Hernia

Also called Inguinal hernia, Rupture, Umbilical hernia

A lump that comes and goes with straining is usually not urgent. A lump that will not go back, and is painful, is an emergency.

What it is

Part of an organ, usually bowel or fat, pushing through a weakness in the muscle wall that should contain it.

Most are in the groin, and most of those are inguinal hernias, far more common in men. Others occur at the navel, at the site of a previous operation, or at the top of the stomach, which is a hiatus hernia and behaves differently.

They do not heal on their own and they do not go away with exercise. A truss or support belt manages a hernia; it does not treat it.

The reason this is more than a lump is strangulation. If the contents get trapped and the blood supply is cut off, the bowel begins to die within hours. That is a surgical emergency, and it is the whole reason to know what a hernia is.

Most hernias that are not causing symptoms in adults can be watched rather than repaired, which is a legitimate decision and not neglect. Umbilical hernias in babies almost always close by themselves in the first few years.

Signs you might notice

A lump or bulge, often in the groin, that appears on standing, coughing or straining and disappears on lying down.

A dragging or aching feeling, worse at the end of the day or after lifting.

The lump gradually getting bigger over months.

999 or A and E now: a lump that suddenly becomes painful, hard, red or purple; a lump that cannot be pushed back; vomiting; a swollen abdomen; being unable to pass wind or open the bowels; or fever with any of these. This is strangulation or obstruction and is measured in hours.

In a baby: an umbilical or groin lump that becomes hard, tender or discoloured, or a baby who is vomiting and distressed.

How it can affect day-to-day life

Waiting lists for routine hernia repair are long, and people are often left for a year or more with a lump that limits what they can lift and how they work. That has real consequences for manual workers.

The anxiety of not knowing whether a lump is dangerous is a common and under-recognised part of it. Being taught explicitly what strangulation looks like, and what to do, removes most of that fear.

After repair, most people are back to normal activity within a few weeks. Some are left with long-term groin pain, which is under-discussed before surgery and worth asking about.

Chronic cough, constipation, an enlarged prostate causing straining, obesity and heavy lifting all make hernias worse and all recur after repair if they are not addressed.

Supporting someone well

Get any new lump examined rather than watched at home, so it is at least identified.

Learn the emergency signs and act on them the same hour. A hernia that will not go back and hurts is A and E, not a GP appointment.

Do not try repeatedly to force a stuck hernia back.

Deal with what causes the straining: constipation, a chronic cough, smoking, weight, and lifting technique at work.

Ask what the plan is if it is being watched, and what would change it.

Ask about the risk of long-term pain before consenting to repair, and about the approach being used.

After surgery, follow the lifting advice for the period given, then get back to normal activity rather than protecting it indefinitely.

Where to get help

A GP practice for a new lump, or for one that is changing.

999 or A and E for a painful, hard, irreducible lump, vomiting, or being unable to open the bowels.

Guts UK publish clear information on hernias and abdominal symptoms.