Hernia Pain: Causes, Seriousness, Relief

Hernia Pain: Causes, Seriousness, Relief


A hernia occurs when part of an internal organ or tissue bulges through a weak spot in your abdominal wall. Depending on the size and location of the hernia, hernia pain may feel like burning, pulling, pressure, aching, or heaviness in the abdomen. The pain often comes and goes and worsens during certain activities, like lifting, bending, or coughing. However, some people with a hernia experience no pain or discomfort but may notice a slight bulge on their abdomen.

It’s important to seek medical attention for a hernia, whether you experience pain or not. An untreated hernia can lead to complications like strangulation, when the blood supply to the herniated tissue is limited or cut off, posing a serious health risk. Strangulated hernias can cause severe, unrelenting pain along with nausea and vomiting.

Treatment options like medications and surgery can help improve symptoms significantly. 

A hernia can occur anywhere on the abdomen—from the ribcage to the groin. The type of pain you experience often depends on the location, size, and type of hernia you have.

Inguinal Hernia 

An inguinal hernia occurs when a portion of the small intestine or fatty tissue protrudes (sticks out) through a weak spot in the lower abdominal wall on either side of the groin. This type of hernia can cause pain or discomfort in the groin area, where the lower part of your abdomen meets your upper thigh. Inguinal hernia pain may feel like: 

  • Burning
  • Pulling
  • Aching
  • Heaviness

Inguinal hernia discomfort often worsens with activities that increase pressure in the abdomen, such as coughing, straining during bowel movements, lifting heavy objects, or bending over. The pain might occur alongside a visible bulge in the groin area and can worsen over time if left untreated.

Hiatal Hernia 

A hiatal hernia develops in the upper abdomen when the top part of the stomach pushes through the diaphragm—the thin muscle separating the chest from the abdomen. This type of hernia can make it easier for stomach acid to flow into your esophagus, leading to gastroesophageal reflux disease (GERD) symptoms.

Hiatal hernia pain is often mistaken for heart problems and may feel like: 

  • Heartburn that worsens after eating or lying down
  • Chest pain or pressure
  • Difficulty swallowing
  • The sensation of having a lump in your throat

Umbilical Hernia 

An umbilical hernia is when part of the intestine or fatty tissue pushes through the abdominal wall near the navel (belly button). This type of hernia is common in infants but can also occur in adults, especially those who have had previous pregnancies or people living with obesity.

The pain associated with an umbilical hernia usually stays around the navel and tends to worsen when straining while coughing, lifting heavy objects, or having a bowel movement. 

Ventral Hernia 

A ventral (also known as an incisional) hernia occurs in the middle of your abdomen, most often where you have a scar from a previous abdominal surgery. Internal tissue can bulge through weakened muscles at your surgery site, creating a noticeable lump in the middle of your stomach. 

Pain from a ventral hernia can range from mild to severe and often worsens when coughing, urinating, having a bowel movement, lifting heavy objects, or after sitting or standing for long periods. Ventral hernia pain may feel:

  • Sharp and sudden
  • Dull aching that worsens throughout the day 

Femoral Hernia

A femoral hernia occurs in the groin area when tissue bulges through a weak spot near the femoral canal—a narrow passage where lymph vessels and loose connective tissues pass from the abdomen to the upper thigh.

Small femoral hernias may not cause pain, but larger hernias may cause dull, aching pain and discomfort in your groin or thigh when lifting heavy objects, standing, coughing, or during bowel movements.

A hernia develops when muscles in the abdominal wall allow a portion of abdominal tissues, such as the stomach, intestines, fat, or other internal organs, to push through a weak spot. Some people are born with weak abdominal muscles and connective tissues, while others can develop this weakness over time due to increased pressure or strain on the abdomen.

Several factors can contribute to this weakness, including: 

  • Chronic coughing or sneezing
  • Straining during bowel movements
  • Obesity
  • Heavy lifting or improper lifting techniques 
  • Aging
  • Pregnancy 
  • Smoking
  • Overuse of abdominal muscles
  • Previous abdominal surgery 

Many hernias do not cause pain and discomfort. When pain does occur, however, it can be due to several underlying health concerns—such as the ones listed below.

Nerve Compression

Herniated tissues can irritate the surrounding muscles, connective tissues, and nerves, causing inflammation and swelling.

Compression neuropathy is nerve pain that develops when a hernia or other irritated tissues press on a nerve in your abdomen. This can lead to sharp, shooting pains that come and go and often worsen during certain movements, like twisting your body, bending, or walking. 

Acid Reflux 

A hiatal hernia can disrupt the function of the lower esophageal sphincter (LES)—a ring of muscle that acts like a valve, preventing contents from your stomach from flowing back into the esophagus (food pipe).

When a hiatal hernia presses on the LES, stomach acid can flow into the esophagus, leading to heartburn, difficulty swallowing, nausea, and regurgitation of stomach contents.

Incarceration and Strangulation

Healthcare providers can sometimes gently massage or push herniated tissue back into place within the abdomen. An incarcerated hernia, or obstructed hernia, occurs when the herniated tissue gets stuck in a weak spot in the abdominal wall and cannot be pushed back into the abdomen. Without treatment, the herniated tissue can become strangulated, meaning the blood supply to the tissue is cut off.  

An incarcerated or strangulated hernia can cause sudden, severe pain and tenderness around the hernia that may radiate to your thighs or stomach, depending on the location of the hernia. 

If you’re experiencing hernia pain (even mild), seeing a healthcare provider sooner rather than later can help you get a proper diagnosis and timely treatment. Early treatment can also help prevent complications like strangulation.

Some situations warrant more immediate medical attention. If you have hernia pain alongside any of the following symptoms, it’s important to see a provider as soon as possible:

  • Sudden, severe pain or tenderness 
  • Nausea and vomiting
  • Inability to pass stool or gas
  • Redness or skin discoloration in the area of the hernia
  • Fever

These symptoms are a sign of a strangulated hernia—a serious medical emergency that requires immediate surgery. 

Healthcare providers diagnose hernia pain by reviewing your medical history, asking about your symptoms, and performing a physical examination. During the exam, your healthcare provider will palpate (touch) your abdomen and groin area to feel for the telltale bulge. They may ask you to cough, stand, or walk to see if the bulge becomes more prominent when you use or strain your abdominal muscles. 

In some cases, imaging tests may be necessary to confirm the diagnosis and visualize the hernia’s size and location. These tests include: 

  • Ultrasound: Uses sound waves to create images of the abdomen and groin to detect and measure a hernia
  • Computed tomography (CT) scan: Creates detailed images of the abdomen and groin to identify a hernia
  • Magnetic resonance imaging (MRI) scan: Utilizes radio waves and strong magnets to create detailed pictures of organs, muscles, connective tissues, and nerves in the abdomen and groin to help identify a hernia and confirm its location and size 

If your healthcare provider suspects you have a hiatal hernia, they may order additional diagnostic tests such as: 

  • Upper endoscopy: Uses a flexible tube with a camera to view the esophagus, stomach, and upper portion of the small intestine and check for the presence of a hiatal hernia 
  • Barium swallow X-ray: Requires you to drink a milkshake-like liquid (barium) that coats the stomach and esophagus and shows up well on X-ray photos to detect a hiatal hernia

If your hernia is causing pain, your exact treatment plan will depend on the size and location of the hernia and the severity of the pain you’re experiencing. Generally, medications and surgery can help improve symptoms.

Non-Surgical Approaches

For mild hiatal hernia pain, your healthcare provider may recommend a conservative treatment approach, including lifestyle changes (e.g., eating smaller meals or avoiding smoking) or medications to help reduce acid reflux symptoms. 

For other types of hernias that do not cause symptoms, your healthcare provider may recommend taking a “watchful waiting” approach. This means carefully monitoring your hernia symptoms and seeing your healthcare provider if the hernia grows larger or begins to cause pain. 

Surgery

Large hernias and hernias that cause severe pain often require surgical treatment to repair the hernia and strengthen the abdominal wall. Severe or persistent hernia pain generally points to a more serious problem like incarceration or strangulation, which requires emergency surgery to repair the hernia and prevent serious complications. Two surgeries can treat most hernias: open and laparoscopic.

  • Open surgery: Involves making an incision (cut) on your abdomen near the hernia and gently pushing it back into place. Surgeons use sutures (stitches) or mesh to close the weak spot in the abdominal wall before closing the surgical incision with sutures, glue, or staples. 
  • Laparoscopic surgery: Involves making several small incisions in the abdomen, where surgeons insert surgical tools into the openings to place the herniated tissue back in the abdomen and strengthen the abdominal wall

Depending on the location and size of the hernia, hernia pain may feel like burning, pulling, heaviness, or pressure in your abdominal or groin area. The pain can come and go and often worsens when you’re lifting heavy objects or bending down.

If you’re experiencing hernia pain, it’s important to see a healthcare provider for diagnosis and treatment. They can offer recommendations like lifestyle changes, medications, and surgery to treat symptoms and prevent complications.

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