Inguinal Hernia: Symptoms, Types, Surgery & Recovery

An inguinal hernia is a soft bulge in the groin, where fat or bowel pushes through a weak point in the lower abdominal wall, just above the groin crease. It is the most common hernia in this part of the body — الفتق الأربي in Arabic — and it is what most people mean when they talk about a rupture in the groin. The weak point is at the inguinal canal, a short passage that runs through the lower abdominal wall in the groin.

The usual picture is a soft swelling under the skin in the groin or near the pubic bone, with normal-coloured skin over it. It appears or grows when you stand, cough or strain, and shrinks or disappears when you lie down. It often starts small and painless, then grows over time and brings a feeling of heaviness or dragging with it. But not every hernia is a visible bulge: a small or deep one — particularly in women, and in people carrying extra weight — may never show at all, and pain or heaviness in the groin is then the only sign. And not every swelling in this area is a hernia; only a medical examination settles that.

Inguinal hernias are more common in men, but this is not a men's condition. Women get them at any age, and in women they usually show up as pain, tightness or a dragging heaviness in the groin rather than an obvious lump — one reason the diagnosis is so often delayed. There is also a second hernia in the same area: the femoral hernia, which comes out through a narrow opening just below the groin crease, whereas an inguinal hernia sits above that crease. The femoral hernia is more common in women than in men, and far more likely to become trapped and strangulated, which is why it is normally repaired rather than watched; the inguinal hernia is still the most common hernia in both men and women. The two cannot be told apart by looking or feeling; that takes a clinical examination. So if you are a woman who has noticed a lump or a persistent pain in the groin, this page is about you too, and there is more in Inguinal hernia in women below.

Inguinal hernias also happen in babies and children, but the cause there is different: a natural passage that was open before birth and never closed, not a weakness in the muscle. Because of that it does not close on its own, it is not left under observation, and it is repaired surgically once it has been diagnosed. The hernia that often does close by itself is the umbilical hernia at the navel, which is a different condition altogether. There is more in Inguinal hernia in children and babies below.

Please note: this information is for general education and does not replace examination and medical advice.

When is it an emergency? Go to the emergency department of the nearest hospital straight away — or take your child there — day or night, and without waiting for an appointment, if any of the following appears. One sign on its own is enough to go; do not wait for the rest to appear:

Severe or sudden pain in the bulge that does not ease with lying down or rest.

The bulge has become hard, or very tender to touch, or has stopped going back in when it used to go back.

A change in the colour of the skin over the bulge, to red or blue, or heat over it. The absence of a colour change does not mean it is safe; discolouration is a late sign.

Nausea or repeated vomiting, especially if the vomit turns greenish.

Not passing gas or stool, with a swollen abdomen and cramping pain.

Severe pain in the groin or abdomen with vomiting and no gas passing, even if there is no visible bulge at all — and particularly with a femoral hernia.

The bulge suddenly disappears, especially after an attempt to push it back in, while the pain or the vomiting carries on. Disappearing here is not improvement.

Fever or a racing pulse.

In a baby or child: constant, inconsolable crying, refusing feeds, vomiting, a firm lump that will not go back in or does not disappear during sleep, or a swollen or discoloured groin or scrotum.

And do not try to force the bulge back in if it is painful, hard or discoloured, and do not let anyone else do it. Forcing it can injure the bowel, or push damaged bowel back into the abdomen so that the bulge disappears and it all looks like an improvement while the danger carries on out of sight. Do not settle for a painkiller, do not use a laxative or an enema, and do not wait for a clinic appointment or for the morning. It is better not to eat or drink until a doctor has seen you, in case urgent treatment is needed.

What is the inguinal canal, and why does a hernia happen?

An inguinal hernia is the most common hernia in the groin — the area where the lower abdomen meets the top of the thigh. In plain terms, part of the contents of the abdomen — fatty tissue, or a piece of bowel — pushes out through a weak point in the lower abdominal wall at the inguinal canal, and appears under the skin as a soft swelling in the groin or near the pubic bone.

The inguinal canal is a short, slanting passage inside the lower abdominal wall. It runs just above the inguinal ligament — the ligament that lies directly under the visible groin crease, the fold that separates the lower abdomen from the thigh:

In men, the spermatic cord passes through it, and it is the route by which the testis descends into the scrotum in the last months before birth.
In women, the round ligament of the uterus passes through it. The canal is narrower and carries less, which is why inguinal hernias are far less common in women than in men: estimates put the lifetime risk at about one man in four compared with about one woman in thirty. But that does not make them rare in women. An inguinal hernia is still the most common hernia women get, and a swelling in a woman's groin matters no less than one in a man's.

Immediately below the inguinal ligament, the femoral artery and vein cross into the thigh, and beside them, on the inner side, lies a different opening — narrower than the inguinal canal, and with stiffer edges — called the femoral canal. A hernia that comes out through this opening is a femoral hernia: a different condition from an inguinal hernia, more common in women than in men, and more dangerous, because it becomes trapped and strangulated far more often. The types section below sets it out in detail.

Why a hernia happens in this particular place

A hernia does not have one single cause. It takes two things coming together:

A weak point in the abdominal wall. This is either present from birth — a natural passage that never fully closed — or acquired later: tissue that weakens with age, an inherited tendency to weaker connective tissue, smoking, which weakens that tissue further, or previous surgery in the area.
Repeated pressure inside the abdomen. A long-standing cough, constipation and straining to open the bowels, straining because of difficulty passing urine, lifting heavy loads, extra weight, and pregnancy.

With repeated pressure the opening widens little by little, so the bulge grows and becomes clearer when you stand, cough or exert yourself, and less obvious or gone when you lie down.

This opening is a gap in a muscular wall. Once a hernia has appeared, it does not heal by itself — not in adults and not in children, and no exercise and no support belt will close it. A hernia belt, or truss, is neither a treatment nor a lighter alternative to one: it is pressure applied from the outside, it does not repair the opening, it does not stop the hernia becoming trapped (incarcerated) or strangulated, and it can hide the fact that the hernia is growing, irritate the skin and delay the diagnosis. It is used only in limited situations, decided by a doctor, for a patient who is not fit for surgery, and it is never a substitute for being examined.

Types of inguinal hernia, and the femoral hernia

To the person who has one, these all look much the same: a soft swelling under the skin in the groin or near the pubic bone, with normal skin colour over it, starting about the size of a grape and sometimes growing well beyond that, appearing or getting bigger when you stand, cough or exert yourself, shrinking or disappearing when you lie down, often with a feeling of heaviness or dragging. Because they look so alike, you cannot work out for yourself which type you have. A doctor tells them apart on clinical examination, with an ultrasound scan when one is needed. And not every swelling in the groin is a hernia: it may be an enlarged lymph node, a fatty lump or something else, which is one more reason to be examined before assuming the diagnosis.

1) Indirect inguinal hernia

The most common type in both men and women. It usually starts from a passage that was open before birth and never closed completely, so the hernia enters through the deep inguinal ring — the entrance to the canal — and travels along the inguinal canal itself. That ring can also widen with age. The hernia may appear in infancy or childhood, or stay hidden for years and show up at puberty or later. In men the bulge may extend down as far as the scrotum; in women it may reach the labium majus. This is the usual type in children, and a child's hernia is not watched in the hope that it will close on its own — it is referred for surgical repair.

2) Direct inguinal hernia

This type appears with age, as the back wall of the inguinal canal weakens. The hernia pushes straight through a weak area of that wall close to the pubic bone, rather than along the passage left over from before birth. It is more common in men after middle age, rare in children, and seldom descends into the scrotum. Direct and indirect hernias can occur together on the same side.

3) Femoral hernia

This one comes out through the femoral canal, immediately below the inguinal ligament, which means its bulge sits below the groin crease, in the upper thigh, while the bulge of an inguinal hernia sits above that crease and closer to the pubic bone. But the difference is a fine one: a femoral hernia can curl upwards as it grows, so that it looks as though it is above the crease. It is not something you can settle for yourself by looking or feeling. What sets this type apart:

It is more common in women than in men, particularly at older ages — although the inguinal hernia is still the most common hernia in both men and women. So the fact that hernias in general are more common in men does not make a swelling in a woman's groin something to ignore.
The opening it passes through is narrow, with stiff edges, so whatever enters it is easily trapped and cut off from its blood supply. That makes the femoral hernia, by a wide margin, the hernia in this region most likely to become incarcerated and strangulated, and a large proportion of them are not found until they are already an emergency.
For that reason, a femoral hernia is normally repaired surgically once it has been diagnosed, even if it is small or painless. Watchful waiting — which may suit a small inguinal hernia with no symptoms in an adult — is not used for a femoral hernia. It is also why, in a woman, surgeons lean towards repairing a groin hernia and inspecting the femoral opening during the operation, rather than settling for observation.
It can be small and hard to see, particularly with extra weight, and its first sign may be an attack of abdominal pain with vomiting and no gas or stool passing, with no obvious bulge at all. Those are signs to go to the emergency department straight away.

The practical point is that any swelling, or any persistent pain, in the groin — in a woman or a man — deserves a medical examination to establish which type it is, because the type is what decides how urgent treatment is. It is worth knowing, too, that watchful waiting for a small inguinal hernia with no symptoms in an adult is a postponement and not a treatment: more than half of those who choose it come to surgery within a few years, as pain appears or the hernia grows, and the figure approaches two-thirds by ten years. It is not used for a femoral hernia, it is not used for a hernia in a baby or a child, and even in an adult it is only ever considered for a small hernia that causes no symptoms.

What follows is not two more anatomical types. These are two states that any hernia can enter, inguinal or femoral, and they are what decide how urgent treatment becomes. Most hernias, at the start, are reducible: the bulge goes back in when you lie down, or with gentle pressure.

Incarcerated hernia: when the bulge will not go back in

The contents of the hernia become trapped inside its sac and no longer return into the abdomen when you lie down, or with gentle pressure; the medical word for this is irreducible. The blood supply may still be intact at this stage, but the situation is unstable and can turn into bowel obstruction or strangulation within hours. So if a hernia that used to go back in stops going back in, that is a reason to go to the emergency department there and then, not to wait for a clinic appointment — all the more so if there is pain, nausea or vomiting.

And do not try to force the bulge back in, and do not let anyone else do it, especially if it is painful, hard or discoloured. Forcing it can injure the bowel, or push it back into the abdomen while it is still trapped and damaged, so that the bulge disappears and the whole thing looks like an improvement while the danger carries on inside. It is better not to eat or drink until a doctor has seen you, in case urgent treatment is needed.

Strangulated hernia

The blood supply to the trapped tissue inside the hernia is cut off, and the tissue begins to die within hours. The pain becomes severe and constant, and does not settle when you lie down. The bulge becomes tense, hard and very tender to touch, and the skin over it may turn red or bluish. There may be nausea, vomiting, a swollen abdomen, or no gas and stool passing, and the temperature may rise and the pulse quicken. Strangulation can happen in a small femoral hernia that is barely visible, so that abdominal pain, vomiting and no gas passing are all there is to see, with no obvious bulge.

This is a life-threatening emergency: go to the emergency department of the nearest hospital immediately, day or night. Do not wait until the morning, do not try to push the hernia back, and do not take a painkiller so that you can put up with the pain — a painkiller hides the signs and does not restore the blood supply to the bowel, and the situation does not get better by waiting. Delay turns a planned repair into a larger emergency operation that may require removing part of the bowel.

Symptoms of an inguinal hernia

In most cases the first thing people notice is not pain but a bulge — many call it a lump or a swelling — in the groin or next to the pubic bone. Months often go by before the person mentions it to a doctor, because it comes and goes and at first causes nothing worse than a feeling of heaviness. So it is worth knowing exactly what it looks like, and knowing the point at which it stops being something to keep an eye on and becomes a warning you cannot put off.

An inguinal hernia: what it looks like, and how to check yourself

In its usual form an inguinal hernia is a bulge under the skin, in the area between the lower abdomen and the top of the thigh. This is what it looks like to someone standing in front of a mirror:

Where it sits: on the right or the left side of the lower abdomen, above the groin crease and close to the pubic bone.
Size: anywhere from a bulge so small it is barely visible to one the size of a fist in advanced cases.
It comes and goes: it pushes out when you stand, cough, sneeze, laugh, strain or lift something heavy, and it shrinks or disappears altogether when you lie flat on your back.
How it feels: soft and springy at first, and not tender to touch. It slips back in by itself when you lie down, or with very gentle, painless fingertip pressure, sometimes with a faint gurgle.
The skin over it: completely normal — no redness, no blue tinge, no warmth.
In men: the bulge may reach the top of the scrotum or extend down into it, so that one side looks clearly larger than the other.
In women: the bulge is usually smaller and sits deeper, so it is easier to miss. When it is visible, an indirect hernia can extend down into the labium majus, just as it extends into the scrotum in men.
It changes through the day: smaller in the morning after a night's sleep, larger by the end of the day after long periods of standing or exertion.
In babies and children: parents usually notice a bulge in the groin or the scrotum that appears when the child cries, strains or passes a stool, and disappears during sleep and rest.
Sometimes there is nothing to see: in some women, and in people carrying extra weight, there is no visible bulge at all, and a sense of fullness, heaviness or dragging in the groin is the only sign.

A simple check you can do yourself: stand up straight and relaxed, rest your fingertips lightly over the area, then give one firm cough. Feeling a push against your fingertips as you cough is one of the clearest signs that a hernia is there, and it is the same thing a doctor looks for during a physical examination. If the area is already painful, or the bulge is hard, do not press on it and do not force yourself to cough — that is a hernia to show a doctor straight away.

Above the groin crease or below it? Inguinal hernia versus femoral hernia

Where the bulge sits in relation to the groin crease is what separates two different hernias — and the two differ in how dangerous they are. An inguinal hernia appears above the crease, near the pubic bone. A bulge that appears just below the crease, at the top of the inner thigh, may instead be a femoral hernia.

A femoral hernia is less common overall, but it happens more often in women than in men, and the opening it comes through is narrow, with rigid edges that do not stretch. That makes it the groin hernia most likely to strangulate, and a large share of cases are first discovered when they have already become an emergency. It is also smaller and harder to spot — it may be no more than a pea-sized swelling under the crease. For that reason it is not left under watchful waiting; once it has been diagnosed it needs prompt medical assessment and surgical repair without long delay. Watchful waiting is only ever an option for a small, symptom-free inguinal hernia in an adult. It is not an option for a femoral hernia, and it is not an option for a child, whose hernia is repaired rather than watched.

Do not decide the type for yourself: telling an inguinal hernia from a femoral hernia by sight or by feel is unreliable, and it may take a clinical examination and an ultrasound scan. Any swelling in this area — above the crease or below it, in a man or a woman — deserves a medical assessment, and you should never conclude from where it sits that it is "the simple type" that can wait.

Symptoms that come with the bulge

Pain or burning, or a dragging feeling that gets worse with exertion, bending or standing for a long time.
Heaviness or discomfort in the groin, which may spread to the top of the inner thigh.
A sudden stab or twinge of pain when you get up from sitting, when you cough, or when you lift something heavy.
Swelling of the scrotum in men, sometimes with a heavy feeling in it.
Pain that eases when you lie down and usually settles once the bulge has slipped back in.
In a fair number of cases there are no symptoms at all, and the hernia is picked up during a medical examination done for something else.

Not every groin lump is a hernia

A swelling in this area can be something else entirely: an enlarged lymph node, a sebaceous cyst, a collection of fluid around the testicle (a hydrocele) or enlarged veins in the scrotum (a varicocele) in men, or varicose veins that swell during pregnancy in women. Some of these have nothing to do with a hernia, and some need a completely different treatment. The sign that usually points to a hernia is that it grows on standing and coughing and shrinks on lying down — but that is not an absolute rule. A lump that stays put and does not change with your position is not automatically harmless; it simply has to be examined so that its nature is known. In the same way, pain in the groin with no bulge may be a muscle strain, a sports injury or a problem in the hip joint, and should not be assumed to be a hernia before it is examined.

Never force a hernia back in

A bulge that slips back in by itself when you lie down, or with very gentle fingertip pressure and no pain, is nothing out of the ordinary. But pressing on a hernia that is painful, hard or discoloured, or trying to push it back by force or with repeated pressure, is dangerous for two reasons: it can injure bowel that is trapped inside the hernia sac, and it can succeed in pushing a damaged or dead piece of bowel back into the abdomen — the bulge disappears, the person assumes the problem is over, while the damage goes on inside the abdomen and the diagnosis is delayed by precious hours. The rule is simple: what goes back gently is fine; what resists is left alone and shown to a doctor at once.

The same principle applies here:

Do not let anyone but a doctor handle the bulge — no pressing, no massage, no cautery, and no "putting it back" by a traditional healer or by a member of the family. Pushing a hernia back in once it has become stuck is a medical procedure, done after assessment and under observation; it is not a knack anyone can pick up.
Do not just take a painkiller to get through a painful bulge until morning; a painkiller masks the warning sign and does nothing about the trapped tissue.
Do not use a laxative or an enema if you have stopped passing wind or stool; the cause may be a bowel obstruction, and a laxative would make it worse.
Do not rely on a hernia belt or truss. A belt repairs nothing and it does not close the weak point. It can press on the herniated tissue and damage the skin and the muscle beneath it, and — more dangerous still — it can keep you from noticing that the hernia has stopped going back in. It is used only as an exception, on a doctor's decision, for a patient who cannot undergo surgery, and it is never a substitute for assessment and repair.

Red flags (go to the emergency department immediately)

Severe or sudden pain in the bulge that does not ease with lying down or with rest, or pain far out of proportion to the size of the bulge.
The bulge turning hard and no longer going back in (irreducible), or becoming very painful to touch.
A change in the colour of the skin over the bulge to dark red, blue or purple, or the skin becoming hot. Note that colour change is a late sign, and its absence does not mean the situation is safe.
Nausea or repeated vomiting, especially if the vomit turns greenish or smells foul.
No longer passing wind or stool, with marked bloating of the abdomen and cramping pain.
Fever, a racing pulse, or going pale and sweaty.
Severe groin or abdominal pain with vomiting and no wind or stool passing, even when there is no visible bulge at all — this is often how a strangulated femoral hernia announces itself.
The bulge suddenly disappearing after an attempt to push it in, while the pain continues or gets worse; the bulge going away here is not an improvement.
In a baby or a young child: constant crying that will not settle, refusing feeds, vomiting, a firm bulge in the area that will not go back in and does not disappear during sleep, or a swollen or discoloured groin or scrotum.

One of these signs is enough to go — do not wait for the rest of the picture to appear. They may mean the hernia has become incarcerated — stuck, and no longer possible to push back into the abdomen — or strangulated, meaning the blood supply to the herniated piece of bowel has been cut off; either can come with a bowel obstruction. These two are not separate anatomical types of hernia: they are states that any groin hernia can enter, inguinal or femoral. An incarcerated hernia can turn into a strangulated one within hours, and no sign tells them apart reliably at home, so both are handled the same way: the emergency department now, not the next day and not after waiting for a clinic appointment. The chance of saving the bowel falls with every hour of delay, and what would have been a straightforward repair can become an operation to remove part of the bowel. Note too that a strangulated femoral hernia may look like a small swelling that draws no attention at all, with vomiting and abdominal pain as the most obvious features.

Until a doctor has seen you: have nothing to eat or drink, in case anaesthesia and urgent surgery are needed, do not try to push the bulge back in, and do not drive yourself there.

Causes and risk factors for an inguinal hernia

An inguinal hernia is not the result of a mistake you made, and it has no single definite cause. It arises when two things come together: a weak point in the abdominal wall, and repeated pressure from inside that pushes the contents of the abdomen towards that point. Once both are present, the bulge appears.

The weak point itself is either congenital — a natural passage that never closed completely after birth and stays a possible route for the rest of your life — or acquired: a gradual weakening of the tissues of the wall with age, or after previous surgery in the area. That is why the moment the hernia "appeared" — while lifting something heavy, say — is not the cause of it. It is the moment a weak point that was already there finally gave way under the pressure.

Factors you cannot change

Sex and age: an inguinal hernia is far more common in men, and the likelihood rises in both sexes with age. But it is not a men's disease: women get it too, and the femoral hernia is more common in women than in men and is the more dangerous of the two.
Being born prematurely, or with a low birth weight.
A family history of hernias, or an inherited weakness of the connective tissue.
A previous hernia on the same side or on the opposite side.
Previous surgery in the lower abdomen or the groin — an operation to remove the appendix, open prostate surgery, or any surgical incision low in the abdomen — because the wall stays weaker afterwards than it was before.

Factors you can do something about

These are the ones genuinely worth your attention, because keeping them in check lowers the chance of a hernia appearing, and lowers the chance of it coming back after a surgical repair:

A long-standing cough: every cough is another surge of pressure against the wall. Treating the cause of the cough — an allergy, a chronic chest condition — is a basic part of dealing with a hernia, and particularly so before surgery.
Smoking: it does harm twice over — a chronic cough on one side, and weakened wall tissue and slower wound healing on the other. It is one of the clearest reasons a hernia comes back after surgery.
Chronic constipation and straining to pass a stool: a daily, repeated strain on the weakest point in the wall. Fibre, enough water and regular movement genuinely reduce it.
Straining to pass urine: difficulty passing urine caused by an enlarged prostate in men after the age of fifty puts repeated pressure on the wall every day, which is why the prostate is assessed as part of the hernia plan rather than as a separate matter.
Lifting badly: bending from the back and holding your breath as you lift raise the pressure inside the abdomen all at once. There is no conclusive evidence that lifting on its own creates a hernia in a sound wall, but it is the commonest thing that brings an already existing weak point to light. Lifting with the knees bent, and breathing out through the effort, puts less load on the wall.
Extra weight and obesity: their link with actually causing an inguinal hernia is less clear-cut than is commonly claimed. But they do make it harder to find early, because the bulge hides among the tissues, and they make the surgical repair harder and complications and recurrence afterwards more likely. So weight control stays part of the plan, especially before surgery.
Pregnancy: it raises the pressure inside the abdomen and loosens the tissues of the wall. Many of the swellings that show up in this area during pregnancy are not hernias at all but enlarged veins that settle after delivery, which is why any new swelling in pregnancy is examined rather than explained away.
Raised pressure inside the abdomen from medical causes: such as fluid collecting in the abdomen, or peritoneal dialysis; following up the underlying cause is part of dealing with the hernia.
Jobs that involve long periods of standing or daily lifting without training or enough rest.

These factors do not create a hernia out of nothing, but they bring it out earlier and make it grow faster. Recurrence after a repair remains possible even when the surgery is meticulous. But ignoring these factors — smoking, a chronic cough and constipation first among them — is one of the commonest reasons a hernia comes back. Recurrence is also not the only long-term outcome worth knowing about before you agree to an operation: lasting pain in the groin after a repair is a common outcome rather than a rare complication, and it is one of the things to go through with your surgeon beforehand.

Inguinal Hernia in Women

An inguinal hernia is more common in men, but it is not a male condition — it happens in women at every age. What matters most in a woman is not only how likely a hernia is, but how it shows itself. A hernia in a woman is usually smaller and sits deeper, which is why it can go unnoticed, and undiagnosed, for a long time.

How does a hernia show up in a woman?

There may be no visible bulge at all, and nothing you can feel, especially if the hernia is small.
The most common complaint is pain, a dragging ache or a feeling of heaviness in the groin. It gets worse with long periods of standing, and with walking, coughing and lifting, and it eases when you lie down.
The feeling can spread into the inner thigh or towards the pubic area.
When there is a visible bulge, it can extend into the labium majus — the outer lip of the vulva — in the same way it extends into the scrotum in a man.
Because the usual symptom is pain rather than a lump, it is often wrongly put down to a muscle strain, to pelvic pain or to a gynaecological problem, and the diagnosis is delayed by months.

This is why a physical examination on its own may not be enough in a woman, and why an ultrasound scan, an MRI or a CT scan may be needed to confirm the hernia and establish its type. Not every lump in the groin is a hernia either: it may be a lymph node, a fatty lump or a dilated vein, and it is the examination and the imaging that tell them apart.

Femoral hernia: the type that must not be overlooked in women

Alongside the inguinal hernia there is another type that appears in almost the same place — the femoral hernia — and it is several times more common in women than in men. Even so, the inguinal hernia is still the most common type in women too. The point is not that every groin lump in a woman is a femoral hernia, but that it is a real possibility, and one that cannot be ruled out without an examination. The difference between the two types is practical, not academic:

Where it sits: an inguinal hernia appears above the groin crease — the fold where your lower abdomen meets your thigh. A femoral hernia appears directly below that crease, at the top of the thigh.
What it looks like: a femoral hernia is usually smaller and firmer, and can easily be mistaken for a swollen lymph node.
How risky it is: the opening a femoral hernia passes through is narrow and its edges are rigid, so it is far more likely than an inguinal hernia to become incarcerated — stuck, and no longer able to go back in — and then strangulated, which means the trapped tissue loses its blood supply. A femoral hernia is often found for the first time only when a complication brings someone to the emergency department needing urgent surgery.

Do not try to settle which type you have by looking or feeling. The difference is a fine one, and a femoral hernia can ride up above the crease as it grows and look exactly like an inguinal one; only a clinical examination, and sometimes a scan, can tell them apart.

Because of that, watchful waiting — which may be raised as an option for a small, symptom-free inguinal hernia in an adult — is not advised in women, because the chance that the hernia is a femoral one is higher. The usual approach is to assess any lump in the groin, or any persistent pain there, and to establish its type first; and to repair a femoral hernia once it has been diagnosed, without long delay, even when it is small and painless, because its risk of strangulating is high. What this asks of you in practice is not to choose between surgery and waiting, but simply not to leave a lump, or a persistent ache in your groin, unexamined.

If a lump in your groin becomes hard and painful and will not go back in, or the skin over it changes colour, or you begin vomiting, or you stop passing wind or stool, this is an emergency: go to the emergency department immediately. Do not try to force the lump back in, and do not wait for a clinic appointment.

Hernia during pregnancy

The rising pressure inside the abdomen as pregnancy advances can bring out a hernia that was never noticeable before, or make an existing one more obvious and more uncomfortable. That in itself is not a reason to be alarmed, but it is reason enough to have it looked at.

Not all groin pain in pregnancy is a hernia. There are other common causes, such as strain of the round ligament of the uterus or varicose veins in the area, and an examination is what tells them apart.
If the hernia is small, painless and goes back in, the usual approach is to keep it under review and plan the repair after delivery rather than during pregnancy — and the timing is a decision shared between the surgeon, your obstetrician and you.
Pregnancy is not a reason to put off an emergency. If the lump becomes hard and will not go back in, or the skin over it changes colour, or it comes with severe pain or vomiting, or you stop passing wind or stool, this is an emergency and you should go to the emergency department immediately, in any month of pregnancy — and do not try to force the lump back in.

Do women get inguinal hernias, or is it only men?

Women get them too, though they are more common in men. The difference is that a hernia in a woman is usually smaller and deeper, so it tends to show up as pain or heaviness in the groin rather than as an obvious bulge — which is why it is sometimes picked up late.

What is the difference between an inguinal hernia and a femoral hernia in women?

The difference is where it sits and how dangerous it is. An inguinal hernia appears above the groin crease; a femoral hernia appears directly below it, at the top of the thigh. A femoral hernia is more common in women and passes through a narrower opening, so it is far more likely to become incarcerated and then strangulated. That is why diagnosing it early matters, and why repair is not put off for long once the diagnosis has been made. The two are not told apart by looking or feeling, but by examination and sometimes a scan.

I have groin pain but no bulge — could it still be a hernia?

It could. A small hernia in a woman may produce no visible bulge at all, and pain or a dragging ache that comes on with standing and exertion may be the only symptom. A physical examination — with an ultrasound scan or an MRI when they are needed — is what separates a hernia from a muscle strain and from the other possible causes.

I am pregnant and I have found a lump in my groin — what should I do?

Have it examined, so that a doctor can establish what the lump is. Many of these can be kept under review, with the repair planned for after delivery — but that decision comes after the examination, not before it. If the lump becomes hard and will not go back in, or the skin over it changes colour, or it comes with severe pain or vomiting, do not wait for the appointment and do not try to force it back in: that is an emergency, and you should go to the emergency department immediately.

Inguinal Hernia in Babies and Children

An inguinal hernia in a baby is not a scaled-down version of an adult's hernia. In an adult the hernia comes from a weakness that develops in the abdominal wall with age, exertion and repeated pressure. In a child the abdominal wall is sound. The cause is a natural passage that was open before birth and should have closed on its own, but has stayed open, letting part of the abdominal contents slip down through it. That is what is called an indirect inguinal hernia.

One practical consequence follows from that difference: an inguinal hernia in a child does not close on its own. No belt, no massage and no amount of waiting will close it — a belt repairs no hernia, at any age — and the rule is that it is repaired surgically once it has been diagnosed, not watched. It should not be confused with an umbilical hernia around a child's navel, which often does close on its own during the first few years.

Not every swelling in a baby's groin or scrotum is a hernia. A hydrocele — a collection of fluid around the testicle — and other conditions can look much the same, and only an examination tells them apart. But that is a decision for the doctor to make after examining your child; it is not something that waiting at home settles.

Who is most at risk?

Boys, far more often than girls.
Babies born prematurely — and the earlier the birth, the higher the chance.
A family history of hernia, or an undescended testicle.
The hernia may also appear on both sides at once.

Repair in a child is not the same as repair in an adult

Because the problem is an open passage rather than a weak wall, the operation in a child consists of closing that passage and tying it off, and no mesh is used: the mesh put in during an adult repair is there to reinforce a wall that has become weak. The timing of surgery is set by the paediatric surgeon, and the usual approach is not to delay it long — particularly in the first months of life and in premature babies, when the risk of the hernia becoming incarcerated (stuck, and no longer able to go back in) is at its highest.

Warning signs in a baby (go to the emergency department immediately)

A baby cannot describe pain, and for that reason a strangulated hernia in a child — one where the trapped tissue has lost its blood supply — can go unnoticed. Take your child to the emergency department immediately if you see any of these signs:

Intense, continuous crying that does not settle when you pick your baby up or feed them, with no obvious cause.
A swelling in the groin or the scrotum that is firm and will not go back in.
Repeated vomiting, especially if the vomit turns green.
Refusing feeds, or being unusually drowsy and still.
Redness or a bluish colour of the skin over the swelling, or a swollen scrotum.
A swollen abdomen, with no wind or stool being passed.

Do not try to force the swelling back in, and do not wait for a clinic appointment or for the next morning. A strangulated hernia in a child is an emergency, exactly as it is in an adult.

In young girls the hernia sac may contain an ovary. This shows up as a small, fixed lump in the groin that does not go back in, and it may not be painful at first, which is why it is often brought to a doctor late. It is not something to watch at home: an ovary inside a hernia sac can twist and lose its blood supply, so it needs an urgent surgical assessment, not a period of waiting. And if it comes with pain, vomiting or a change in the colour of the skin over it, go to the emergency department immediately.

Will my baby's hernia close on its own, or does it need surgery?

An inguinal hernia in a baby does not close on its own, because its cause is a passage that failed to close before birth and not a weak muscle — so it is repaired surgically. The one that often does close on its own is the umbilical hernia around the navel, which is an entirely different condition.

Do children get mesh the way adults do?

No. In young children the repair is limited to closing the open passage and tying it off; their tissues are sound and do not need reinforcing with mesh. Mesh belongs to adult repairs, because in adults the underlying problem is a weakness in the abdominal wall itself.

When should I take my child straight to the emergency department?

Go straight there if the swelling becomes firm and will not go back in, if the skin over it changes colour, or if it comes with intense crying that will not settle, repeated vomiting, refusal of feeds, or a swollen abdomen. These are the signs of an incarcerated or a strangulated hernia. Do not try to force the swelling back in and do not wait for the morning — a delay of a few hours here can make a real difference to the outcome.

Complications of an Untreated Inguinal Hernia

A hernia is not new tissue that has grown in the body. It is an opening — a weak point in the abdominal wall that lets tissue from inside push out. In adults that opening does not heal by itself, and there is no medicine that closes it. Every cough, every strain and every heavy lift pushes tissue towards it, and the opening slowly widens. So the usual course of a hernia left unrepaired is gradual enlargement, and the larger it gets, the more likely it is that bowel will get caught inside it.

Most complications do not come out of nowhere. They follow a sequence that any hernia can move along, and the risk rises with every step. And the stages below are not separate kinds of hernia: incarcerated and strangulated are states that any hernia — inguinal or femoral — can pass into.

How an ordinary hernia turns into an emergency

Reducible hernia: the swelling appears when you stand or cough, and goes back in when you lie down or with gentle pressure. This stage is not an emergency, but nothing has healed either — the opening is still there.
Incarcerated hernia (irreducible): the tissue that has pushed through gets stuck and no longer goes back into the abdomen. The swelling stays visible even when you lie down, and turns painful or tight. The blood supply is usually still intact at this stage, but the hernia is now one step away from the far more dangerous complication.
Bowel obstruction: if the trapped part is a segment of bowel, nothing can move through it, and the result is cramping abdominal pain that comes in waves, a swollen abdomen, nausea and vomiting, and no gas or stool passing.
Strangulated hernia: the narrow neck of the hernia presses on the blood vessels and the trapped part loses its blood supply. The pain becomes severe and constant and does not settle when you lie down, the skin over the swelling may turn red or bluish, the pulse races and the temperature rises. Tissue starved of blood dies, the bowel can perforate, and the peritoneum — the membrane lining the abdomen — becomes inflamed. This is a life-threatening emergency that needs surgery without delay.

When to go to the emergency department immediately

Go to the emergency department immediately if the swelling turns hard, or becomes severely painful in a way that will not settle, or stops going back in; if the skin over it changes colour; or if it comes with vomiting, a fever, or no gas or stool passing.
Do not try to force the swelling back in if it is painful, hard or discoloured. Forcing it can injure bowel that is already damaged, and can push it back into the abdomen while it is still strangulated.
Do not eat or drink until a doctor has assessed you, because you may need an urgent operation.
Do not just take a painkiller and wait for the pain to pass. A painkiller hides the warning sign; it does nothing about the lost blood supply.
Do not put it off until the next morning, and do not wait your turn at a clinic. This is a case for the emergency department, not for an appointment.

The reason for the urgency is that strangulation is measured in hours, not days. Once the blood supply to the trapped bowel is cut off, its wall begins to break down within a few hours, and the damage can become irreversible before the day is out. The difference between an operation that repairs the hernia alone and one that has to remove a segment of bowel is usually a difference of hours — and emergency surgery carries a higher risk than planned surgery.

One situation catches many people out: a swelling that was painful and then went back in, either by itself or after someone pushed on it. The lump disappearing does not always mean the problem is over, because a piece of bowel may have gone back into the abdomen already damaged. If pain, vomiting or abdominal swelling carries on after the lump has gone, go to the emergency department anyway.

Not everything that comes from leaving a hernia alone is sudden. Some of it builds up slowly, and shows itself in the details of daily life.

Problems that build up slowly without being emergencies

The hernia enlarges until it becomes an obvious mass, and in men it may extend into the scrotum, changing its shape and causing a constant heaviness.
Chronic pain or a dragging feeling in the groin that limits work, walking, carrying children, praying, and finding a comfortable position to sleep in.
A belt or a truss is no substitute for assessment or repair: a hernia belt does not close the opening, does not prevent the hernia becoming trapped and does not prevent strangulation. It can hide the fact that the hernia is slowly enlarging, and with long use it can break down the skin or press on nerves. It leaves the cause exactly where it was, and adds a false sense of safety on top.
A more difficult repair later: a hernia that is large, or that has been left alone for a long time, usually needs a wider operation and a longer recovery than a small one.
Emergency surgery instead of planned surgery: if strangulation happens, the operation is done under emergency conditions and may include removing part of the bowel. Its risks are higher than those of a repair arranged in advance and carried out while you are in stable health.

Situations where incarceration and strangulation are more likely

Femoral hernia: it appears below the groin crease, not above it where an inguinal hernia sits. It is more common in women, and its neck is narrow with rigid edges, so it becomes trapped and strangulates far faster than an inguinal hernia — to the point that around a third of cases are first discovered in the emergency department, already incarcerated. For that reason watchful waiting is not an appropriate option for a femoral hernia; it is repaired without delay, even if it is small and even if it is painless.
A groin swelling in a woman: the chance that it is a femoral hernia is higher than it is in a man, so watchful waiting is not offered as a first option in a woman until the type of hernia has been established.
A hernia with a narrow opening, or a small tight swelling: a narrow opening traps tissue faster than a wide one, and a small hernia is not necessarily less dangerous than a large one.
A hernia that has appeared recently: the risk of it becoming trapped is highest in the first months after it shows up.
A hernia in a baby or a young child: it becomes trapped faster than an adult's and it does not close on its own, so it is repaired rather than watched. Any swelling that is hard or painful, or that comes with persistent crying and vomiting in a child, needs assessment straight away.
A hernia that has been trapped once before and then went back in by itself: it can happen again, and next time it may not go back.

None of this means that every hernia turns into an emergency, or that every patient needs an operation tomorrow. Strangulation is not the common outcome; the usual course is slow enlargement. That is why watchful waiting remains an acceptable option for a narrow group: an adult man with a small inguinal hernia that causes no symptoms worth mentioning. But it has to be said plainly that it is a postponement, not an alternative to repair. In the studies that followed these patients, about a quarter went on to surgery within the first two years — usually because pain appeared or got worse — and by around ten years of follow-up the figure had passed two thirds. In other words, most people who choose watchful waiting end up having the repair at some point, although the postponement itself does not make the later operation more dangerous, as long as it is still carried out as a planned procedure and not as an emergency.

Watchful waiting is not neglect. It comes with conditions: the patient knows the warning signs, keeps to follow-up, and is reassessed as soon as the hernia changes size or new pain appears. It is not suitable at all for a femoral hernia, for a child, for a hernia that causes pain or limits activity, or for a hernia that has been trapped before. And surgery itself is not without risks — recurrence, and chronic pain in the groin, which is one of the more common long-term problems after hernia repair rather than a rare complication. That is why the decision is a shared one between the patient and the surgeon after a direct examination, not a single rule applied to everyone.

How an inguinal hernia is diagnosed: examination and imaging

An inguinal hernia is diagnosed clinically in most cases: the doctor asks what you have noticed and examines the groin by hand, and that is usually enough to settle it. Most patients need nothing painful and nothing invasive. Imaging is not a routine step for everyone — it is requested when the examination does not settle the question, or when it will help in planning treatment.

Your history and the physical examination

The questions that matter: when did you first notice the bulge? Does it get bigger when you stand, cough or strain? Does it disappear when you lie down? Is there pain, nausea, or any change in your bowel habit? Do you have a chronic cough, constipation, a job that involves lifting, or previous abdominal surgery?
Examination standing, then lying down: a small hernia may not show at all while you are lying flat, so you are examined standing first and asked to cough or strain. That raises the pressure inside the abdomen, which brings the bulge out and lets its exact position be seen.
Where the bulge sits relative to the groin crease: an inguinal hernia lies above the crease; a femoral hernia appears just below it, at the top of the thigh. This is not a technicality — it changes how urgent the repair is and how it is done. Even for a doctor, though, examination alone does not always settle it: a large femoral hernia can ride up above the crease and look inguinal. That is why imaging is sometimes used, and why the answer is occasionally only certain during the operation itself.
Whether it can be pushed back: does the bulge go back in with gentle pressure, or not? No attempt is made to push it back if the hernia is painful, hard, or suspected of being strangulated — and in that situation, pushing a hernia back in is a medical decision taken after examination, never something to try at home.
The other side is examined too: a hernia on one side does not rule out a small, unnoticed hernia on the opposite side, and knowing that before surgery changes the plan.

The tests that help, and when they are actually needed

Ultrasound of the groin, done while you are standing and while you strain or cough. It helps when extra weight hides the bulge, when the hernia is small, when there is groin pain without a clear bulge, and in telling an inguinal hernia from a femoral one.
A normal ultrasound does not on its own rule out a hernia when your symptoms and the examination both point to one, because the accuracy of this scan depends on the experience of the person doing it and on its being done in the right position. In that situation a different scan is used, or you are reassessed.
CT or MRI for unclear cases, for a large hernia, for one that has come back after previous surgery, for planning the repair, or when bowel obstruction is suspected.
In an emergency the assessment is faster and broader — urgent examination together with blood tests and whatever imaging the situation calls for — but imaging must not delay surgery once the signs of strangulation are clear, because that decision is governed by time.

Not every swelling in the groin or the upper thigh is a hernia, so part of the doctor's job is separating a hernia from the other things that turn up in the same place.

Other causes of a groin lump that get ruled out

Enlarged lymph nodes in the groin.
A hydrocele, or varicose veins of the spermatic cord (a varicocele), in men.
A fatty lump (a lipoma) under the skin, or fat around the spermatic cord.
A skin cyst or an abscess.
A varicose swelling of the saphenous vein at the point where it drains into the groin, or a widening (aneurysm) of the femoral artery — a lump that pulsates needs a completely different kind of assessment.
An undescended or retractile testis in children and young men.
A muscle or ligament strain in the groin, which causes pain without any lump.

Because telling these apart depends on how the lump feels and how it behaves when you cough and when you lie down, it is the hands-on examination that settles the question — not a description in words, and not a photograph.

In short: most cases are diagnosed by clinical examination alone, with no painful or invasive procedure, and the role of a scan is to answer a question the examination left open, not to take its place.

Treating an inguinal hernia: when is surgery needed?

An inguinal hernia does not close by itself — not in an adult and not in a child — and there is no medicine, no exercise and no belt that rebuilds the weak point in the abdominal wall. The only curative treatment is surgical repair. So the real question is not "surgery or no surgery", but when it is done and by which technique. For one person the answer is "now, immediately"; for another it is "when symptoms appear".

Emergency surgery and planned surgery are two different decisions

One is an emergency you go to hospital for straight away; the other is a decision taken unhurriedly, after a full assessment. Keep one thing in mind as you read the list below: incarceration and strangulation are not separate anatomical types of hernia — they are states that any hernia, inguinal or femoral, can enter, and they are what decide how urgent treatment becomes.

An emergency — go to the emergency department now: severe pain in the bulge that does not settle when you lie down, skin over it turning dark red or bluish, nausea and vomiting, a swollen abdomen with no gas or stool passing, or a fever. These are the signs of a strangulated hernia or of bowel obstruction, and time is the deciding factor. This is not a situation for watchful waiting and not one for booking a later appointment: go to the emergency department of the nearest hospital immediately. Surgery is carried out urgently, and if arrival is delayed and the blood supply has been damaged, it may include removing a segment of bowel.
A bulge that will no longer go back in — assessed the same day: an incarcerated (irreducible) hernia can start out without severe pain and without vomiting, so people assume it can wait. It cannot. A hernia that has become trapped is one step away from strangulation, and there is no way to judge the blood supply from the outside. Be seen the same day — which in practice means the emergency department, not a clinic appointment and not the following morning.
Planned surgery: a hernia that causes pain or heaviness, that is gradually getting bigger, or that gets in the way of your work and your movement. Here the date is set once the assessment is complete, and this is the best situation for the patient, because the operation is done under stable conditions rather than as an emergency.
A femoral hernia: it appears below the groin crease, not above it, it is commoner in women, and its risk of becoming trapped and strangulated is far higher than that of an inguinal hernia — it is the hernia in this area most likely to become trapped, and strangulation is often the very thing that reveals it. For that reason a femoral hernia is normally repaired without delay once it is diagnosed, even if it is small or painless, and watchful waiting is not a suitable option for it. You cannot tell it apart from an inguinal hernia by looking at it or by describing it; clinical examination — and sometimes imaging — is what separates the two, which is why no one should decide for themselves which type they have.
Babies and children: a child's hernia is a different problem at its root. It is caused by a natural passage that failed to close before birth, not by weakness in the muscle. So once it is diagnosed it is repaired surgically, by closing that passage and without mesh, and it is not left under observation — particularly in the first months of life and in babies born prematurely, where the risk of it becoming trapped is at its highest. An inguinal hernia in a baby does not close on its own; the hernia that often does close on its own is the umbilical one, around the navel, and that is an entirely different condition.

If your hernia becomes trapped: what to do and what not to do

Do not force the bulge back in if it is painful or hard, or if the skin over it has changed colour. Forceful pressure can push bowel whose blood supply is already damaged — or bowel that has already died — back into the abdomen: the visible sign disappears, the danger continues inside, the diagnosis is delayed, and the bowel may tear. In this situation, pushing a hernia back in is a medical decision taken after examination, not something to attempt at home — and do not let anyone else attempt it either, not a family member and not a traditional healer, by pressing, massaging or any other method.
Do not apply hot compresses, do not massage the area, and do not strap it with a belt or a binder to hold the bulge in.
Do not take a laxative and do not use an enema if gas or stool has stopped passing. The cause may be bowel obstruction, and both make it worse.
Do not treat the pain at home and wait for it to pass. Painkillers can mask a sign that is needed for the assessment, and waiting is exactly what turns a repairable situation into a bigger operation.
Do not eat or drink on your way to hospital, in case you need an anaesthetic and urgent surgery.
If the bulge slips back in by itself after an episode of severe pain, still be seen by a doctor the same day and do not treat the matter as finished; the episode itself is a signal that the hernia has begun to become trapped.

Watchful waiting: who it suits and where its limits are

Watchful waiting is a legitimate option for an adult with a small, symptom-free, reducible inguinal hernia, and it is an option that has mainly been studied in men. In that specific picture the risk of strangulation is low, and there is no sense in rushing into an operation that is not treating a complaint you actually have. It is a decision your doctor makes after examining you and after confirming what type of hernia it is — not a decision you make for yourself because the bulge "doesn't hurt". And it is never the plan for a femoral hernia, and never the plan for a baby or a child.

The picture is only complete with one more fact: watchful waiting is a postponement, not an alternative to surgery. More than half of the people who choose it end up having the operation within a few years, because symptoms appear or because the hernia grows, and that proportion rises the longer follow-up continues. So it is a decision to be reviewed regularly rather than a final one, and it works only if you know the warning signs clearly and keep your follow-up appointments.

Watchful waiting is not suitable in these situations:

Pain, heaviness or discomfort that affects daily activity.
An incarcerated (irreducible) or strangulated hernia — that is an emergency, with no room for observation and no room for waiting.
A femoral hernia, because of its high risk of strangulation.
Any uncertainty about the type of hernia, and particularly in women, until a femoral hernia has been ruled out by examination or by imaging.
Babies and children, whose hernias are repaired rather than watched.
A hernia that is clearly growing over time, or that has become difficult to push back in.

The hernia belt: what it does not do

Hernia belts and trusses are sold in pharmacies, and many people buy one before they have shown the problem to a doctor. It is only fair to be clear about this: a belt repairs nothing. It is external pressure that holds the bulge in for as long as it is strapped in place; take it off and the bulge returns exactly as it was, because the weak point in the abdominal wall is unchanged.

It does not prevent complications: wearing a belt does not protect you from the hernia becoming trapped or strangulated, and it does not slow the hernia down as it grows.
It can do harm: constant pressure on the contents of the hernia can cause pain or break down the skin, and it can produce tissue changes and adhesions that make a later repair harder.
The most dangerous thing about it is the false reassurance it gives: someone used to a bulge that comes and goes with the belt may explain a new, sharp pain away as "the belt pressing", and so reach the emergency department late, in the hours when every hour counts.
Never put a belt over a hernia that is painful or that will not go back in. That is direct pressure on trapped tissue, and it makes the situation worse; it is a reason to go to the emergency department, not a reason to reach for a belt.
Its use is very limited: a doctor may prescribe one temporarily for a patient whose health does not allow surgery at that time — and even then it is used under medical supervision, and it removes neither the need for assessment nor the need to revisit the decision.

The same applies to exercise: no exercise closes a hernia that already exists, and hard abdominal workouts raise the pressure inside the abdomen rather than lowering it.

Surgical options: the repair techniques

The goal is the same in every technique: return the contents to the abdomen, then reinforce the weakened area. What differs is how the surgeon reaches it.

Open repair

The idea: a single incision over the hernia, the tissues are returned to their place, and the wall is then reinforced — usually with a mesh, and sometimes with stitches alone.
Advantages: in selected cases it can be done under local or regional (spinal) anaesthetic, which suits people who cannot tolerate a general anaesthetic, and the operating time is often shorter.
What you should know: the incision is relatively larger, and discomfort in the first few days may be more noticeable than after keyhole surgery.

Laparoscopic (keyhole) or robot-assisted repair (TAPP / TEP)

The idea: several small incisions through which a camera and fine instruments are passed, with the mesh placed behind the abdominal wall so that it covers the weak area from the inside.
Advantages: usually less pain in the first days and smaller scars, and it is a strong option for a hernia on both sides and for a hernia that has come back after an open repair, because it avoids the scarred tissue left by the previous operation. It also allows the femoral canal and the other side to be inspected during the same operation — a meaningful advantage in women, where femoral hernias are commoner and may sit alongside an inguinal hernia without showing up before surgery.
What you should know: it needs a general anaesthetic and specific experience with the technique, and it may not suit every patient, depending on general health or on previous lower abdominal surgery.

Mesh: why it is used and when it may not be

Mesh is a synthetic sheet fixed in place to cover the weak area. Using it in adults is the standard approach, because it reduces the chance of the hernia coming back compared with stitches alone. It is not compulsory in every case, though: a surgeon may choose a stitch repair in particular circumstances, such as contamination in the operative field, or the need to remove a segment of bowel in a strangulated hernia. Mesh is not used at all in children's surgery.

What you should know before you consent: recurrence and chronic pain

Hernia repair is one of the most frequently performed operations in the world, but no operation is without risks, and you have a right to hear them before you consent, not afterwards:

Recurrence (the hernia coming back): this happens in a proportion of patients whatever technique is used. It becomes more likely with smoking, extra weight, an untreated chronic cough or constipation, and going back to heavy lifting too soon.
Chronic groin pain: pain, burning or numbness that persists after the wound itself has healed. This is one of the most common long-term problems after inguinal hernia repair, not a rare complication, and it usually comes from one of the nerves in the area being irritated or injured. Many cases ease considerably with time; some need follow-up and treatment aimed specifically at the pain. This possibility in particular is one reason not to rush a small hernia that is troubling nobody into surgery.
Less common complications: a collection of fluid (a seroma) or of blood at the repair site, wound infection, temporary difficulty passing urine, numb skin around the scar, and rarely problems affecting the testicle in men or problems relating to the mesh itself.

Choosing the technique is not a matter of "old" versus "modern". It is a shared decision between you and your surgeon, based on the type of hernia, which side it is on and how large it is, your age and general health, your previous operations, the anaesthetic that suits you, and your surgeon's experience with the technique. Ask what the alternatives are, and why this particular technique is being recommended for you.

What to expect before and after hernia surgery

Before the operation

General assessment: tests and checks according to your age and condition, an anaesthetic assessment, and a review of long-term conditions such as diabetes and high blood pressure so that they are controlled before the date.
Medication review: tell your doctor about everything you take, especially anticoagulants and antiplatelet medicines (blood thinners), supplements and herbal remedies. Do not stop any medicine or change a dose on your own; whether to stop it, and when, is your doctor's decision alone.
Fasting before the operation for the period your anaesthetic team specifies — not the period people generally assume.
Controlling whatever raises the pressure inside your abdomen: treating a chronic cough and constipation before the date, and stopping smoking as far in advance of surgery as you can, because of its effect on breathing, on tissue healing, and on the chance of the hernia coming back.
The consent conversation: the technique proposed, whether mesh will be used, the risks including recurrence and chronic pain, the alternatives available, and what recovery is likely to look like. This is your time to ask, and no question is too small.
If the hernia changes before your operation date — it becomes painful, or hard, or will not go back in, or is accompanied by vomiting — do not wait for the booked date; go to the emergency department.

After the operation

Going home: in many cases this happens on the same day or the day after, and your surgeon decides based on the technique, the type of anaesthetic and your own condition.
Pain: expect soreness or a pulling feeling around the wound that eases gradually over the first few days, controlled with pain relief your doctor prescribes. Any medicine after the operation — including an antibiotic, if your surgeon judges one is needed — is dispensed on a prescription from your treating team, and is not bought from a pharmacy on your own initiative.
Moving early: start gentle walking from the first day unless you are told otherwise; moving reduces the risk of clots and of chest problems.
Swelling and bruising: swelling or a change of colour in the groin, and in the scrotum in men, is common after the operation and settles gradually. Fluid can also collect at the repair site so that it looks as though the hernia has come back — that is assessed by a doctor, not settled by guesswork.
Wound care, follow-up appointments, and removal of stitches if there are any, all according to your treating team's instructions.
Bowels: enough fluids and fibre to avoid constipation and straining, during this period in particular.

Getting back to activity: by stages, not by the calendar

There is no single number that fits everyone, and your recovery is not measured against a relative's experience or a post on the internet. The practical rule is gradual progression: walking and light daily tasks early on, then widening your activity little by little as the pain allows, while leaving heavy lifting, hard exertion and strenuous sport until the time your surgeon specifies, based on the technique used, the nature of your work, and your own condition. When you can drive and when you go back to work are decided with your surgeon too, not by a general timetable. And pain during an activity is a sign to ease off it, not to push through it.

Signs that mean you should contact your doctor or return to hospital

A new bulge at the operation site with severe pain, or with vomiting, or one that will not go back in — to the emergency department immediately, as the hernia may have come back and become trapped.
A fever, or redness and warmth spreading around the wound, or discharge from it.
Pain that increases instead of easing, or that is not controlled by the pain relief you were prescribed.
Being unable to pass urine after the operation, or clear difficulty in doing so.
Repeated vomiting, a swollen abdomen, or no gas or stool passing.
A new painless swelling at the operation site — it may be a collection of fluid and it may be a recurrence, and that is not settled by looking at it but by assessment with a doctor.
Pain or swelling in the leg, shortness of breath, or chest pain.

Prevention and reducing your risk

Let us be honest about this: not every hernia can be prevented. If the weak point is anatomical, present from birth or inherited, then no diet and no exercise will stop it appearing, and nothing "tightens" the abdominal wall enough to close a gap that is already there. What you genuinely can do is reduce the repeated pressure inside the abdomen, and that lowers the chance of a hernia appearing or getting worse, and lowers the chance of it coming back after a repair.

Treat a chronic cough rather than living with it; a repeated cough is daily pressure on the weakest point in the wall.
Stop smoking: the cough eases, and smoking has a known effect on how tissue heals and on the chance of the hernia coming back after a repair.
Treat constipation: fibre in your food, enough fluids, daily movement, and not spending a long time straining on the toilet. And any lasting change in your bowel habit deserves to have its cause looked into.
Do not ignore difficulty passing urine, or straining to pass it: causes such as an enlarged prostate in men from middle age onwards raise the pressure inside the abdomen every day and deserve to be assessed.
Keep your weight moderate: extra weight raises the pressure inside the abdomen, and it makes both the clinical examination and the surgery harder.
Lift properly: keep the load close to your body, bend at the knees rather than the back, do not hold your breath as you lift, and for heavy loads get someone to help you or use suitable equipment. If your work involves repeated lifting, build the load up in stages rather than jumping straight to it.
In pregnancy: keep up your follow-up with your doctor, and have any swelling that appears in the groin or at the top of the thigh during pregnancy assessed rather than assuming what is causing it.

What does not help: abdominal exercises neither treat a hernia nor prevent one, and a hernia belt is neither a way of preventing one nor a treatment for one. After a repair there is no need for a belt unless your surgeon prescribes one for a particular reason. The most useful thing you can do to avoid complications is to have any swelling in the groin or at the top of the thigh assessed early — and its type identified — rather than putting it off until it becomes an emergency.

Frequently asked questions about inguinal hernia

What does an inguinal hernia look like, and how do I know if the lump is a hernia?

An inguinal hernia usually looks like a soft bulge under the skin in the groin, where the top of the thigh meets the lower abdomen, or just beside the pubic bone, with normal skin colour over it and no redness. It often starts about the size of a grape and can grow over time until it is close to the size of a fist. The clearest sign that a lump is a hernia is that it changes with your position: it pushes out when you stand, cough, sneeze, strain on the toilet or lift something heavy, it gets smaller or disappears completely when you lie flat on your back, and it comes straight back when you stand up again. A feeling of heaviness or dragging in the groin often comes before the bulge is easy to see. In men the bulge may extend down into the scrotum. In women it may sit at the groin crease or reach the labium majus, and it is usually smaller and harder to notice. Where the bulge sits also helps separate two different types of hernia: an inguinal hernia sits above the groin crease, while a femoral hernia sits just below it, is smaller, is more common in women, and traps bowel far more often, which is why a femoral hernia is repaired rather than watched. You cannot settle that difference by looking at the lump or feeling it yourself; it takes a clinical examination and sometimes an ultrasound. Other swellings in the groin can look like a hernia too, such as an enlarged lymph node, a fatty lump, a fluid collection around the testicle or varicose veins, and telling them apart needs a medical assessment. If the lump stays put and no longer disappears when you lie down, or it turns hard, painful or hot, or the skin over it changes colour, or it comes with severe pain, nausea and vomiting, or you stop passing gas and stool, do not try to push it back in, and go to the emergency department immediately.

Do women get inguinal hernias too, and is it different in women?

Inguinal hernias are more common in men, but women get them too, at any age. They are harder to diagnose in women, because the hernia is usually smaller and deeper and may not show as a bulge at all. The first symptom is often pain, pulling or heaviness in the groin that gets worse with long standing and exertion, and it is often put down by mistake to pelvic pain, back pain or pregnancy. The more important difference is that women are more prone to a femoral hernia, which comes through a narrow opening lying just below the groin crease. Because that opening is narrow, bowel is far more likely to become trapped in it and lose its blood supply than in an ordinary inguinal hernia, so much so that a large proportion of femoral hernias, around a third or more, are only found after the woman reaches the emergency department with an acute complication. For that reason watchful waiting is never applied to a femoral hernia, and surgical repair is advised without delay even when it is small or causes few symptoms. So any lump or lasting pain in the groin in a woman deserves a clinical examination soon rather than being put off, and an ultrasound or a CT scan may be requested to pin down the type of hernia and its exact position. In many women surgeons also lean towards a laparoscopic repair, because it lets them inspect the femoral opening and deal with it during the same operation.

Is a hernia in a baby or a child different from a hernia in an adult?

Yes, it is different in both its cause and its treatment. A hernia in a child is usually an indirect inguinal hernia caused by a natural passage that was open before birth and did not close afterwards. It is more common in babies born prematurely, and it shows as a bulge in the groin or the scrotum that appears with crying, straining or pushing during a bowel movement and disappears during sleep and when the child is settled. This kind of hernia does not close on its own, and it is not managed by watching it or by a belt: it is repaired surgically once it is diagnosed, and surgeons prefer not to delay it, because the risk of bowel becoming trapped is higher in infants than in adults and rises the younger the child is, and because trapping can also threaten the blood supply to the testicle in boys. The repair in children closes the open passage itself, and no mesh is used, because the abdominal wall is still growing. If the bulge turns hard or painful or will not go back in, or the skin over it changes colour, or the groin or scrotum looks swollen or discoloured, or the child refuses feeds, or vomits, especially if the vomit turns greenish, or keeps crying in an unusual way that will not settle, this is an emergency: go to the emergency department immediately, and do not try to press the bulge back in.

Can a hernia go away on its own without treatment?

A hernia in an adult does not disappear on its own, and the abdominal wall does not heal itself, because a hernia is an opening or a weak point in the muscle wall, not a growth or an inflammation that settles with time. What happens in practice is that the bulge may disappear for a while when you lie down and return when you stand. That only means the contents of the hernia have slipped back into the abdomen; it does not mean the hernia has healed. Over time a hernia tends to widen gradually, so the repair becomes harder and the chance of bowel becoming trapped goes up, which is why putting off a medical assessment does not make the situation simpler. Two different conditions are often confused here: an inguinal hernia in a baby does not close by itself and is repaired surgically rather than watched, unlike an umbilical hernia around a child's navel, which very often does close on its own during the first few years.

Can an inguinal hernia be treated without surgery?

No medicine, exercise, course of physiotherapy or belt closes the hernia opening; the only cure is surgical repair. What you can do without surgery is lower the pressure inside the abdomen, which eases symptoms and slows the widening of the hernia: controlling your weight, treating constipation and a chronic cough, stopping smoking, and avoiding heavy lifting or lifting in the wrong way. For a small, symptom-free hernia in an adult man, the doctor and the patient may agree on watchful waiting after a clinical examination. That postpones surgery rather than replacing it, and it is not a cure. It stays conditional on knowing the warning signs and being reviewed immediately if anything changes. Long-term follow-up has shown that most people who chose watchful waiting ended up having surgery anyway, roughly a quarter to a third within the first two years and close to seven in ten within seven to ten years, usually because pain appeared or the hernia grew. Watchful waiting is not an option at all if the hernia is painful, is growing or will not go back in, nor for a femoral hernia, nor for babies and children. And be wary of anyone unqualified who offers to push a hernia back in by massage, pulling or cautery: it does not repair the abdominal wall, it can injure trapped bowel, and it delays proper treatment.

Does a hernia belt actually work?

A hernia belt or truss does not treat the hernia, does not close the opening in the abdominal wall and does not stop it widening. All it does is press the bulge inwards for as long as it is worn, which is why some people feel some relief while standing or walking. It is not a harmless option either: a badly fitting belt chafes and irritates the skin, it can press on the herniated tissue and injure it, and, most dangerous of all, it can mask the fact that your hernia is growing, so proper treatment is delayed. On top of that, it does not prevent bowel from becoming trapped or from losing its blood supply, so it cannot be relied on instead of assessment and surgical repair. It is never acceptable to put a belt over a hernia that is painful or will not go back in, because that is direct pressure on trapped tissue and can make matters worse; that situation calls for the emergency department, not a belt. Its use is acceptable only temporarily and only on a doctor's instruction, for instance while a patient waits for a scheduled operation, or when their general health does not allow anaesthesia at that time.

Does every hernia need surgery right away?

Not every hernia needs urgent surgery, but every hernia needs a medical assessment. A small, symptom-free inguinal hernia in an adult man that causes no pain, does not limit activity and slips back in easily can be followed with watchful waiting and regular review, provided the patient knows the warning signs well and can reach a hospital quickly if they appear. Surgery becomes the option to discuss if the hernia is painful, is growing gradually, or gets in the way of work and movement, and it can no longer be postponed in an incarcerated hernia that will not go back in, in a femoral hernia, or in a hernia in a baby or a child. A strangulated hernia is an emergency, and surgery is carried out immediately. It is important to know that planned surgery is far less risky than emergency surgery performed after bowel has become trapped or lost its blood supply, which is why waiting until a complication happens is not a safe choice. The surgeon decides the right timing after examining you and assessing the type of hernia and your general health.

Is the mesh used in hernia surgery safe, and does it stay in my body for life?

Surgical mesh is a synthetic material placed to reinforce the abdominal wall at the weak point, and it is the standard in repairing most adult hernias because it lowers the chance of the hernia coming back (recurrence) compared with stitching alone, in both open and laparoscopic surgery. The body forms fibrous tissue around it that fixes it in place over a few weeks, and it is designed to stay for life: it does not need replacing periodically, it does not stop you having an MRI scan, and it does not set off security scanners. Like any surgical procedure it carries possible complications that should be discussed with your surgeon before you consent, among them wound infection and a collection of fluid (a seroma) at the operation site, and, above all, chronic groin pain lasting beyond the third month. That is one of the most common long-term problems after inguinal hernia repair and not a rare complication, and it may need follow-up and treatment aimed at the pain itself. The chance of the hernia returning is lower with mesh but it is not zero, and a recurrence can appear years later and need a fresh repair. Mesh is not normally used in babies and young children, because their abdominal wall is still growing.

When can I go back to exercise and lifting weights after hernia surgery?

Going back to activity is gradual and follows a plan set by your surgeon according to the size of the hernia, the repair technique and your general condition. Light walking is usually advised from the same day or the day after, because it lowers the risk of clots and speeds up recovery, and you then build up the distance day by day. Lifting weights and exercises that strain the abdominal muscles are usually put off for about two to four weeks, and it may be longer depending on your case and the technique used, because the tissues need time to heal around the site of the repair. The practical rule is to let pain be your guide: stop any movement that causes pulling or pain at the wound, and try it again later in a gentler form. Mild swelling or bruising at the wound or in the scrotum during the first few days is expected and settles gradually, but see your doctor if the swelling increases, or there is redness, discharge from the wound, a raised temperature or severe pain, and likewise if a new bulge appears at the operation site, because it may mean the hernia has come back (recurrence).

What is the difference between an incarcerated hernia and a strangulated hernia?

These are not two separate anatomical types of hernia; they are states that any hernia, inguinal or femoral, can enter. An incarcerated hernia is one whose contents have become stuck outside the abdominal wall and no longer slip back in when you lie down or with gentle pressure, although the blood supply is usually still intact; on its own it is a warning sign that calls for urgent medical assessment, because it can turn into strangulation within hours. In a strangulated hernia the blood supply to the trapped bowel or fatty tissue is cut off and the tissue begins to die, with severe and escalating pain, a hard bulge and a change in the colour of the skin over it to red or blue, along with nausea, vomiting and no passage of gas or stool; it is life-threatening and needs urgent surgery. Do not wait for that whole picture to appear before you act, and do not wait for it to settle by itself: severe pain in a hernia that will not go back in is on its own reason enough to go to the emergency department immediately, all the more so because just part of the bowel wall can strangulate on its own, which happens more often in a femoral hernia, so the damage occurs with no vomiting and no obstruction and all you can see is a small painful lump that will not go back in. In neither case should you try to force the hernia back in.

When exactly should I go to the emergency department?

Go to the emergency department immediately, not to a clinic, not waiting for an appointment and not waiting until morning, if any of these signs appear: severe or sudden pain in the bulge that does not ease with lying down or resting; the bulge turning hard and tender to touch and no longer going back in after it used to; the skin over it turning red, dark or bluish; nausea and repeated vomiting; no passage of gas or stool along with a swollen, painful abdomen; or a raised temperature together with any of the above. In a baby or a small child there are further signs: a hard bulge that does not disappear during sleep, continuous unusual crying, refusing feeds, or repeated or greenish vomiting. One sign is enough to go, and it is wrong to wait for them all to appear. Do not try to force the hernia back in, and do not rely on painkillers to put off going, because they mask how the condition is developing. It is better to avoid food and drink on the way to hospital, because the situation may need urgent surgery.