Wondering if the aching in your belly or groin could be a hernia? Hernias are common in both men and women, but symptoms vary. 

Gina Adrales, M.D., M.P.H., director of the Division of Minimally Invasive Surgery, explains how to recognize signs of a hernia, the most common types, and treatment options.

What is a hernia?

Your abdomen is covered in layers of muscle and strong tissue that help you move and protect internal organs. A hernia is a gap in this muscular wall that allows the contents inside the abdomen to protrude outward. There are different types of hernias, but the most common hernias occur in the belly or groin areas.

What does a belly (or ventral) hernia feel like?

If you have a ventral hernia, also called a belly or abdominal hernia, you may see or feel a bulge along the outer surface of the abdomen. Typically, patients with ventral hernias describe:

• Mild pain, aching or a pressure sensation at the site of the hernia. 

• Worsening discomfort with any activity that puts a strain on the abdomen, such as heavy lifting, running or bearing down during bowel movements.

• Some patients may have a bulge without discomfort. 

Who is at higher risk for a belly hernia?

Anyone can develop a belly (or ventral) hernia but it is a higher risk for:

• Those who’ve had abdominal surgery. If you have an incision that disrupts the abdominal wall, the scar will never be as strong as the original tissue. This makes it more likely that you’ll develop a hernia, known as an incisional hernia, along the incision area. This occurs in up to 30% of patients who have open abdominal surgery.

• Pregnant women. Pregnancy is a risk factor that makes women more susceptible to developing another type of ventral hernia near the belly button called an umbilical hernia. The umbilicus is the thinnest part of the abdominal wall. It’s a very common site to develop a hernia, whether you’re a man or a woman.

How can you tell if you have a groin(or inguinal) hernia?

First, it’s important to understand that both sexes can develop inguinal (groin) hernias. People often believe that only males get them, and for anatomical reasons, they do have a higher risk. But female patients can certainly have inguinal hernias, too.

Many experts agree that females are likely underdiagnosed for this condition because they tend to have different symptoms than males. Female patients may not have a noticeable bulge. If symptoms indicate a possible hernia but your doctor cannot confirm it by an exam, an MRI can provide definitive evidence.

Groin Hernia Symptoms in Males

• A bulge you can see or feel

• Aching pain in the area

• A feeling of pressure

• A tugging sensation of the scrotum around the testicles

• Pain that worsens with activities that add pressure to the area, such as heavy lifting, pushing and straining

Groin Hernia Symptoms in Females

• Aching or sharp pain

• Burning sensation

• A bulge at the hernia site, but this may not be present with a groin hernia

• Discomfort that increases with activity

How are hernias treated?

Treatment varies depending on the type of hernia, symptoms, and the patient's preferences and risk factors for hernia recurrence.

Groin (Inguinal) Hernias

• For female patients: Groin hernias in females are more likely to become emergencies. They also have a greater chance of developing complications than men. So, we typically recommend surgical repair after diagnosis.

• For male patients: Males with groin hernias often may put off surgery if they’re not symptomatic. Studies of males with groin hernias indicate the risk of having an emergency, like part of the bowel getting stuck or strangled in the muscle gap, is quite low. But because hernias tend to grow larger or cause symptoms over time, most male patients will require surgery within 10 years of hernia diagnosis.

• Surgical treatments: There are two surgical treatments for groin, or inguinal, hernias. 

• Minimally invasive surgery is often performed laparoscopically, requiring only keyhole-size incisions through which a tiny camera and instruments can be inserted to make repairs. Minimally invasive robotic-assisted surgery (similar to laparoscopy, but surgeons use a controller to move instruments) is also an option. Some aspects of robotic-assisted surgery have allowed more patients with complex hernias to have a minimally invasive approach when they otherwise would have required large incision surgery. With minimally invasive surgery, many patients are back to their regular activity within a few weeks. 

• Open surgery is the other treatment option — recovery takes four to eight weeks.

Belly (Ventral) Hernias

• Repair is recommended for most belly hernias. The exception is if you have risk factors for complications or hernia recurrence, such as obesity or poorly controlled diabetes. It’s better to get those conditions under control before surgery. Some patients do not have symptoms and may decide to delay repair after discussion of the risks and benefits with their surgeon.

• Surgical options and recovery time for belly hernias vary widely because these hernias come in all shapes and sizes. A small umbilical or incisional hernia can often be treated on an outpatient basis. However, repairing more complex hernias may require a hospital stay of one to five days.

What are the signs of a hernia emergency?

When most hernias start, the internal tissue that pushes through the muscle gap is usually fat. But it’s also possible for part of the bowel to protrude through the opening. The risk of this is very low, but when it happens, it needs emergency repair. Seek immediate medical attention if you have:

• A painful bulge that doesn’t reduce in size when you lay down and rest

• Worsening pain

• Nausea and/or vomiting

• Difficulty having a bowel movement

• Bloating

• Racing heart rate

• Fever

For more information about hernias and their treatment, visit the Johns Hopkins Comprehensive Hernia Center.

Medically reviewed by Gina Lynn Adrales, M.D., M.P.H, FACS.