You’ve been hitting the gym extra hard as summer approaches. But after weightlifting, your abdomen starts to hurt. Could that belly or groin pain be a sign of a hernia? Jeffrey S. Fronza, MD, a surgeon at Northwestern Medicine, explains the types of hernias, as well as symptoms, diagnosis and treatment options.

Types of Hernias

There are many types of hernias, but the most common include:

• Inguinal: This is the most prevalent form of a hernia. It occurs when tissue protrudes through a weak spot or a tear in the abdominal wall within the groin.
• Femoral: Less common than inguinal hernias, femoral hernias occur when tissue protrudes through a weak spot or tear in the abdominal wall, near the upper thigh or groin crease.
• Incisional: This type of hernia develops at the location of a previous surgical incision in the abdominal wall. It occurs when the intestine pushes through the weakened area where the incision was made.
• Umbilical: Newborns often experience this type of hernia, caused by part of the intestine protruding through a weakened spot in the abdominal muscles around the belly button.

Often, there is confusion between hernias and diastasis rectus, which is the stretching of the abdominal wall. “A rectus diastasis can be misdiagnosed as a hernia because they look similar,” says Dr. Fronza. ”"Instead of a hole in the abdominal wall, it’s a stretching of the abdominal wall such that there’s a bowing out of a certain part resulting in a bulge.” The treatment and ramifications of diastasis rectus are different. It is more common in those who have:

• Delivered a high birth-weight baby
• Had multiple pregnancies
• Had a multiple pregnancy (twins, triplets or more)

Symptoms of a Hernia

The symptoms of a hernia can vary depending on its location and severity. However, some common signs and symptoms include:

• Visible lump in the affected area
• Pain or discomfort during physical activity
• Bloating
• Difficulty having a bowel movement
• Nausea and vomiting

While some people may experience no symptoms or only mild discomfort, others may have significant pain. “Once a hernia develops, it typically does not resolve on its own,” says Dr. Fronza. “It’s not uncommon for people to live with a hernia for years, as it can remain asymptomatic for extended periods.”

Diagnosis

Hernias can usually be identified through medical history, physical examination and imaging tests such as ultrasound, CT scan or MRI. The imaging studies can also help identify complications, such as a bowel obstruction. “One of the major risks associated with hernias, although it doesn’t happen often, is the possibility of your intestine becoming trapped between the muscles of the abdominal wall,” explains Dr. Fronza. “If this happens, it can block the intestine and restrict blood flow.” if it does get trapped, it can cause serious issues.

Treatment

Some people who have a hernia and consult their primary care clinician may be advised to take a wait-and-see approach. "If you’re not experiencing any symptoms, it's reasonable to observe a hernia," says Dr. Fronza. "If someone chooses not to have surgery during a time when a hernia isn’t causing any symptoms, I don't impose any activity restrictions on them in terms of lifting or working out."

However, if the hernia is limiting your activities, that could be a good reason to consider getting it repaired. Most hernias will eventually need surgical repair. There are various surgery options to repair common and rare types of hernias. The main options include:

• Conventional (open hernia repair): Conventional surgery may involve a major surgery performed under general anesthesia, and it requires an incision (cuts) near the hernia. Recovery time may be longer compared to other techniques, with potential for more pain and scarring.
• Laparoscopic/robotic: This minimally invasive surgery involves several small incisions. A tiny camera and special surgical tools are inserted through the incisions, allowing the surgeon to see inside and perform the repair. This usually results in less pain, quicker recovery and smaller scars compared to open surgery.

Most hernias, regardless of the type of surgery, are repaired with mesh reinforcements made from synthetic materials. “Mesh provides an extra layer of security to reinforce weak areas of the abdominal wall where hernias occur,” says Dr. Fronza. Very small hernias can often be closed with stitches instead of mesh. Dr. Fronza suggests directing any questions about mesh to your physician. “Patients may be apprehensive about the use of mesh due to misinformation on the internet, but it’s important to discuss any concerns with a clinician to make an informed decision about hernia repair options.” 

Learn more about surgical services.