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Hernia Treatment: A Complete Guide

Hernia Treatment: A Complete Guide
Canva (2); Everyday Health
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Updated on November 1, 2024
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Hernias happen when part of an organ, intestine, or other tissue pushes through a weakened area of muscle in the abdomen or groin, sometimes leading to a bulge. This might cause pain and other unpleasant symptoms, especially when you’re moving around or lifting heavy objects.

There are two main types of hernia. There are those that are on the body wall, such as inguinal, umbilical, and incisional hernias. These are what most people tend to think of when they think of a hernia. However, there is another type of hernia that is internal. The most common type of internal hernia is a hiatal hernia. Treatment and management methods are very different for this type of hernia. As opposed to other types of hernia, hiatal hernias may not need surgery and can often be treated with medication.

This article will focus on treatment for the most common types of hernia, including internal hiatal hernias as well as the more common types of external hernias. However, be sure to speak to a doctor about options for hernias that occur less regularly, as well as before starting or combining treatments for a hernia.

Medication for Hernias

If treatment is necessary, a surgical repair is the best option for most hernias.

 However, medications can help with the heartburn and acid reflux that hiatal hernias often cause.

 Other types of hernia that appear on the body wall do not require treatment with medications.

Antacids

These are pills, powders, chewable tablets, or liquid solutions available over the counter. They neutralize stomach acid, making it less uncomfortable when it moves back up the food pipe and providing quick relief for heartburn.

Medications in this class include:

  • Bismuth subsalicylate (Pepto-Bismol)

  • Calcium carbonate (Tums, Rolaids)

Try not to take these too often.

 They can cause a range of side effects, including nausea, vomiting, excessive gas, headaches, and imbalanced levels of nutrients like magnesium, calcium, and phosphorus.

 Children and people with kidney problems should be especially careful with antacids, as they have a higher risk of developing toxicity.

H2-receptor blockers

These are pills or capsules that reduce stomach acid production. Medications in this class include:

  • Cimetidine (Tagamet HB)
  • Famotidine (Pepcid AC)
  • Nizatidine (Axid AR)
Side effects are rare and usually mild. They might include constipation, diarrhea, extreme tiredness or sleepiness, headaches, and muscle aches.

Proton pump inhibitors (PPIs)

PPIs are long-term, daily pills or capsules that block acid production more completely than H2 blockers. This gives the esophagus time to heal.

Medications in this class include:

  • Lansoprazole (Prevacid 24HR)
  • Omeprazole (Prilosec, Zegerid)
  • Esomeprazole (Nexium)

  • Dexlansoprazole (Dexilant)

  • Pantoprazole (Protonix)
  • Rabeprazole (AcipHex)
Side effects aren't common when taking PPIs, but these medications can cause belly pain, changes in bowel habits, increased gas, dizziness, dry mouth, headaches, lightheadedness, vomiting, itching, and rash. They may also change the bacterial community in the gut, increasing a person's risk of Clostridium difficile infection.

Though current scientific evidence is limited, PPIs may also affect how well the body absorbs calcium, magnesium, and vitamin B12, increasing a person's risk of wrist, spine, or hip fractures and nutrient deficiencies. They may also contribute to kidney disease, or worsening symptoms of kidney disease.

Surgery for External Hernias

Surgery is the most common treatment for all types of external hernias. That said, in many cases hernias do not require surgery. Rather, the management technique is to watch them, especially if they are asymptomatic (or very close to being asymptomatic). If there are painful or debilitating symptoms, surgery can be an option for either hiatal hernias or those appearing on the outside of the body (inguinal, umbilical and incisional, for example).

The type of surgery your doctor recommends will depend on the type of hernia, the severity of symptoms, your overall health, and the complexity of the repair. For example, a repair may be more complex if you’ve had previous abdominal surgeries, and it becomes more complex with each successive surgery.

There are two basic types of surgery for external hernia repair: open and laparoscopic.

Open Hernia Repair

For this method, you may be under either general anesthesia or local anesthesia with sedation. Your surgeon will make a cut in your groin or abdomen, push the hernia back into your abdomen, and repair the weakened muscle where the hernia occurred. Fixing the muscle often involves sewing the gap shut. If the tissue is too weak, they might reinforce it by inserting a piece of mesh in the area.

 An advantage of using mesh is that it doesn’t put any strain or pressure on your abdominal wall, which reduces the risk of another hernia developing.

Once the repair is complete, the surgeon closes the cut using stitches, staples, or surgical glue.

There are a few different subtypes of open hernia repair, including Lichtenstein repair, Shouldice repair, and Bassini repair.

Laparoscopic Hernia Repair

Laparoscopy is a minimally invasive method in which a surgeon uses several small incisions in your abdomen to perform the operation. It usually takes place under general anesthesia. Your surgeon inflates the abdomen with gas, then inserts a flexible tube containing a light and tiny camera in one incision to guide the surgery. They will then slot surgical tools into the other incisions.

Laparoscopy can result in quicker healing and less discomfort and scarring than an open hernia repair. It can also help your surgeon avoid scar tissue from a previous hernia repair.

Umbilical Hernia Repair

Children below the age of 3 are unlikely to need surgery to repair an umbilical hernia, as these heal on their own in over 90 percent of cases. A child might need umbilical hernia repair if the hernia is trapped, larger than 2 centimeters, or causing abdominal pain. Adults with umbilical hernias are more likely to have complications and eventually need surgery.

If needed, surgery to repair an umbilical hernia involves general anesthesia and a small incision at the base of the navel. Your surgeon will push the intestine back in place, remove the hernia’s sac, and reinforce the weakened muscle wall with several layers of sutures. They may sometimes use a mesh to strengthen the abdominal wall.

Surgery for Hiatal Hernias

Hiatal hernias are inside the body and require different surgical methods.

Hernia Repair and Fundoplication

Most hiatal hernias cause only mild symptoms or none at all. Symptoms are typically those of gastroesophageal reflux disease (GERD), in which stomach acid moves up into the esophagus. A surgical repair is typically necessary if lifestyle changes and medication can’t control the symptoms of GERD, or if the hernia is large enough to risk serious future complications.

To repair a hiatal hernia, your surgeon will carry out a procedure called a fundoplication in which they take the following steps:

  • They pull the entire stomach back into your abdomen.
  • They’ll make the hole in your diaphragm smaller so that your stomach stays in place.
  • The surgeon shrinks the junctions between the esophagus, or food pipe, and the stomach. They achieve this by wrapping the upper part of your stomach, or fundus, around the lower esophagus, then surgically stapling or stitching it in place.

In most cases, the surgery is done laparoscopically.

Lifestyle Changes

Small hernias that cause relatively mild symptoms don’t always need immediate treatment. Certain lifestyle measures can help you control symptoms and prevent complications.

Watchful Waiting

Your doctor may recommend watchful waiting. Watchful waiting involves keeping an eye on your hernia and symptoms, and seeing your doctor once a year. You should also see your doctor if and when any symptoms associated with your hernia get worse.

Adjusting Daily Habits

People not planning to undergo a hernia repair may need to prevent it from worsening.

 Some simple changes to daily habits can help you reduce the risk of a growing or complicating hernia:

  • Not lifting heavy objects, when possible, as this can put stress on the groin
  • Lifting with the legs, not the back, and avoiding bending over during lifts
  • Keeping your head lifted during sleep, and sleeping on your left side, possibly with the help of a specialized body pillow
  • Quitting smoking
A restraining belt may help by applying pressure to the hernia and relieving symptoms. These strap around the abdomen to compress umbilical and incisional hernias or work similarly to underwear for inguinal hernias.

People should also be aware that in some cases hernias can cause a lot of limitations to daily habits, such as being unable to exercise. This can make overall health worse. If you are concerned about limitations to your daily habits because of a hernia, be sure to speak to a doctor to discuss your options.

Diet and Food Habits

You can manage hiatal hernia symptoms by adjusting what and when you eat, as well as how you sleep, and making other lifestyle changes. This can help lessen the severity and frequency of acid reflux. These changes might include:

  • Weight management, if being overweight is a factor
  • Eating smaller portions
  • Consuming less fat
  • Sticking to an earlier dinner time
  • Eating high-fiber foods to help your digestion
  • Keeping a healthy body weight

The Takeaway

Surgery is the main treatment for an external hernia, but many people have hernias that don’t cause pain or affect daily life too much, and these may not require treatment. Surgery aims to push the tissue back through the weakness or opening in the abdomen or groin and strengthen the muscle to hold it in place. You should speak to your doctor if you feel pain or experience other hernia symptoms, in order to get a diagnosis and discuss treatment options if needed.

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Ira Daniel Breite, MD

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Castle Connolly Top Doctor

Ira Daniel Breite, MD, is a board-certified internist and gastroenterologist. He is an associate professor at the Icahn School of Medicine at Mount Sinai, where he also sees patients and helps run an ambulatory surgery center.

Dr. Breite divides his time between technical procedures, reading about new topics, and helping patients with some of their most intimate problems. He finds the deepest fulfillment in the long-term relationships he develops and is thrilled when a patient with irritable bowel syndrome or inflammatory bowel disease improves on the regimen he worked with them to create.

Breite went to Albert Einstein College of Medicine for medical school, followed by a residency at NYU and Bellevue Hospital and a gastroenterology fellowship at Memorial Sloan Kettering Cancer Center. Working in city hospitals helped him become resourceful and taught him how to interact with people from different backgrounds.

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Adam is a freelance writer and editor based in Sussex, England. He loves creating content that helps people and animals feel better. His credits include Medical News Today, Greatist, ZOE, MyLifeforce, and Rover, and he also spent a stint as senior updates editor for Screen Rant.

As a hearing aid user and hearing loss advocate, Adam greatly values content that illuminates invisible disabilities. (He's also a music producer and loves the opportunity to explore the junction at which hearing loss and music collide head-on.)

In his spare time, Adam enjoys running along Worthing seafront, hanging out with his rescue dog, Maggie, and performing loop artistry for disgruntled-looking rooms of 10 people or less.

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