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Frequently Asked Questions About Hernias

What is a hernia?

A hernia occurs when fatty tissue or an organ pushes through an opening the fascia (the layer of tissue overlying the muscle), the most common hernias occur in the abdomen, but they can also happen in the belly button, upper thigh and groin area.

The most common hernias are protrusions through the abdominal wall. Organs from the abdominal cavity, such as the intestines, push through the opening in the wall of the abdomen and create a bulge.

The abdominal wall is a sheet of tough muscle and tendon that runs from the ribs down to the legs. One of its primary functions is to hold the abdominal contents, primarily the intestines, in place.

If a weakness occurs in the abdominal wall, for whatever reason, then the organs behind the wall will simply push through the opening, creating a bulge that is often quite visible against the skin. This is the hernia.

The opening in the layer of tissue that is supposed to contain the protruding organ is called the “hernia orifice.”

The inner-most lining of the cavity that contains the organ as it pushes through the hernia orifice is called the “hernia sac.”

Doctors will describe the size of your hernia both by the dimensions of the hernia orifice and the volume of the distended hernia sac.

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What are Hernia symptoms?

The symptoms of a hernia can vary, and they often depend on the type or location of the hernia. In hernias located in the abdominal area, these are the most common hernia symptoms:

Protruding bulge

This is the most common symptom, and is often easily noticeable. Typically, a hernia bulge will appear at the site of an incision from a prior abdominal surgery, in the groin belly button, or between the belly button and the chest. The size of the bulge will vary from person to person. It may also change in size during the day, or after you rest at night.


Some people won't notice pain connected to the hernia at all, while others have immediate or excruciating pain. You may experience a sharp, sudden pain when the muscle tears or strains, creating the hernia, but you may not feel it at all. Some patients describe a pain similar to a muscle ache or strain. Others just notice a funny feeling or tearing in the groin that wasn't there before.

Pain from the creation of the hernia will usually lessen in a week or two, but your hernia will remain. Hernias do not self-repair.

Even if you did not experience pain when the hernia begins, you may experience localized hernia pain, as hernia enlarges. You may also experience pain in the hernia area when doing heavy lifting, during exercise, or while performing other strenuous work.

Sometimes patients experience referred pain from a hernia. This happens when the irritated nerves around the hernia share a nerve root with other parts of your body. The pain signals will travel on the same channel. Depending on the size and location of the hernia, pain could travel to the testicle, thigh, back or abdomen. This happens because the nerve roots originate from the back and the nerve to the testicle originates in the abdominal region.

Generalized abdominal pain could also be caused by a hernia. This happens when your intestines or other internal organs are trapped in the hernia sac, and become pinched.. Surgeons call this a strangulated hernia, and it is a serious and life-threatening condition.

The pain from a strangulated hernia is an abdominal pain which initially starts as a stomach ache and increases in severity, causing nausea and vomiting later. If the pinched tissues are not treated, they will die. The results could be fatal to the patient. A strangulated hernia requires immediate emergency surgery.

Nausea and vomiting

If you are experiencing nausea and vomiting with your hernia, you should seek immediate medical treatment. This could be a signal of intestinal obstruction, full or partial, and you may require emergency surgery.


If the hernia is blocking your intestine, you may experience constipation, or possibly blood in your stool. If you have an intestinal obstruction, you may require emergency surgery.


If the protrusion compresses a nerve, you could experience numbness or loss of feeling to the area of the hernia.

Urinary Difficulties

Sometimes a patient's bladder will be trapped within the hernia. If this happens, you could experience urinary burning, frequent infections, bladder stones and hesitancy or frequency in urinating. If you are experiencing these difficulties, you should consult your urologist or surgeon and see if they are caused by a hernia.

Other symptoms

Hernias can result in many less specific discomforts, depending on the placement of the hernia sac or the pressure that the sac places on nearby tissues. These symptoms may or may not be related to your hernia.

Hernia-related symptoms are usually worse at the end of the day, and may be relieved at night, when you are lying down and the hernia naturally becomes smaller.

A thorough examination by one of our surgeons can determine if your symptoms would be relieved with hernia surgery.

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What causes a hernia?

Hernias can happen to anyone: men, women, children, even babies, as some of us are born with congenital hernias.

The abdominal wall provides strong support for the internal organs, which are constantly exerting significant outer pressure. A gap can open in the tissue of the abdominal wall of its own accord at a point of natural weakness, or because it is over-stretched. Over-exertion or heavy lifting can cause a gap to open, but so can something as simple as a cough or sneeze.

Some things can increase your risk of hernia, including

  • Obesity
  • Tobacco use
  • Connective Tissue Disorders (for example, the genetic disorder, Marfan's Syndrome)
  • Conditions that lead to chronic straining or coughing
  • Prior abdominal surgery
  • Diabetes Mellitus

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How do you treat a hernia?

Hernias can't heal on their own, and they never just go away. If the bulge you have is indeed a hernia, then you will need to have surgery in order to have it repaired.

Even if you are not experiencing pain or other discomfort from your hernia, it is not a condition that you should leave untreated. Our hernia specialists recommend that you have elective surgery to repair your hernia and avoid the chances of experiencing an obstruction or surgical emergency in the future.

There are different types of surgical procedures available to repair hernias. Your surgeon will be happy to discuss these with you, recommend the best procedures, and explain the benefits and risks of hernia surgery.

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What is laparoscopic hernia repair?

In the age of minimally invasive surgery, laparoscopic hernia repair through small incisions is often the the best surgery with the fastest recovery. In this technique, the hole in the abdominal wall is seen from the inside. A soft mesh is placed from within, safely keeping the abdominal contents within the abdominal cavity by closing the hernia defect.

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My hernia isn’t bothering me, do I still need to have surgery?

Yes. A hernia can’t repair itself, and if you leave it untreated, you run the risk of dangerous illness and complicated surgery.

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I had my hernia fixed once, why has it come back?

When we fix a hernia at the Hernia Center, we do everything in our power to make sure that your hernia stays fixed. As a result, we have a very low percentage rate of patients requiring hernia revision surgery after we have treated them. We also see many patients who have experienced hernia treatment elsewhere who are now coming to see us for a successive repair.

Hernia revision procedures are unfortunately common, with as many as 30% treated elsewhere experiencing a second hernia after their first repair. Here at the Hernia Center, we see patients who have had as many as seven prior hernia repairs at outside centers.

The key to fixing these hernias is to figure out why the hernia is recurring, and make sure that we fix the actual problem. Usually we will discover one of these causes for the recurrence:

Overlay mesh: In most cases, the initial surgeon used an overlay mesh to repair the hernia. This is simply placing a patch on the hole in the abdominal wall and is much more likely to fail than other techniques for repair.

Infection: In other cases, the patient may have had an infection that prevented the fascia (connective tissue) from closing and healing properly. In this cases, it is critical to make sure no infected mesh is still present in the field, and to ensure that the bacteria causing the infection has been eradicated.

Underlying fascia weakness: Another common reason for recurrence is that the repair was performed in an area where the fascia is not strong. In most cases involving a fascia weakness, the patient has an unrecognized rectus diastasis. This is a split in the two vertical "six-pack" abdominal muscles, so that there is a gap between them. The whole abdomen will bulge outward in these cases, especially towards the end of the day, and not just in the area of hernia. In this case, the entire muscle split must be repaired when the hernia is repaired, or the hernia repair will be unsuccessful.

At the Hernia Center, our surgeons will find out exactly what is causing your hernia, and why you are having difficulty with it recurring. Once the cause is determined, they will be able to execute a surgical plan that will resolve your hernia once and for all.

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Can you repair a hernia if it recurs?

Our surgeons our frequently called upon to repair recurrent hernias, when surgeries tried by other surgeons have failed. They have performed thousands of hernia revision surgeries, many of them complex, and have an extremely high success rate, so that if you have hernia surgery here, it is very unlikely that your hernia will recur.

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Can you combine my hernia repair with another type of surgery?

If you are a good candidate for additional procedures, your hernia surgery could be combined with another type of abdominal surgery. In some cases, there is extra fat and skin hanging off the abdomen. If an open hernia repair is to be performed, it is a perfect time to remove it. In some cases, the overhanging fat and skin may cause rashes and other health concerns, and may be covered by insurance. A tummy tuck is performed with our board-certified plastic surgeon working together with our hernia specialist for the best possible cosmetic and functional outcome.

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How can I tell if I have rectus diastasis?

Rectus diastasis is a split between the two rectus muscles that are normally located vertically in the center of the abdomen, called the "six pack". Over time, or with pregnancy, the muscle can become split, causing the abdomen to bulge.

You can tell if you have a rectus diastasis with a few simple tests. First, lie down. Then bring your head and shoulders a few inches off the floor. You can feel your muscle on either side of your belly button - they should be together. If you feel a gap there, then the muscle have split, and you have a rectus diastasis. IF the split is wide enough that your abdomen actually bulges as you do a small sit up, then the diastasis should be repaired as it will get worse over time and has become "non-functional".

Second, at the end of the day, attempt to "pull in" your stomach. If the top near your ribs flexes, but the lower part continues to bulge, this may also be from a rectus diastasis.

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How does rectus diastasis affect my hernia surgery?

Hernias down the center of the abdomen are often accompanied by an overall abdominal bulge. This bulge worsens toward the end of the day an cannot be pulled in, no matter how much you try. The bulging is caused from a muscle split which has occurred over time, called a rectus diastasis (see How can I tell if I have rectus diastasis?)

At the Hernia Center Los Angeles, we repair not only the hernia, but the entire rectus diastasis defect. It is our belief that the repair of the rectus diastasis is critical to a good outcome. Not only will it decrease the chance of a hernia recurrence, but will improve your core strength, stop post-pregnancy bulging due to abdominal wall laxity, and create a flatter, more functional muscular abdomen.