How Common Are Hernias? By Type, Sex, and Age

Abdominal wall hernias affect roughly 1.7% of people across all ages, and that figure climbs to about 4% in adults over 45.¹ Those overall numbers, though, hide enormous variation depending on which type of hernia you’re talking about, whether the person is male or female, and how old they are. Inguinal hernias alone make up three-quarters of the total, and they skew overwhelmingly male, while other types like umbilical, femoral, and hiatal hernias follow quite different demographic patterns.

Inguinal Hernias Dominate the Numbers

Inguinal hernias, the kind that bulge through the groin area, account for about 75% of all abdominal wall hernias. The lifetime risk is strikingly lopsided between the sexes: roughly 27% for men versus 3% for women.¹ That means more than one in four men will develop an inguinal hernia at some point. The anatomy behind this disparity has to do with the inguinal canal, the passage through which the testicle descends before birth. That descent creates a natural weak spot in the abdominal wall that persists throughout life. Women have a much narrower inguinal canal and lack that same embryonic migration path, which is why their rates are so much lower.

Age-wise, inguinal hernias follow a distinctive two-peak pattern. They’re common in young children, particularly boys between ages one and five, and then they surge again in middle-aged and older adults, peaking in people from their fifties through their seventies.² In children, the cause is usually a developmental one: a small channel called the processus vaginalis, which should seal shut after birth, stays open and creates a pathway for tissue to push through.³ In older adults, the cause shifts toward wear and tear on connective tissue. Male sex and advancing age are the two strongest risk factors, but connective tissue disorders and low body mass index also raise the odds.⁴

The low-BMI connection surprises people because they assume hernias are a weight-bearing injury. In fact, the opposite is often true for inguinal hernias: being underweight may reflect thinner, less supportive abdominal musculature, and the research consistently points to low BMI as a risk factor rather than high BMI.

Femoral Hernias Are Rarer but More Dangerous

Femoral hernias, which push through a small opening near the top of the inner thigh just below the inguinal ligament, are far less common than inguinal hernias. In one study of nearly 500 groin hernias, only about 8% were femoral.⁵ But what they lack in frequency they make up for in urgency. The same study found that the cumulative probability of strangulation, where the herniated tissue’s blood supply gets cut off, was 22% at three months and 45% at 21 months for femoral hernias. That’s dramatically higher than for inguinal hernias over the same period.

The sex pattern for femoral hernias runs counter to the inguinal trend. While they can occur in men, femoral hernias are proportionally much more common in women. Studies have found that female sex and femoral hernia type both independently predict higher rates of incarceration and strangulation, along with worse surgical outcomes overall.⁶ Delayed diagnosis is part of the problem: a small femoral hernia in a woman may not produce an obvious bulge and can be missed or misattributed to other conditions, meaning the hernia is more likely to present as an emergency.

Umbilical Hernias in Children Versus Adults

Umbilical hernias are the belly-button bulges that parents notice in newborns, and they’re extremely common in infancy. The reassuring news is that the vast majority close on their own. One institutional review found that 85% of conservatively managed pediatric umbilical hernias resolved spontaneously between ages one and five.⁷ Spontaneous closure becomes unlikely after age five, at which point surgery is typically recommended if the hernia persists. Premature babies are considerably less likely to see their hernia close on its own, and larger defects also have lower odds of resolving without intervention.⁸

In adults, umbilical hernias are a different story. They don’t spontaneously close and tend to enlarge over time. Among adult women, risk factors include obesity, heavy lifting, chronic constipation, chronic cough, and having had three or more pregnancies.⁹ Nationwide surgical data from the Netherlands showed that umbilical hernia repairs peaked in men aged 60 to 70, with a five-year repair prevalence of about 0.5% in that age group.¹⁰ Men accounted for about two-thirds of umbilical hernia repairs in that dataset, which may reflect both higher occurrence and greater likelihood of hernias reaching a size that warrants surgery.

Incisional Hernias After Surgery

Any time the abdominal wall is cut open for surgery, the healed incision site becomes a potential weak point. Incisional hernias develop at those sites, and they’re one of the most common long-term complications of abdominal surgery. Estimates vary depending on the procedure and follow-up period, but they affect a meaningful fraction of patients after open abdominal operations.

Surgical technique matters. A systematic review and meta-analysis comparing laparoscopic and open approaches found that incisional hernia rates were significantly lower after laparoscopic surgery.¹¹ The advantage was most pronounced for fully laparoscopic procedures. Laparoscopically assisted surgeries, where part of the work still requires an open incision, didn’t show the same reduction. The logic is straightforward: smaller incisions mean less structural disruption to the abdominal wall, which means less opportunity for a hernia to form during healing.

Risk factors for incisional hernia incarceration, where the herniated tissue gets trapped and can’t be pushed back in, include older age, female sex, higher BMI, and smoking. A population-based study of over 30,000 incisional hernia patients found that even though women were more likely to get early elective repair, they still had a higher risk of incarceration than men who were initially managed without surgery.¹²

Epigastric and Spigelian Hernias

Epigastric hernias occur in the upper midline of the abdomen, between the belly button and the breastbone. They’re relatively small and sometimes discovered incidentally during imaging for other reasons. In one cross-sectional study from Ethiopia, epigastric hernias were the most frequently identified type among surgical outpatients, and the majority of those were in women.¹³ Dutch national data showed that the highest rate of epigastric hernia repair occurred in women aged 40 to 50.¹⁰ They tend to be small, and many remain asymptomatic, but they can cause localized pain or tenderness when they do produce symptoms.

Spigelian hernias are genuinely rare. They protrude through a gap in the lateral abdominal wall along a band of tissue called the semilunar line. A high-volume hernia center found that Spigelian hernias made up just 0.14% of all hernias repaired over their study period. The median age at repair was 67 in men and 62 in women, and the majority occurred on the left side.¹⁴ Because they sit beneath the external oblique muscle layer, Spigelian hernias don’t always produce a visible bulge, making them easy to miss on physical exam and often requiring imaging to confirm.

Hiatal Hernias Become Increasingly Common with Age

Hiatal hernias are different from the external abdominal wall hernias discussed above. They occur internally, where the upper part of the stomach pushes up through the diaphragm’s esophageal opening into the chest cavity. They’re a major contributor to gastroesophageal reflux and can, in large cases, cause difficulty swallowing or chest pain.

The prevalence of hiatal hernias climbs steeply with age. Research has found that about 28% of people between 60 and 69 have one, rising to 31% between ages 70 and 79, and reaching 42% in people over 80.¹⁵ Many of these are small sliding hiatal hernias that produce mild or no symptoms and are discovered during upper endoscopy or imaging for other conditions. Larger paraesophageal hernias, where a portion of the stomach rolls up alongside the esophagus, are less common but more concerning because they can twist or lose blood supply.

Sex differences in hiatal hernia prevalence are less dramatic than with inguinal hernias, though some studies suggest slightly higher rates in women. Obesity and age are the dominant risk factors. If you’ve had persistent heartburn or reflux symptoms and you’re over 60, there’s a reasonable chance a hiatal hernia is involved.

Why Women Face Worse Complications Despite Lower Overall Rates

One of the more counterintuitive findings in hernia research is that while women develop external hernias far less often than men, they tend to have worse outcomes when they do. The pattern shows up across hernia types. In femoral hernias, women are disproportionately affected and face high rates of strangulation. In incisional hernias, female sex is independently associated with a higher risk of incarceration even after controlling for other variables.¹² And broadly, female patients with any incarcerated external hernia carry a higher risk of surgical complications.¹⁶

Several explanations may contribute. Women’s hernias are more likely to be femoral rather than inguinal, and the femoral canal’s narrow, rigid ring makes strangulation more likely once tissue enters it. There may also be diagnostic delay: because hernias are widely perceived as a “male problem,” symptoms in women can be attributed to other causes before a hernia is considered. Whatever the mix of reasons, the clinical takeaway is that a groin lump in a woman deserves prompt evaluation, not reassurance that hernias are uncommon in females.

Pregnancy, Parity, and Ventral Hernia Risk

Pregnancy puts unique stress on the abdominal wall, and having more pregnancies raises the risk of certain hernia types. A population-based register study found that women who had two deliveries had an 18% higher rate of umbilical hernia repair compared with women who had one delivery, and women with three or more deliveries had a 48% higher rate. A similar trend appeared for epigastric hernia repairs, with rates about 29% to 34% higher in women with two or more deliveries compared to those with one.¹⁷

Diastasis recti, the separation of the two halves of the rectus abdominis muscle that commonly occurs during pregnancy, likely plays a role. When those muscles separate, the connective tissue between them stretches and thins, making the midline of the abdomen more vulnerable to hernia formation. Cesarean sections add another layer of risk because they create an incision-site weakness, with some fraction of women eventually developing an incisional hernia at the surgical scar.

What Makes Hernias Come Back After Repair

Hernia recurrence is a real concern for anyone who has had a repair, and the risk factors differ somewhat depending on the hernia type. For inguinal hernias, a meta-analysis of observational studies found that female sex, having a direct (as opposed to indirect) hernia, undergoing surgery for a hernia that had already recurred once, and smoking were all significant predictors of another recurrence.¹⁸

For ventral hernia repairs done with mesh, a large study identified a long list of recurrence risk factors including higher BMI, immunosuppressant use, wider hernias, surgical site infection after the initial repair, and the type of mesh used. Biological tissue-derived mesh and resorbable synthetic mesh were associated with higher recurrence than permanent synthetic mesh.¹⁹ Smoking appears across nearly every hernia type as a recurrence factor, which makes sense given that smoking impairs wound healing and degrades connective tissue.

The Role of Aging Connective Tissue

One reason hernias cluster in older adults goes beyond accumulated wear on the abdominal wall. Collagen, the structural protein that gives fascia and tendons their strength, undergoes changes with age. Its production slows while its breakdown accelerates, and lifestyle factors like smoking, poor nutrition, and physical inactivity can worsen that imbalance.²⁰ The result is abdominal wall tissue that is structurally weaker and less able to resist the constant intra-abdominal pressure generated by standing, coughing, lifting, and straining.

There’s also an evolutionary dimension. Walking upright concentrates gravitational force downward onto the lower abdomen and groin. In four-legged animals, that force is distributed more evenly along the trunk, and inguinal hernias are comparatively rare. In humans, the erect posture amplifies the inherent weakness of the inguinal region and makes it more likely that hernias will develop and become symptomatic.²¹ You can think of inguinal hernias as, in part, a trade-off for bipedalism.

The Global Burden and Access Gap

In high-income countries, hernia repair is one of the most commonly performed operations, and outcomes are generally good when surgery happens electively. The picture looks very different in low-resource settings. A substantial number of people in sub-Saharan Africa and other developing regions live with untreated hernias for years or even decades because they lack access to surgical care.²² The result is a disproportionate burden of emergency complications, including strangulation and bowel death, that would have been easily preventable with elective surgery.

Hernia repair is considered one of the most cost-effective surgical interventions in global health, yet it remains largely neglected as a public health priority in developing countries.²³ The gap isn’t driven by a lack of skilled surgeons alone. Transportation to a surgical facility, the cost of the procedure, lost income during recovery, and limited anesthesia resources all contribute. Community screening programs in parts of West Africa have found hernia prevalence rates many times higher than those reported in Western populations, partly because hernias that would have been repaired years earlier in wealthier settings simply persist and accumulate.

1
JAMA Surgery. Trends in Emergent Hernia Repair in the United States
2
Annals of Surgical Treatment and Research. Inguinal hernia surgery in Korea: nationwide data from 2007–2015
3
PubMed Central. Current Perspectives on the Contralateral Patent Processus Vaginalis: What About the Other Side?
4
Frontiers in Surgery. Etiology of Inguinal Hernias: A Comprehensive Review
5
PubMed. Risk of strangulation in groin hernias
6
PubMed. Risk factors related with unfavorable outcomes in groin hernia repairs
7
PubMed Central. A Systematic Review of Current Consensus on Timing of Operative Repair Versus Spontaneous Closure for Asymptomatic Umbilical Hernias in Pediatric
8
PubMed Central. Predictors of spontaneous resolution of umbilical hernia in children
9
The Insight. Prevalence and Risk Factors of Umbilical Hernia among Female Patients Attending in A Tertiary Hospital
10
PubMed. The prevalence of umbilical and epigastric hernia repair: a nationwide epidemiologic study
11
PubMed. Incisional Hernia Rates After Laparoscopic or Open Abdominal Surgery-A Systematic Review and Meta-Analysis
12
PubMed Central. The Risk of Incarceration During Nonoperative Management of Incisional Hernias: A Population-based Analysis of 30,998 Patients
13
PubMed Central. Incidence, types, and associated factors of external abdominal hernias among adult patients visiting the surgical outpatient department, eastern Ethiopia
14
PubMed Central. Spigelian hernias: A high volume institutional review
15
Elsevier / ScienceDirect (Journal of Gastrointestinal Surgery). Hiatal Hernia Repair and Anti-Reflux Surgery in Older Patients: A Brief Communication
16
The American Journal of Surgery. Presentation and outcome of incarcerated external hernias in adults
17
International Journal of Abdominal Wall and Hernia Surgery. Risk for ventral hernia related to parity: A population-based register study
18
PubMed. Patient-related risk factors for recurrence after inguinal hernia repair: a systematic review and meta-analysis of observational studies
19
JAMA Surgery. Year-Over-Year Ventral Hernia Recurrence Rates and Risk Factors
20
PubMed. Effect of lifestyle, gender and age on collagen formation and degradation
21
PubMed. Is inguinal hernia a defect in human evolution and would this insight improve concepts for methods of surgical repair?
22
PubMed Central. The global, regional, and national burden and its trends of inguinal, femoral, and abdominal hernia from 1990 to 2019
23
PubMed. The Prevalence and Characteristics of Untreated Hernias in Southwest Cameroon