Hernias - Injury Overview

Hernias come in many different varieties, which can become painful and troublesome if not addressed. You can get a head-start on your recovery by getting an in-depth look at all of the major symptoms and causes here. A quick diagnosis and proper treatment will shorten recovery time, here’s what you need to know.

What is a Hernia?

A hernia occurs when part of an organ or tissue pushes through an opening in muscle or other tissue.

Many people may not experience pain or discomfort and only notice a small bulge. Ultimately, your experience with a hernia will be dependent on its location and severity. Hernias occur most often in the abdomen but can happen in many other locations.

Types of Hernias

Each type of hernia is different. They occur in different areas and require different treatment. Find a quick overview on each hernia below:

Hiatal Hernia

When the opening in the diaphragm, called the hiatus, allows the stomach to come through, you may experience hiatal hernia symptoms. Many people may never experience any symptoms from their hiatal hernia and only find out they have one when their doctor is checking for other conditions. However, if the hernia is large enough, it can cause issues with reflux and heartburn.

Inguinal Hernia

What is an inguinal hernia? An inguinal hernia is when part of the intestine or other tissue pushes through the inguinal canal, located in the inner groin or the lower abdominal wall. It accounts for 70% of all hernias and occurs near the groin, on either side of the pubic bone. More than 60% of people with an inguinal hernia have symptoms related to pain with coughing, exercise or a bowel movement. An inguinal hernia will be closely monitored by your doctor to prevent complications if it worsens.

Femoral Hernia

This hernia is similar to an inguinal hernia, affecting the groin as well. However, it affects the upper groin instead of the lower groin. This type of hernia is much less common and most often affects older women.

Sports Hernia

A sports hernia is similar to inguinal hernia but is specific to a sports injury in the groin. The injury, usually from running, kicking, and other high impact activities, results in weak compromised tissues in the muscles near the groin. It doesn’t usually present with a bulge of tissue like an inguinal hernia, but can progress to one over time.

Incisional Hernia

A less common type of hernia is an incisional hernia. It occurs after someone has had abdominal surgery and tissue herniates through the incision site. When the surgeon is closing the incision after surgery, there are multiple layers of tissue that need to be brought together. The incisional hernia happens when some of the tissue breaks apart at the incision site. This type of hernia primarily affects the abdominal wall.

Abdominal Hernia

Any hernia that pushes through at any point in the abdomen can be placed into this category. It can also be referred to as a ventral hernia. These types of hernias are usually painless and the bulge is made up of fat tissue. Unfortunately, these hernias typically will only enlarge over time if not addressed. The most common type is an umbilical hernia, where the hernia protrudes through the belly button itself.

Strangulated Hernia

A strangulated hernia is what happens when any of the hernias above lead to a loss of blood to the affected tissues. It is considered a medical emergency and can be fatal without immediate attention. This is why it’s important to have regular check ups with your doctor to address any concerns.

Where are Hernias Located?

Hernias can affect a variety of locations in the body. However, they all primarily deal with the abdominal wall. Even when the groin or diaphragm is affected, this often affects the overall integrity of the abdominal cavity and the organs housed inside.

Hernia Causes

How do you get a hernia? There are numerous causes and each depends on the location of and type of hernia. Here are some of the most common general causes for hernias of all kinds:

• Abdominal pressure
• Pregnancy
• Injury
• Surgery
• Weakened abdominal muscles
• Bowel strain
• Obesity

Risk Factors by Type of Hernia

• Inguinal and femoral hernias - most often caused by weakened muscles in the groin. This can be secondary to birth defects, aging, pregnancy, overexertion, or obesity.
• Abdominal hernias - associated with a lot of the same risk actors are inguinal and femoral hernias. The primary causes are related to being overweight or having a chronic cough. 
• Hiatal hernias - causes are not well understood. Aging is the biggest risk factor for this type of hernia.
• Incisional hernias - caused by a previous surgery, resulting in a weak spot along the incision. 
• Strangulated hernias - caused by surrounding muscles closing down on the intestine or other herniated tissue.

What are the Symptoms of a Hernia?

Hernia symptoms are strongly dependent on the hernia type and location. Here are the signs and symptoms to look for with each type hernia:

Hiatal Hernia Symptoms (Diaphragmatic Hernia)

• Abdominal pain
• Difficulty swallowing or pain with swallowing
• Chest pain or heartburn
• Feeling bloated, gassy, or nauseous
• Bad breath
• Acid reflux and poor digestion 

Inguinal Hernia Symptoms (Groin Hernias)

• A visible bulge or swelling in the groin, usually on one side of the pubic bone
• A burning or aching sensation in the groin (or  near scrotum or testicles in men) near the bulge
• Groin pain that is exacerbated with heavy lifting, coughing, or other forms of strain

Femoral Hernia Symptoms

• A bulge in the groin near the upper thigh (if moderate to severe)
• Pain with standing, lifting, or strain

Sports Hernia Symptoms

• Moderate to severe groin pain without a bulge
• Pain with activity, particularly high impact moves or twisting, that goes away with rest
• Tenderness or bruising along the inner thigh or lower abdomen

Incisional Hernia Symptoms

• A bulge along a surgical incision
• Pain at the bulge that worsens with strain
• Redness and swelling at the bulge

Abdominal Hernia Symptoms (Epigastric Hernia)

• A heavy feeling in the abdomen
• Trouble with regular bowel movements (constipation)
• A bulge in the abdomen or groin area
• Aching or swelling around the bulge
• Pain with bending and lifting

Strangulated Hernia Symptoms

• Nausea, vomiting, or both
• Fever
• Inability to have a bowel movement or pass gas
• Sudden worsening of pain near the bulge
• The bulge appear purple, red or dark due to loss of blood supply
• Note: this is a life-threatening medical emergency; call your doctor for medical advice or go to the ER immediately

Hernia Diagnosis

With an inguinal, incisional, abdominal, and strangulated hernia your doctor will be able to make a diagnosis based on a physical exam. He or she will look at the hernia site and determine if additional testing is necessary. With a hiatal hernia, your doctor will need to complete further testing to confirm the hiatal hernia diagnosis.

Endoscopy

A hiatal hernia endoscopy (EGD) is done when a small camera is placed in your esophagus. It can visualize your esophagus and stomach. Your doctor will be able to determine if your stomach has pushed up through the hiatus and caused a hiatal hernia.

X-ray

Hernia pictures done with an x-ray may be done with swallowing a liquid that coats your esophagus and stomach. This will provide images that show the silhouette of the esophagus and stomach showing any hernias.

Ultrasound

Typically an inguinal hernia can be diagnosed based on an exam but your doctor may order an ultrasound to confirm the diagnosis.

CT Scan

Although less common, this is another option for assessing soft tissue damage or the size of a hernia.

Do Hernias Go Away?

Unfortunately, hernias do not go away on their own and require surgery for removal. However, if they are asymptomatic or symptoms are mild, hernias can simply be monitored. If symptoms are severe or the tissue is at risk of strangulation, surgery will be recommended. 

Hernia Surgery

Your recovery from hernia surgery can range from four weeks to several months, based on the type of hernia and operation. Larger hernias can make for a longer recovery, which is why many surgeons encourage early hernia repair. Luckily, most people are able to move around quite well hours after surgery. 

Life After a Hernia

Maintaining an active life with a hernia or after hernia surgery is possible. Understanding the types of hernias and potential treatments will lead to a better outcome. If you are suffering from a hernia, this article will help you understand your condition and get you back to living a full life!