Types of Hernia: Everything you need to know

18 mins read

Let us take a hypothetical situation…you have a lump in or around your abdominal area. When you discussed this with friends, they told you that this might be Hernia. While, some said it might be an umbilical hernia, others said it might be an epigastric hernia.

If you want to get an idea about what type of hernia you have, then read the following sections. It has detailed explanations about different types of hernia.

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There are several types of hernia and they are:

  • Hernia of the abdominal and pelvic floor
    • Inguinal Hernia
    • Femoral Hernia
    • Obturator Hernia
  • Hernia of the anterior abdominal wall
    • Epigastric Hernia
    • Umbilical Hernia
    • Spigelian Hernia
    • Incisional Hernia
    • Diastasis Recti
  • Hernia of the Diaphragm
    • Hiatal Hernia
    • Traumatic Diaphragmatic Hernia

Hernias of the abdominal and pelvic floor

These types of hernia are located in the abdominal and pelvic floor, they are:

  1. Inguinal Hernias
  2. Femoral Hernia
  3. Obturator Hernias

Inguinal Hernias (Groin Hernia)

This type of hernia comprises of 70% of all types of hernia and is the most common type.When your intestine pushes through a weak spot or a tear in the lower abdomen (often in the inguinal canal), the medical condition that develops is called inguinal hernia.

Inguinal hernia often develops when people lift heavy objects. It is more common in men than in women.

In men, testicles need to operate at a lower temperature than that of the body. Hence, they descend through the inguinal canal after birth. Once the testicles descend, the inguinal canal is supposed to close completely. In some situations, the canal does not close completely and leaves behind a weak spot that is prone to hernia. 

In case of women, there is no need for such an opening, hence the inguinal canal is smaller than that of men. 

Types of inguinal hernia

There are two types of inguinal hernia, they are:

  • Direct inguinal hernia: The intestine does not enter the canal, but it enters through a place where the abdominal wall is slightly weaker or thinner.
  • Indirect inguinal hernia: In this type, the intestine enters into the inguinal canal. Indirect inguinal hernia is more common than direct inguinal hernia.

In inguinal hernia, you will see a lump in your groin or thigh. When you lie down, it is almost unnoticeable, but becomes prominent when you stand, strain or cough. In case you have inguinal hernia, it is best to avoid any strenuous activity such as coughing or lifting heavy objects because it might worsen the pain. It is advisable to consult a doctor. If you don’t get treatment for them, then there is a chance that they can lead to severe problems. If these hernias don’t show any symptoms, then they are not dangerous.

Femoral Hernia

In femoral hernia, a part of the intestine protrudes through the femoral canal and may result in a lump around the groin or just in the upper thigh.

Femoral canal is where the femoral veins, femoral artery and nerve leave the abdominal cavity and enter the thigh. Femoral canal is usually a tight space. Sometimes it may become large enough to allow content from the abdominal cavity, which is usually the intestine, to get pushed into the canal.

Femoral hernias are rare and are usually found in older women. Women have a higher risk of femoral hernia than men and this is because women have a wider bone structure compared to men.

Femoral hernia can be life-threatening and has a risk of becoming irreducible and strangulated. This means that they cannot be pushed back into the abdominal cavity and the tissue may become trapped. This results in lack of or no blood supply and may lead to a medical emergency.

In femoral hernia, you may not see the symptoms often and you may also not notice any lump. But, when you see symptoms in femoral hernia you may need medical help right away. If the patient does not get any medical help, then it may become life-threatening. This sudden need for medical help is what makes femoral hernia dangerous.

Obturator Hernia

If a part of the intestine or other abdominal content passes through the obturator foramen (opening in the pelvic bone), then it is called obturator hernia. It is extremely rare. Due to anatomical differences, it is more common in women than in men. Women who are old and have lost significant weight or those who have had multiple pregnancies are at a higher risk for obturator hernia.

If you have this type of hernia then no bulge will appear but it can act like a bowel obstruction and cause nausea and vomiting. Since there is no bulge or signs of hernia and the pain is often diffused around the area, it is hard to diagnose this type of hernia.

Since it can act like a bowel obstruction, diagnosis can be made intra-operatively after the patient presents with bowel obstruction. Doctors might also look for Howship-Romberg sign since it is suggestive of obturator hernia.

Hernias of the anterior abdominal wall

When the abdominal content protrudes through the front portion of the abdominal wall, it is said to be hernia of the anterior abdominal wall. There are several types of hernias of the anterior abdominal wall and they are:

  1. Epigastric Hernia
  2. Umbilical Hernia
  3. Spigelian Hernia
  4. Incisional Hernia
  5. Diastasis Recti Hernia

Epigastric Hernia

Fat or sometimes intestine protrudes through a weak spot in the epigastric region of the abdominal wall and results in epigastric hernia. The region of the abdominal wall which is just below the lower part of the rib cage and above the belly button is called epigastric region.

Most of the time epigastric hernia do not show any symptoms because they are often painless. If and when they show symptoms, they are minor symptoms. Due to this tendency, where it shows little to no symptoms, these types of hernias go unreported.

Epigastric hernia is more common in men than in women. It is a common condition among children and adults. In some cases, it can develop in infants and can even be present at the time of birth.

Typically, they are small, where only the lining of the abdomen will push through the surrounding tissue. However, larger hernias are possible, this is when fatty tissue or part of the intestine or stomach pushes through. Epigastric hernia can vary in size and it is possible for an individual to have multiple epigastric hernia at the same time.

If it is a small hernia, then it may not cause any problems and may appear at certain times. It may not be noticeable when the patient is lying down and there is also a chance that many people who have Epigastric hernia are unaware that they have it.

Umbilical Hernias

This type of hernia accounts for 10% to 30% of all hernias & are second most common type of hernias. Umbilical Hernias are more common among newborns who are either born prematurely or under 6 months of age.

In babies, there is an opening in the abdominal wall which normally closes before birth. If it doesn’t close completely then part of the intestine might push through this weak spot near the belly button. 

If the hernia is small (i.e. less than half an inch), then it usually closes gradually as the abdominal wall muscles get stronger. This happens when the baby is around 2 years of age. In such cases, there is no need for surgery.

Umbilical hernia is the only type of hernia that usually goes away on its own as the abdominal wall muscles become stronger.

When small hernias don’t close by themselves or larger hernias are present then surgery will be required. The surgery is usually done when the baby is 2 years to 4 years old.

Even if the abdominal opening is closed at birth there is a chance that it can appear later in life. This is because this anatomical area is still a weaker place in the abdominal wall when compared to other areas. Because of this reason, it can also appear in middle-aged women who had children or in elderly people. Obesity is an added risk factor for these people.

Umbilical Hernias show in or around the belly button as a lump. They don’t usually hurt and won’t lead to any other health problems. Therefore, people who are opting for surgery will usually opt for surgery because of aesthetic purposes.

Spigelian Hernia 

It is a type of hernia where fat tissue pushes through the Spigelian fascia. Spigelian fascia is the layer of tissue that separates rectus muscles and the lateral obliques. Unlike most hernias, Spigelian hernia does not protrude from below the subcutaneous fat but penetrates between the muscles of the abdominal wall. As a result, in many cases, there is no notable swelling. Usually, spigelian hernia is small and as a result there is a high risk of strangulation.

Spigelian hernia are rare and usually develop in people who are 40 years to 70 years old. Healthcare providers can diagnose it using ultrasonography or a CT Scan. Among these two, CT scan provides greatest sensitivity and specificity.

If spigelian hernia is left untreated, it can block a portion of the bowel or may end up cutting off blood supply to other organs or tissues and may end up becoming life-threatening.

Incisional Hernia

One in every three people who undergo abdominal surgery is at risk of Incisional Hernia. An incisional hernia develops when abdominal content protrudes at the proximity or at the abdominal surgical incision.

Usually the incision heals well and leaves behind an abdominal wall which is as strong as it was before the surgery. In some cases the abdominal wall does not grow as strong it was before surgery. This leaves a weak spot in the abdominal area. This weak spot will come under high pressure when the patient gains weight, becomes pregnant (in case of females) or does strenuous activities. In such cases, when the weak spot is unable to withstand high pressure, the abdominal content will protrude through the weak spot resulting in incisional hernia.

Although weight gain, pregnancy, and strenuous activities play a role in the development of incisional hernia, the sewing technique and scar type are the main factors that increase the risk of this type of hernia. Along with these, old age and having other medical conditions can increase the risk of hernia.

People who undergo abdominal surgery are at a higher risk of an incisional hernia within three to six months of surgery. However, an incisional hernia can develop at any time.

Diastasis Recti

When the linea alba becomes weak, a gap will develop between the “Six Packs” or rectus abdominis. When the linea alba weakens, a bulge may develop in the midline which does not trap any abdominal contents, thus leading to diastasis recti. Since it is just a weakening of the linea alba it is not a true hernia.

Diastasis recti is common among newborns and pregnant women. Among newborns, it is more common in premature newborns. Pregnant women are at risk of diastasis recti not only during pregnancy but also after it.

Although diastasis recti is more prevalent among pregnant women and newborns, it is not limited to them. Adult men and women may also develop diastasis recti. It can also result from strenuous activities, lifting heavy weights without proper form or sometimes due to excessive or unsafe abdominal exercises.

Hernia of the diaphragm

In some situations, abdominal content pushes through the diaphragm and results in hernia of the diaphragm.

  1. Hiatal Hernias
  2. Traumatic Diaphragmatic Hernias

Hiatal Hernia

Hiatal hernia occurs when the upper portion of the stomach pushes through the diaphragm into chest cavity through an opening called the esophageal hiatus.

Esophagus (food pipe) carries food from throat to stomach. It passes through diaphragm through an opening called the esophageal hiatus. In normal conditions, this opening is just large enough to accommodate the esophagus . When the esophageal hiatus weakens or it enlarges, the stomach may protrude through it leading to hiatal hernia.

There are two types of hiatal hernia:

  • The sliding type: When the abdominal pressure increases, the stomach and esophagus slides up through the opening and when the pressure decreases, they fall back to their normal position. This makes it unique among different types of hernia.
  • Fixed type (Paraesophageal Hernia): In this type of hiatal hernia, the stomach protrudes through the opening and rests in the chest cavity.

Traumatic Diaphragmatic Hernia

A major blunt injury may weaken the diaphragm or tear it. The abdominal content might protrude through this weakened spot or the tear, thus leading to diaphragmatic hernia.
This type of hernia usually happens on the left side of the diaphragm. This is because the liver (located under the right diaphragm) protects the right diaphragm against the protrusion of the abdominal content.

After reading this, you will be able to understand the types of hernia. If you have a hernia, it is always advisable to consult a doctor. You can consult an expert doctor here.


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