A hernia happens when part of an organ or tissue bulges through a weak spot in the muscle, most often in the abdominal wall. Among the most common are inguinal, incisional, and ventral hernias. Knowing the differences can help you recognize symptoms early and get the right care. Specialists at Washington University School of Medicine are experts diagnosing and treating all types of hernias.
An inguinal hernia occurs in the groin when intestines or tissue push through a weak area in the lower abdominal wall, creating a bulge that often becomes more noticeable when you stand, cough, or strain. An incisional hernia develops at the site of a previous abdominal surgery; the old incision remains weaker than surrounding tissue and, over time, can stretch and allow internal tissue to protrude. A ventral hernia is a broad term for hernias on the front surface of the abdominal wall, including umbilical and epigastric hernias as well as incisional hernias. In everyday use, “ventral hernia” often refers to any non‑groin abdominal wall hernia, whether or not it is related to prior surgery.
Symptoms
Symptoms vary somewhat by type but share common features. All three can cause a visible or palpable bulge in the groin or abdomen that may become more prominent with standing, coughing, lifting, or exertion, along with discomfort, aching, or a sense of heaviness. Inguinal hernias typically cause a groin bulge with burning, dragging, or sharp pain. Incisional hernias often present as a bulge or stretching sensation at or near an old surgical scar, with discomfort that increases during activity. Ventral hernias can appear as a bulge anywhere along the midline or front of the abdomen and may be associated with localized pain or pressure; some patients also notice changes in bowel habits. Sudden severe pain, a firm tender bulge that cannot be pushed back in, redness or warmth over the area, nausea, vomiting, abdominal swelling, or inability to pass gas or stool can signal a dangerous complication and require urgent medical attention.
Causes
Hernias usually arise from a combination of weakened tissue and increased pressure inside the abdomen. Important contributors include older age, genetic or congenital weakness in the abdominal wall, obesity, pregnancy, heavy lifting, chronic cough from lung disease or smoking, and chronic constipation or straining. For incisional hernias, factors such as wound infection, poor nutrition, diabetes, or steroid use can interfere with incision healing and increase the chance that the scar will stretch and form a hernia. You cannot prevent every hernia, but you can reduce risk and lower the chance of recurrence by maintaining a healthy weight, not smoking, treating chronic cough and constipation, using proper lifting techniques, and closely following postoperative instructions about activity limits and wound care after abdominal surgery.
Prevention, detection, and diagnosis
There is no routine screening test for hernias in people without symptoms, so paying attention to early warning signs is important. You should seek evaluation if you notice a new bulge in the groin or abdomen, discomfort or heaviness that worsens with standing or exertion, or a change in the shape or feel of a prior incision site. People who do heavy physical work, have had multiple abdominal surgeries, or have significant risk factors such as obesity or chronic cough should be especially alert. Emergency evaluation is needed if pain at the hernia becomes severe or rapidly worse, if the area becomes red or warm, if you can no longer gently push the bulge back in, or if you develop symptoms of bowel obstruction such as vomiting, abdominal distension, and inability to pass gas or stool.
Diagnosis begins with a detailed medical history and physical examination. Your surgeon will ask when you first noticed a bulge or discomfort, what makes it better or worse, and what prior surgeries or medical conditions you have had. During the exam, you may be asked to stand, cough, or strain so the hernia becomes more obvious. In many cases, this exam is enough for diagnosis. When the diagnosis is uncertain, or when planning a complex repair, imaging studies may be used. Ultrasound is especially useful for groin (inguinal) hernias and for patients who are difficult to examine. CT scans are commonly used for ventral and incisional hernias to define size, location, and relationship to surrounding organs, and MRI may be used when even more detail is needed.
Medical intervention
Hernias generally do not heal on their own; the only definitive treatment is surgical repair. The timing and type of surgery depend on the hernia type, symptoms, overall health, and patient goals.
Small, minimally symptomatic inguinal hernias in higher‑risk patients can sometimes be managed with careful “watchful waiting” if patients understand and promptly act on emergency warning signs, but most inguinal hernias eventually require surgery. Options include open repair through a groin incision or minimally invasive laparoscopic or robotic repair; both approaches typically use mesh to reinforce the abdominal wall and reduce recurrence.
Incisional hernias are usually treated surgically because they tend to enlarge and can cause complications; repairs may be open or minimally invasive and often involve mesh reinforcement, while larger or recurrent hernias may require complex abdominal wall reconstruction.
Ventral hernias are treated similarly. Small umbilical or epigastric hernias may be repaired through a small open incision, sometimes without mesh, whereas larger or more complex ventral hernias typically need mesh and may be repaired with open, laparoscopic, or robotic techniques; very large defects can require staged reconstructive procedures tailored to the individual patient.
Comprehensive hernia care at WashU Medicine
The Section of Minimally Invasive Surgery at WashU Medicine specializes in evaluating and treating inguinal, incisional, and ventral hernias. The team includes fellowship‑trained minimally invasive and robotic surgeons, experts in complex abdominal wall reconstruction, and collaborating specialists in anesthesia, pain management, and rehabilitation, allowing for personalized plans that emphasize durable repair, faster recovery, and long‑term quality of life.
If you have noticed a new bulge, groin or abdominal pain, or changes at a prior incision site, consider contacting the Section of Minimally Invasive Surgery at 314‑362‑7408.
You can learn more about hernia care and minimally invasive options at the Department of Surgery’s Hernia Surgery Conditions & Treatments page.
If you are concerned you may have a hernia, reaching out to a hernia specialist is the best next step to get an accurate diagnosis and a tailored treatment plan.