What Is a Hernia? How Does It Form?

How Do Medical Professionals Define a Hernia Condition?

Hernia” is the term healthcare professionals use to identify “the medical condition resulting from the bulge of an organ or tissue pushing through an area of weakness in the partition or the wall of muscle that should confine it.” These bulging contents usually consist of portions of intestine or abdominal fatty tissue. They exist within the thin membrane that naturally lines the inside of the cavity. Hernias can develop at any number of locations in the human body. Most often, though, they involve a portion of the gastrointestinal tract protruding through the abdominal/pelvic wall.

Depending on the nature and severity of the hernia, the opening may need immediate surgical repair, or there might be less drastic remedies available. It is advisable to see a qualified medical caregiver for diagnosis and treatment advice early on. Hernias may be asymptomatic, or they may cause anything from slight to severe pain. Nearly all, though, carry the potential risk of eventually becoming strangulated. The result then may very well develop into a medical/surgical emergency.

How Does a Hernia Begin?

A hernia occurs when some part of an organ or fatty tissue squeezes through a hole or a weakened spot in the surrounding muscle or fascia.  Some hernias are congenital, originating from defects in the muscular diaphragm or abdominal wall. Such a condition is generally discovered at birth or early in life.  Other hernias, in contrast, develop over time. They may result from a combination of muscle weakness within the abdominal wall along with increased stress from pressure inside the abdominal cavity. In some cases it is possible over time for the bulge to come and go. Even then, though, the defect in the tissue will persist.

The actual cause of the hernia can vary depending on each individual situation. Some hernias may occur as the consequence of a single instance that acutely increases pressure inside the belly.  Heavy lifting, straining while using the toilet or some other activity may be responsible. Often, though, there is no one, clear cause. At the most basic level all hernias result from some combination of pressure and a pre-existing opening or weakness of muscle or fascia. The pressure pushes an organ or tissue through the opening or weak spot. Sometimes the muscle weakness can be present at birth. If so, it probably involves pathways formed during fetal development, existing openings in the abdominal cavity or areas of abdominal wall weakness. More often, though, the condition occurs later in life.  Depending on its cause, a hernia can develop quickly or over a long period of time.

What Situations Can Increase the Likelihood of Hernia Development?

Any activity or medical problem that increases pressure on tissue in the belly wall and muscles or within the abdominal cavity also has the potential to cause stress at weak points. That stress then might subsequently contribute to the formation or worsening of a hernia.  Increased pressure within the abdomen may occur with a variety of chronic situations:

  • persistent, hard coughing or sneezing bouts (chronic lung disease)
  • incorrect posture
  • increased fluid within the abdominal cavity (ascites)
  • peritoneal dialysis (procedure used to treat kidney failure)
  • growth of tumors or masses in the abdomen
  • situations caused by improper lifting of excess weight without stabilizing the abdominal muscles
  • straining to have a bowel movement or to urinate (e.g., diarrhea, constipation, enlarged prostate)
  • physical trauma such as sharp blows to the abdomen
  • pregnancy
  • undescended testicles
  • excess abdominal weight/girth

Also, if muscles are already weak because of prior injury or surgery, congenital defect, poor nutrition, aging, smoking or overexertion, then hernias are more likely to occur.  In addition a family history of hernias may predispose to further developments too.

Are There Different Kinds of Hernias?

There are multiple types of hernias.

Inguinal and femoral hernias occur in the groin, while umbilical hernias develop around the belly button. Hiatal hernias occur when part of the stomach protrudes upward into the chest cavity.  Incisional hernias are found at the site of an earlier surgical incision.

Babies and children can develop hernias when there is pre-existing weakness in the belly wall.  In the U. S. typically about five out of 100 children exhibit symptoms of an inguinal hernia. The condition is more common in boys.  Occasionally children do not exhibit symptoms until they are on their way to adulthood. Some hernias can be present at birth, others develop later, or the bulge itself simply may not be noticeable until later in life.

Groin hernias affect an estimated 5 to 10% of all Americans. They are the most common type of hernia and are the third most frequent reason for outpatient physician visits for gastrointestinal complaints overall. Inguinal hernias make up about 96% of all groin hernias. Men are almost eight times more likely to get a hernia and 20 times more likely to require surgical repair than women. Statistics suggest that one in four men will develop a groin hernia at some point in his lifetime, compared to fewer than one in 20 women.

There is also a physiological school of thought which contends that the risk of hernia is the result of a physiological difference between patients who suffer hernia and those who do not. Some scientists suspect involvement of aponeurotic extensions from the transversus abdominis aponeurotic arch. Research continues in this area.

How Can You Detect a Hernia?

If you think you might have a hernia, you certainly would not be the first such case, nor would you be alone.  The earliest known description of a hernia dates all the way back to at least 1550 B. C. in the Ebers Papyrus from Egypt. Currently at least five million people in the U.S. develop hernias every year.

You very well may have a hernia if you can feel a soft lump in your belly or groin or even within an old scar where you may have had abdominal surgery in the past.  You might find that such a lump will go away when you press on it or lie down.  In many hernia cases, though, there are no apparent symptoms at all. Consequently the condition may not even be detected and diagnosed until a routine physical exam is conducted by a health care professional for some unrelated situation.  Other cases, however, may present with discomfort or pain. The sensation typically worsens when standing, bending over, coughing, straining or lifting heavy objects.

What Health Effects, Signs and Symptoms Can You Expect with a Hernia?

Most common hernia complaints involve a bump or bulging protrusion that feels sore and may be growing larger Initially, however, the signs and symptoms of a hernia can range anywhere from simply noticing a painless lump all the way up to confronting a potentially life-threatening, severely painful, tender, swollen protrusion of tissue that is impossible to push back into the abdomen.  When a hernia gets bigger, it can even get stuck inside the hole and lose its blood supply. Such an emergency condition is known as an incarcerated, strangulated hernia.
Symptoms and signs may vary depending on the type of hernia. With a groin hernia, symptoms are present in about 66% of patients. They may include bulging that produces pain or discomfort especially with coughing, exercise or going to the toilet. Often such pain worsens throughout the day but improves when lying down.  Groin hernias occur more often on the right side than on the left. 
A femoral hernia usually produces a bulge just below the groin (found more commonly in women). An inguinal hernia (more common in men) typically produces a bulge in the groin that may reach all the way to the scrotumFor inguinal hernias, most patients notice a feeling of fullness or an uncomfortable lump in the groin area Femoral or obturator hernias may present with symptoms of recurrent inguinal or pelvic pain without other obvious physical findings. These may, therefore, eventually require a CT scan in order to establish a definitive diagnosis
Umbilical hernias are generally easier to diagnose and locate. They feature a typical bulging of the belly button itself Hiatal hernias often cause heartburn and belching. They may also result in upper abdominal or chest pain with difficulty in swallowing or a feeling of fullness or discomfort after eating.