Hernia
By The Treatment Registry editors
Protrusion of an organ or tissue through a weakness in surrounding muscle or fascia. The most common varieties are inguinal, umbilical, incisional, and hiatal. Treatment selection depends on hernia type, size, symptoms, and the patient's surgical risk profile. Watchful waiting is appropriate for small asymptomatic inguinal hernias in older patients; surgical repair (open or laparoscopic, with or without mesh) is the definitive treatment for symptomatic hernias.
Clinical overview
Signs and symptoms
Symptoms vary with the type of hernia, and about 66 per cent of people with groin hernias have symptoms. Abdominal and groin hernias typically produce a bulge that can be seen and felt, becoming more obvious on standing or bending and sometimes coming and going, although the underlying fascial defect persists. There may be pain or discomfort in the lower abdomen, often worse with coughing, exercise, or straining, worsening through the day and easing when lying down; in men there may be scrotal pain or swelling. An irreducible or incarcerated hernia cannot be pushed back and may progress to strangulation, which is always painful with tenderness and may bring nausea, vomiting, or fever from bowel obstruction, with the bulge turning red, purple, or dark. Hiatus hernias often cause heartburn or chest pain.
Causes and risk factors
Hernias arise from a disruption or opening in the fascia that forms the abdominal wall. Conditions that raise intra-abdominal pressure can cause them or worsen existing ones, including obesity, straining during defecation or urination (from constipation or an enlarged prostate), chronic lung disease, and ascites; muscles weakened by poor nutrition, smoking, or overexertion are also more prone. Recognised risk factors include smoking, chronic obstructive pulmonary disease, obesity, pregnancy, peritoneal dialysis, collagen vascular disease, and previous open appendicectomy. Predisposition is genetic, running in certain families with apparently dominant inheritance, especially in men. Abdominal wall hernias may also follow trauma, and blunt trauma is an emergency that can be associated with solid organ and hollow viscus injuries.
How it is diagnosed
Hernias can often be diagnosed from the signs and symptoms; a reducible hernia typically shows a bulge that can be seen and felt and becomes more obvious on standing. Medical imaging is occasionally used to confirm the diagnosis or exclude other causes, and it is the principal means of detecting internal, diaphragmatic, or otherwise nonpalpable hernias. Multidetector CT can show the anatomical site of the hernia sac, its contents, and any complications, and defines the abdominal wall clearly. Hiatus hernias are often diagnosed by endoscopy. Inguinal hernias, up to 75 per cent of abdominal hernias, are classified as indirect or direct by their position relative to the inferior epigastric vessels.
Who it affects
About 27 per cent of males and 3 per cent of females develop a groin hernia at some time in their lives. In 2013 roughly 25 million people had a hernia. Inguinal, femoral, and abdominal hernias caused about 32,500 deaths globally in 2013, down from 50,500 in 1990.
Clinical overview sourced from encyclopaedic medical reference; see sources below. General information only — not a substitute for individual clinical assessment.
Treatment ladder
Conservative options are first-line where appropriate; surgical options are typically reserved for cases where lower-tier options are unsuitable or have failed. Decisions are individual and depend on clinical assessment.
Conservative
- Watchful waiting (small asymptomatic)
Reasonable for small, asymptomatic inguinal hernias particularly in older patients with comorbidity. Crossover to surgical repair occurs in a minority of patients over time as symptoms develop.
- Truss or supportive garment
Symptomatic relief only; does not reduce the hernia or prevent progression. Of limited modern role.
Procedural
- Manual reduction (incarcerated hernia, emergency)
Manual reduction of an incarcerated hernia by trained clinician, deferring surgery to elective scheduling. Only appropriate when reduction can be achieved without force and without signs of strangulation.
Surgical
- Open hernia repair · View procedure page
Single-incision repair, typically with synthetic mesh reinforcement (Lichtenstein technique for inguinal). Shorter operating time than laparoscopic; suitable under local or general anaesthesia.
- Laparoscopic hernia repair
Minimally invasive transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) approach with mesh placement from inside the abdominal wall. Faster return to normal activity than open repair; preferred for bilateral and recurrent inguinal hernias per NICE TA160.
- Component-separation repair (large incisional)
Reserved for large or complex incisional hernias. Releases of the abdominal wall layers permit tension-free closure of large defects, often with biological or large-pore synthetic mesh.
Related procedures
Sources
- [1]NICE TA160 — Laparoscopic surgery for inguinal hernia repair — nice.org.uk(accessed 2026-05-09)
- [2]Wikipedia — Hernia — en.wikipedia.org(accessed 2026-07-24)
- [3]Cochrane Database — Open versus laparoscopic mesh repair for primary unilateral inguinal hernia — cochranelibrary.com(accessed 2026-05-09)
Sources marked “on file” are held by The Treatment Registry but are not publicly accessible.