery because they’ve caused strangulation or bowel obstruction, according to the Food and Drug Administration.

Surgery isn’t always the only fix for a hernia. If it isn’t causing problems or if you’re older and less active, your doctor may not recommend an operation, Ashley says.

Still, you’ll probably wind up in surgery at some point if you have a hernia, Ashley adds. The more tissue that juts out, which typically happens over time, the higher the likelihood of complications.

Surgical options for hernia include open surgery with a large incision or laparoscopic and robotic surgeries, which typically require smaller incisions. The high-tech methods may lead to less discomfort compared with open surgery, but all can be effective, Ashley says. Your doctor can advise on which is best.

Surgeons usually use surgical mesh to reinforce the area and stop the tissue or organ from popping out again. Mesh may lower the risk of recurring hernia, according to research, Ashley says.

Even with mesh in place, hernias can still return. A 2022 study published in JAMA (The Journal of the American Medical Association) of 175,735 people who had hernia surgery showed that 16.1 percent needed another operation because the hernia came back within 10 years of the first operation. The more times you have hernia surgery, the higher the risk that you’ll need another operation, Ashley notes. The larger the hernia, the tougher it is to repair and the more likely it is to recur, Altieri says.

Delaying surgery can have drawbacks. About 70 percent of men with an inguinal hernia who put off surgery developed new or worsening symptoms and needed surgery within five years, the National Institute of Diabetes and Digestive and Kidney Diseases reports. A 2019 study found that delaying emergency surgery for a day or more is linked with higher odds of having a major complication.

“Hernias don’t resolve on their own. They can stay the same, but they can also enlarge, hurt or can become an emergency,” Altieri says.