There are more than a dozen types of hernias, but they all share the same basic problem: an organ or tissue pushes through a weak spot in the muscle or connective tissue that normally holds it in place. The differences come down to where in the body that weak spot is and what’s pushing through it. More than one million hernia repairs are performed each year in the United States, and inguinal hernias in the groin account for roughly 770,000 of them. Here’s a breakdown of the major types, what makes each one distinct, and which ones need the most attention.
Inguinal Hernia
This is the most common hernia by a wide margin. It occurs in the groin, where tissue or a loop of intestine pushes through a weak point in the lower abdominal wall into the inguinal canal, a passage that runs through the groin on each side. You’ll typically notice a bulge near your pubic bone that becomes more obvious when you stand, cough, or strain. It may ache or burn, especially after prolonged standing or physical activity.
Inguinal hernias are far more common in men, who make up roughly 88 to 92 percent of all groin hernia surgeries. Women account for 8 to 11.5 percent of cases, but their situation can be trickier. Women are three to four times more likely than men to need emergency surgery for a groin hernia, partly because a higher proportion of their groin hernias turn out to be femoral hernias, which carry greater risk of complications.
Femoral Hernia
A femoral hernia also occurs in the groin but sits lower, where tissue pushes through the femoral canal near the top of the inner thigh. These are less common overall but disproportionately affect women, who develop femoral hernias in 16 to 37 percent of their groin hernia cases. The concern with femoral hernias is that they’re more likely to become trapped and cut off from their blood supply. The rate of emergency surgery for femoral hernias reaches about 28 percent in men and over 40 percent in women, making them one of the more urgent types to address.
Hiatal Hernia
Unlike most hernias, a hiatal hernia doesn’t create a visible bulge. It happens inside the chest, where part of the stomach pushes upward through the hiatus, the small opening in the diaphragm where the esophagus passes through. There are two main categories, and they behave very differently.
Sliding Hiatal Hernia
This accounts for 95 percent of all hiatal hernias. The junction between the esophagus and stomach slides up through the diaphragm at times, then slides back down. Most people with a sliding hiatal hernia never feel it, and most don’t need treatment. When symptoms do occur, they typically involve acid reflux, heartburn, or a sensation of food coming back up.
Paraesophageal Hiatal Hernia
In the less common types (types 2 through 4), part of the stomach pushes up alongside the esophagus and can stay there. In the rarest form, the opening in the diaphragm is wide enough for another organ, such as the spleen, pancreas, or intestine, to push through alongside the stomach. These types carry real risks. A trapped stomach can become obstructed, develop ulcers from acid buildup, or lose its blood supply entirely. Larger paraesophageal hernias tend to cause nausea, shortness of breath, and pressure or pain in the upper abdomen or lower chest. Surgical repair is typically recommended when symptoms are significant or the hernia is large enough to pose a risk of serious complications.
Umbilical Hernia
An umbilical hernia appears at or near the belly button, where tissue bulges through a weak spot in the abdominal wall. These are extremely common in newborns and infants. The good news for parents: 95 percent of umbilical hernias smaller than 1 centimeter close on their own by age 5 as the abdominal muscles strengthen. Surgical repair is generally recommended only if the hernia persists past age 5 or causes symptoms.
Adults can develop umbilical hernias too, particularly after pregnancy, with obesity, or after abdominal surgery. Unlike in children, adult umbilical hernias don’t resolve on their own and usually require repair if they grow or become symptomatic.
Incisional Hernia
If you’ve had abdominal surgery, the scar site can become a weak point where tissue pushes through later. About 5 percent of people who undergo abdominal surgery eventually need an incisional hernia repair. The risk varies significantly depending on the type of surgery. Colorectal surgery carries the highest rate at 10 percent, followed by liver and gallbladder surgery at 8.2 percent and transplant surgery at 6.8 percent. Gynecologic surgery has the lowest rate at 2.6 percent.
Incisional hernias can appear weeks, months, or even years after the original operation. Risk factors include infection at the surgical site, obesity, and activities that put pressure on the healing incision.
Epigastric Hernia
This type occurs in the upper abdomen, between the belly button and the breastbone, where fat pushes through a gap in the tissue connecting the abdominal muscles. Epigastric hernias are usually small and often contain only fatty tissue rather than intestine. They can be painless, but some people experience tenderness or a dull ache in the upper belly, especially with straining.
Spigelian Hernia
A Spigelian hernia is rare and can be difficult to diagnose because it develops within the abdominal wall rather than pushing outward in an obvious way. It occurs along the outer edge of the front abdominal muscles, typically in the lower belly. A common sign is a lump or bump that appears two to three inches to the side of the belly button when you stand and disappears when you lie down.
Because these hernias can be hard to spot, they sometimes go undiagnosed until complications develop. Warning signs include sharp belly pain that comes in waves, severe constipation, nausea, vomiting, or redness over the area of the lump. Spigelian hernias generally need surgical repair because of their relatively high risk of the intestine becoming trapped.
Lumbar Hernia
Lumbar hernias occur through weak points in the muscles of the lower back, on either side of the spine. They’re uncommon and can develop spontaneously or after trauma or surgery to the flank area. You might notice a bulge in the side or back that becomes more prominent with coughing or straining.
When a Hernia Becomes an Emergency
Most hernias start as a mild, reducible bulge, meaning you can gently push the tissue back in or it goes back on its own when you lie down. Two situations turn a hernia into something more urgent:
- Incarceration: The herniated tissue gets stuck and can’t be pushed back into place. This can cause pain, nausea, and vomiting if the trapped tissue creates a blockage in the digestive tract.
- Strangulation: The trapped tissue gets squeezed so tightly that its blood supply is cut off. This causes intense pain, swelling, and discoloration of the skin over the hernia. Strangulation is a surgical emergency because the tissue will begin to die without blood flow.
Any hernia that suddenly becomes painful, firm, or discolored, or that you can no longer push back in, needs immediate medical evaluation.
How Hernias Are Diagnosed
Many hernias are diagnosed with a simple physical exam, especially when there’s an obvious bulge. But some hernias are “occult,” meaning they cause groin or pelvic pain without any visible or palpable lump. In these cases, imaging is needed. Ultrasound, CT scans, and MRI are all options, and each has strengths. When performed by an experienced specialist, ultrasound can detect hidden groin hernias with a sensitivity above 96 percent. MRI is particularly useful for borderline cases, correctly identifying hernias in about 91 percent of confirmed cases. CT scans are somewhat less precise for occult hernias, with sensitivities ranging from 54 to 80 percent, but they’re widely available and useful for evaluating complications.
Surgical Repair: What to Expect
Most hernias that cause symptoms or pose a risk of complications are treated with surgical repair. The two main approaches are open surgery, where the surgeon makes an incision directly over the hernia, and laparoscopic surgery, which uses several small incisions and a camera. Both methods typically involve placing a synthetic mesh to reinforce the weakened tissue.
Recovery from laparoscopic repair tends to be faster, with less post-operative pain and a quicker return to normal activities. However, the choice between the two depends on the hernia’s size, location, and complexity, as well as whether it’s a first-time repair or a recurrence. Your surgeon will recommend the approach that fits your specific situation.