A hernia can be external, pushing through muscle toward the outside of your body and visible under your skin, or internal, when it pushes through a different muscle layer deep under the skin. There are several types of hernias, each of which is associated with its own set of symptoms. Your doctor will diagnose a hernia based on your symptoms and health history, a physical exam, and possibly blood tests or imaging scans of the affected area. (1) Inguinal hernias are the most common type of hernia. They happen when a section of intestine or fatty tissue pushes through the abdominal wall in the groin area, at the top of your inner thigh. Femoral hernias also affect the groin but involve a different area of muscle weakness. They’re much less common than inguinal hernias. Umbilical hernias involve a section of intestine or fatty tissue pushing through the abdominal wall near the navel (belly button). Incisional hernias happen in an area where an incision was made for prior abdominal surgery. Fatty tissue or part of your intestine can push through your abdominal wall at the incision site. (1) The location of each of these hernia types vary, and not all of them will cause the same symptoms. But the most common symptoms of an external hernia include the following:
A noticeable lump or bulge in the groin or abdomenA bulge that can be pushed back in or disappears when lying downAn increase in the size of the bulge over timeSwelling, pain, or a bulge in the groin or scrotum in menPain or a burning or aching sensation at the site of the bulgePain while coughing, bending over, or lifting heavy objectsA heavy feeling in your groinWeakness or a feeling of pressure in your groinA sense of fullness or bowel obstruction (1,2)
One of the most common types of internal hernia is a hiatal hernia, in which part of the stomach pushes up through the diaphragm, the sheet of muscle that separates your abdomen from your chest. (1) In many cases, a hiatal hernia doesn’t cause any symptoms. But sometimes a hiatal hernia can cause digestive juices in the stomach to move up into the esophagus, known as acid reflux, or gastroesophageal reflux disorder (GERD). Symptoms of GERD include these reactions:
Heartburn (a burning sensation in the upper chest)An acidic, bitter, or sour taste in the back of your throatA bloated feeling in your stomachFrequent belching (burping)Discomfort or pain in your stomach or esophagus (3,4)
Hiatal hernias don’t always cause GERD, and most cases of GERD aren’t caused by a hiatal hernia, so these symptoms, or a lack of them, can’t definitively let you know whether you have this condition. A hiatal hernia can also cause chest pain, which may be a symptom of a heart attack. If you experience chest pain, it’s important to call or see a doctor right away. (3) There are several other relatively rare types of internal hernias, most of which involve areas of the digestive tract pushing through surrounding structures and tissues. These hernias are often the result of abdominal surgery, especially certain kinds of gastric bypass operations. But they can also be the result of congenital (present since birth) openings or weaknesses in internal abdominal structures, the most common of which is known as a paraduodenal hernia. As noted in an article published in the January–February 2016 issue of the journal RadioGraphics, less common types of internal hernias sometimes cause no symptoms but can also cause abdominal pain and symptoms of a bowel obstruction. (5) External hernias can often be found in a physical exam at your doctor’s office, since they typically cause a bulge that is visible or can be felt in certain situations. Checking for an inguinal hernia is a standard part of a physical exam for men. (1) During your exam, your doctor will typically feel around your groin and testicles, and ask you to cough. This is done because standing and coughing or straining usually make a hernia more prominent. If your doctor suspects that you have an inguinal or other external hernia but can’t be sure based on a physical exam alone, you may be asked to undergo an imaging test. (2) Common imaging to diagnose a hernia includes these tests: Ultrasound Your doctor may recommend this test if you’re a woman to rule out causes of pain related to your reproductive system, such as ovarian cysts or fibroids. Men might have an ultrasound to assess for inguinal or scrotal hernias. This test uses sound waves to create images of your abdomen and pelvic organs. (6) Computer Tomography (CT) Scan Your doctor may order this test to rule out other conditions that can cause abdominal pain and swelling. CT scans use X-rays to create images of your abdomen and its organs, and they may involve having a contrast dye injected into your arm. Magnetic Resonance Imaging (MRI) Your doctor may order this test if your pain gets worse when you exercise, since physical activity can initially cause a hernia with no bulge in some people. An MRI scan can detect a tear in your abdominal muscles even when no bulge is present. This test uses radio waves and a magnetic field to create images of your abdomen and its organs, and it may also involve having a contrast dye injected into your arm. If your doctor believes that your hernia may have developed a complication — such as becoming trapped or having its blood supply cut off — then you may undergo imaging tests as well as blood tests to look for signs of infection. (7)
