The hernia most likely to cause back pain is a herniated disc in the spine, not an abdominal hernia. While people often associate the word “hernia” with a bulge in the belly or groin, a spinal disc herniation is by far the most common type linked to significant back pain. Abdominal hernias (inguinal, umbilical, incisional) can cause localized discomfort near the hernia site, but they rarely produce true back pain.
Spinal Disc Herniation: The Primary Culprit
Each vertebra in your spine is cushioned by a disc with a tough outer ring and a gel-like center. When pressure or stress causes that outer ring to bulge, crack, or tear, the soft interior can push outward and press against a nearby nerve root. This is a herniated disc, and it affects roughly 1% to 3% of the population each year, most commonly between ages 30 and 50.
The pain comes from two sources working together. First, the bulging material physically compresses the nerve. Second, the inner disc material triggers a chemical inflammatory response that irritates the nerve on its own. Your body actually recognizes the escaped disc material as foreign and mounts an immune response to shrink it, which is why many herniations improve over time without surgery.
The lower back (lumbar spine) is where most symptomatic herniations occur. Depending on which disc is affected, the pain can radiate into very different areas. A herniation between the fourth and fifth lumbar vertebrae tends to send pain down the outer leg, while one at the lowest lumbar level often causes pain that shoots through the back of the leg and into the foot. This radiating leg pain is commonly called sciatica.
Can Abdominal Hernias Cause Back Pain?
Abdominal hernias, including inguinal hernias in the groin, umbilical hernias near the belly button, and incisional hernias at surgical sites, usually show up as a visible bulge or swelling. They can cause discomfort, pain, or a dragging sensation, but that pain is typically localized to the hernia itself. It does not commonly radiate to the back.
That said, a very large inguinal hernia can sometimes produce referred pain in the hip or lower back because of shared nerve pathways in the pelvis. This is the exception rather than the rule. If you have an abdominal hernia and back pain at the same time, the two problems are more likely independent of each other than directly connected.
Hiatal Hernias and Mid-Back Pain
A hiatal hernia occurs when part of the stomach pushes up through the diaphragm into the chest cavity. Most hiatal hernias cause acid reflux symptoms like heartburn and difficulty swallowing rather than back pain. A very large paraesophageal hernia (a subtype where a significant portion of the stomach migrates into the chest) could potentially cause pain between the shoulder blades or in the mid-back, but this is uncommon. If you’re experiencing mid-back pain alongside severe reflux or difficulty eating, it’s worth mentioning both symptoms together so the connection isn’t overlooked.
Why an MRI Doesn’t Tell the Whole Story
One important nuance: having a herniated disc on an MRI does not automatically mean the disc is causing your pain. Imaging studies of people with no back pain at all show that disc protrusions are surprisingly common. Among 20-year-olds with zero symptoms, 29% already have a disc protrusion visible on MRI. That number climbs to 43% by age 80. This means a herniated disc found on imaging could be an incidental finding unrelated to whatever is actually hurting.
This is why doctors look at the full picture: where exactly you feel pain, whether it radiates into a leg, what movements make it worse, and whether there are neurological signs like numbness or weakness. A disc herniation is considered the likely cause of pain when the imaging findings match the clinical symptoms.
How Most Disc Herniations Resolve
The natural course of a lumbar disc herniation is more encouraging than most people expect. The body’s immune response gradually breaks down and reabsorbs the herniated material. In studies tracking patients over time, about 48% of cases showed a reduction of more than 70% in the size of the herniation. Clinical symptoms, both back pain and leg pain, decreased in step with this physical shrinkage.
Conservative treatment (physical therapy, anti-inflammatory medication, activity modification) and surgery produce similar outcomes by the two-year mark. A large meta-analysis covering roughly 3,000 patients across 12 randomized trials found no significant difference in leg pain or disability scores between surgical and non-surgical groups at 24 months or later. Surgery does provide faster relief in the short term, which matters if pain is severe or interfering with your ability to work and function. But the long-term trajectory converges regardless of which path you take.
About 10% to 15% of people who start with conservative treatment eventually cross over to surgery because symptoms persist or worsen. Reoperation rates after initial surgery range from 8% to 12%.
Signs That Need Emergency Attention
A rare but serious complication of a large lumbar disc herniation is compression of the bundle of nerves at the base of the spine, called cauda equina syndrome. The warning signs are distinct from ordinary back pain:
- Bladder or bowel changes: inability to urinate, inability to control urination, or loss of bowel control
- Saddle numbness: tingling, burning, or loss of sensation in the inner thighs, buttocks, or groin area
- Progressive leg weakness: difficulty walking or a foot that drags
These symptoms require an emergency room visit. Cauda equina syndrome needs surgical decompression within hours to prevent permanent nerve damage. Ordinary back pain from a disc herniation, even when severe, does not carry this urgency.