The most common symptom of a hernia is a visible bulge or lump, usually in the groin, abdomen, or near the navel. The bulge typically becomes more noticeable when you stand up, cough, or strain, and it may flatten or disappear when you lie down. But not all hernias produce a bulge you can see or feel. Some cause internal symptoms like heartburn or pelvic pain, and roughly 15% of hernias are discovered incidentally during imaging for something else entirely.
Groin Hernia Symptoms
Inguinal hernias, the most common type, occur in the groin area between the lower abdomen and thigh. The hallmark is a bulge that appears on one side of the groin or, in men, in the scrotum. Along with the bulge, you may feel discomfort, a heavy or dragging sensation, or a burning feeling in the groin. These symptoms tend to worsen when you strain, lift something heavy, cough, or stand for long periods, and they typically ease when you rest or lie down.
Femoral hernias are less common but worth knowing about, especially for women. They show up in the inner upper thigh, just above the crease of the groin, and can cause lower abdominal pain or a sharp, sudden ache in the upper thigh. Because the bulge sits so close to the inguinal area, femoral hernias are often mistaken for inguinal hernias. The distinction matters because femoral hernias carry a higher risk of becoming trapped and cutting off blood supply to the tissue.
Hiatal Hernia Symptoms
Hiatal hernias are different from other types because they happen internally, where part of the stomach pushes up through the diaphragm into the chest cavity. There’s no visible bulge. Most small hiatal hernias cause no symptoms at all.
Larger hiatal hernias, however, can produce a cluster of digestive symptoms that overlap heavily with acid reflux: heartburn, regurgitation of food or liquid back into the mouth, trouble swallowing, and feeling full soon after eating. Some people experience chest or abdominal pain, which can be alarming because it mimics heart-related discomfort. Shortness of breath is another possible symptom. In serious cases, vomiting blood or passing black stools can signal bleeding in the digestive tract.
Umbilical and Incisional Hernias
Umbilical hernias create a soft bulge near the belly button. In babies, the bulge often appears only when they cry, cough, or strain, and it’s usually painless. Most umbilical hernias in infants close on their own. When umbilical hernias develop in adults, they’re more likely to cause abdominal discomfort and won’t resolve without treatment.
Incisional hernias develop at the site of a previous surgical scar, where the abdominal wall was cut and may not have healed completely. Small ones (under about 2 inches) often cause no symptoms. Larger incisional hernias, those over 4 inches, tend to produce pain near the scar, ranging from a dull ache to sharp discomfort. The bulge becomes more visible when you stand or engage your abdominal muscles, and pain may increase with lifting, coughing, or sneezing.
How Symptoms Change Over Time
Hernias tend to get worse, not better. A hernia that starts as a small, painless bulge you can push back in will generally enlarge over time. What begins as mild discomfort during heavy lifting may progress to pain during everyday activities. The opening in the muscle wall stretches, allowing more tissue to push through. With the exception of umbilical hernias in babies, hernias don’t heal on their own.
If you have a small hernia that only appears occasionally and causes minimal symptoms, your doctor may recommend monitoring it rather than operating immediately. But because progression is the norm, most hernias eventually need surgical repair.
When a Hernia Becomes an Emergency
The serious complication to watch for is strangulation. This happens when the herniated tissue gets trapped in the muscle opening and its blood supply is cut off. The tissue can die if it isn’t freed quickly.
Warning signs of a strangulated hernia include:
- Sudden, severe pain in the abdomen or groin that keeps getting worse and doesn’t let up
- Skin color changes around the bulge, where the skin turns paler than normal and then darker
- Nausea and vomiting
- A bulge that won’t flatten when you lie down or gently press on it
These symptoms require emergency medical attention. Strangulation can lead to tissue death within hours.
How Hernias Are Diagnosed
Diagnosis usually starts with a physical exam. Your doctor will look at the groin, abdomen, or affected area while you’re standing, checking for a visible bulge. You’ll then be asked to cough or bear down (a Valsalva maneuver) while the doctor watches and feels for a bulge or impulse beneath the skin. For suspected inguinal hernias in men, the doctor may use a finger to follow the spermatic cord up through the inguinal canal, feeling for tissue pushing through.
When the diagnosis isn’t clear from a physical exam alone, imaging such as an ultrasound or CT scan can confirm the hernia’s location and size. This is especially useful for femoral hernias, which can be subtle, and for hiatal hernias, which can’t be detected by touch at all.