The clinical signs and symptoms of a hernia vary and depend on which type of hernia a person has. The symptoms of a hernia may range from nonexistent (asymptomatic) to severe complications, depending on the case, the size of the hernia and whether or not the hernia is incarcerated or strangulated. If a person has a hernia, they will most likely see a small, soft protrusion or bulge, usually in the groin or upper thigh area. This bulge may be most apparent when a person is standing up straight.
The bulge of an intestinal hernia that is coming out of the abdominal wall, such as an inguinal hernia or femoral hernia, may only be visible part of the time if the hernia is not trapped, or incarcerated. In other words, the hernia may go back in part of the time and bulge out when abdominal pressure increases during straining or coughing. Being in a standing position for a while may also cause the hernia to bulge out. Sometimes inguinal and femoral hernias may cause pain, a feeling of heaviness or discomfort in the groin and lower abdominal region. The pain may be subtle and it may get more severe when coughing, straining, lifting something heavy or bending over.
Inguinal or femoral hernias should be able to be temporarily pushed back in without too much pressure. If you can not do this, there is a chance that the hernia has become trapped at its exit point in the abdominal wall and you should have it examined by a doctor. Sometimes this can happen on a temporary basis due to swelling, and if the swelling goes down the hernia becomes unstuck. If the trapped hernia becomes squeezed to the point that its blood supply gets cut off, however, this is a serious medical emergency. This is called a strangulated hernia and it requires surgical treatment because without adequate blood supply, the trapped section of small intestine can become blocked off and can even start to die, possibly becoming necrosed and gangrenous. Symptoms of a strangulated hernia, besides the hernia being trapped outside the abdominal wall, include: intense pain, the hernia turning purple or red, nausea, vomiting and fever. Most hernias never become strangulated, but they should all be monitored. If a strangulated hernia does occur, seek medical attention immediately.
An umbilical hernia has similar symptoms to inguinal and femoral hernias, but it is coming out of the front of the abdominal wall near the belly button instead of in the groin and upper thigh area. A hiatal hernia, however, is different; instead of intestine coming through the abdominal wall, a hiatal hernia involves part of the stomach coming through the hole in the diaphragm that the esophagus passes through. A hiatal hernia may be completely asymptomatic or it may involve chest pain or discomfort. A hiatal hernia can also cause stomach symptoms such as heartburn due to acid reflux, nausea, upset stomach and excessive burping.
Not all hernias will be noticed by the person who has them. Some hernias are not noticed until a clinical examination when a person goes in to see a doctor for another reason. These asymptomatic hernias are usually not a problem, however. Hernias usually only require treatment if they are painful and swollen, if they are getting larger or if they become incarcerated or strangulated. Treatment for hernias will be discussed further in an upcoming article.