A hernia is a condition where tissue or part of an organ pushes through a weak spot in the surrounding muscle or connective tissue, often forming a visible bulge.
What is a hernia?
A hernia occurs when an internal organ or tissue pushes through a weakened area in the surrounding muscle or connective tissue, which creates a noticeable bulge and may cause discomfort. This protrusion typically develops in the abdominal region but can also appear in the groin, upper thigh, or diaphragm. While not all hernias are immediately dangerous, they do not resolve on their own and may lead to serious complications without proper treatment.
Hernias can develop due to a combination of muscle weakness and strain. Risk factors include ageing, chronic coughing, heavy lifting, obesity, previous surgical incisions, and congenital defects. Some people may have a genetic predisposition that makes their abdominal wall more prone to developing hernias over time.
Common types of hernias
There are several different types of hernias, each named according to its location in the body:
Inguinal hernia — the most common type, particularly in men. It occurs when part of the intestine or fatty tissue pushes through the inguinal canal in the groin.
Femoral hernia — more common in women, this occurs when tissue bulges through the femoral canal, located just below the groin. Femoral hernias are less common but carry a higher risk of complications.
Umbilical hernia — occurs when tissue pushes through the abdominal wall near the belly button (navel). This type is seen in both infants and adults.
Incisional hernia — develops at the site of a previous surgical incision where the muscle has not fully healed, allowing abdominal contents to protrude.
Hiatal hernia — happens when part of the stomach pushes up through the diaphragm into the chest cavity. This type of hernia may not cause a visible bulge but can result in symptoms such as acid reflux or heartburn.
Spigelian hernia — a less common type, it develops through the spigelian fascia, which is located along the side of the abdominal wall.
Although many hernias start as small, painless lumps, they can enlarge over time and cause discomfort, especially when coughing, bending, or lifting heavy objects. In some cases, a hernia can become trapped (incarcerated) or have its blood supply cut off (strangulated), which is a surgical emergency.
Common types of hernia include inguinal, femoral, umbilical, incisional, and hiatal hernias, each named based on their location in the body.
What causes a hernia?
A hernia forms when there is a break or weakness in the muscle or connective tissue that normally holds internal organs in place. This weakness may be present at birth or develop over time due to repeated stress or injury to the area. When the internal pressure exceeds the strength of the muscle wall, tissue or organs — often intestines or fat — can push through the opening, forming a bulge.
Hernias are typically caused by a combination of two elements: structural weakness in the tissue and increased internal pressure. Contributing causes of hernia include:
Muscle weakness (congenital or acquired) — some individuals are born with a naturally weaker abdominal wall, which makes them more susceptible to hernias. Others may develop weakened muscles over time due to ageing, injury, previous surgeries, or chronic illness.
Heavy lifting or physical strain — frequently lifting heavy objects without proper technique can place excessive pressure on the abdominal wall, particularly if the muscles are already weakened.
Chronic coughing or sneezing — long-term coughing caused by conditions such as chronic obstructive pulmonary disease (COPD), asthma, or smoking can repeatedly strain the abdominal muscles. Persistent sneezing from allergies may have a similar effect.
Constipation and straining during bowel movements — regular straining due to constipation increases intra-abdominal pressure and contributes to the development of hernias, particularly inguinal and femoral types.
Straining during urination, commonly in male patients with prostate conditions
Obesity — excess body weight places added stress on the abdominal wall, which can stretch and weaken the muscles over time, which may increase the risk of hernia.
Pregnancy — the natural stretching of the abdominal wall during pregnancy, especially in multiple or closely spaced pregnancies, can create or exacerbate muscle weakness.
Previous abdominal surgery — surgical incisions can compromise the integrity of the abdominal wall. If the tissues do not heal properly, an incisional hernia may occur.
Persistent vomiting — repeated bouts of forceful vomiting can raise pressure in the abdominal cavity, particularly in the upper abdomen, contributing to the development of hiatal or epigastric hernias.
In many cases, a hernia develops slowly, beginning with a small bulge that may come and go. Over time, the bulge can enlarge or become painful, particularly when the underlying cause — such as heavy lifting or chronic coughing — remains unaddressed.
An inguinal hernia is caused by a weakness in the abdominal wall near the groin, often triggered by increased pressure from heavy lifting, straining, or chronic coughing.
What are the symptoms of a hernia?
The symptoms of a hernia can vary depending on its type, size, and severity. In many cases, the most noticeable sign is a visible or palpable bulge in the affected area — such as the groin, abdomen, or near a surgical scar — which may become more prominent when standing, coughing, or straining.
Some hernias cause no pain or discomfort initially, but over time, they can lead to more persistent or severe symptoms. Common symptoms of a hernia include:
A noticeable lump or bulge — typically soft to the touch, the bulge may flatten or disappear when lying down and reappear with physical activity. It often enlarges over time.
Pain or discomfort — a dull ache or sharp pain may develop around the hernia site, especially during movement, lifting, or prolonged standing. This is more common in inguinal, femoral, and incisional hernias.
Heaviness or pressure sensation — some individuals describe a feeling of heaviness, dragging, or weakness in the abdomen or groin, particularly after exertion.
Burning or aching sensation — the bulging area may be accompanied by a burning, gurgling, or aching sensation, often worsened by exertion.
Symptoms that worsen throughout the day — pain and swelling may become more noticeable towards the end of the day or after prolonged physical activity.
In cases of hiatal hernia, where part of the stomach pushes through the diaphragm, symptoms can differ significantly and may include:
Heartburn or acid reflux
Difficulty swallowing
Chest pain
Regurgitation of food or sour liquid
A feeling of fullness or discomfort after eating
Signs of a hernia emergency
Occasionally, a hernia can become trapped (incarcerated) or lose its blood supply (strangulated), both of which require immediate medical attention. Symptoms of a strangulated hernia include:
Sudden, severe pain at the hernia site
Redness, swelling, or tenderness over the lump
Nausea and vomiting
Fever
Inability to pass gas or have a bowel movement
A strangulated hernia is a surgical emergency. If you notice any of these signs, you should seek urgent medical care immediately.
A hernia causes a visible bulge or lump, especially when standing, coughing, or straining.
Who is at risk of a hernia in Singapore?
In Singapore, hernias affect individuals across all age groups, but certain populations are more susceptible due to biological, occupational, and lifestyle-related factors. The risk increases with age, physical strain, and any condition that weakens the abdominal wall or raises intra-abdominal pressure. Individuals more likely to develop a hernia include:
Men, particularly over the age of 40 — inguinal hernias are far more common in men than women due to the natural weakness in the groin area where the spermatic cord passes. As men age, the muscle wall can weaken, making hernias more likely.
Women who are pregnant or have had multiple pregnancies — the abdominal muscles stretch significantly during pregnancy. This, combined with hormonal changes and increased intra-abdominal pressure, raises the risk of both umbilical and incisional hernias.
People with a chronic cough or respiratory conditions — long-term coughing, as seen in chronic obstructive pulmonary disease (COPD), asthma, or among smokers, places continuous pressure on the abdominal wall. This is a known contributor to both inguinal and incisional hernias.
Individuals with obesity — excess weight exerts constant strain on the abdominal muscles and tissues, particularly around the umbilical and lower abdominal regions. Obesity is also associated with poorer post-operative healing, increasing the risk of incisional hernias.
Elderly individuals — ageing is associated with the gradual weakening and thinning of connective tissues, which makes older adults more prone to various types of hernias, especially if they have a history of surgery or chronic health conditions.
Manual labourers and those performing heavy lifting — occupations involving frequent or improper lifting of heavy objects — such as construction workers, warehouse staff, and delivery personnel — are at higher risk due to repeated strain on the abdominal wall.
Individuals with a history of abdominal surgery — previous surgery may compromise the strength of the abdominal wall at the incision site. Patients who have undergone procedures like laparotomy, caesarean section, or bowel surgery are at higher risk of developing incisional hernias.
People with chronic constipation or urinary straining — repeated straining during bowel movements or urination, common in conditions like chronic constipation or prostate enlargement, increases intra-abdominal pressure and may trigger hernia formation.
Infants and children with congenital defects — some babies are born with a weakness in the abdominal wall, particularly around the umbilical region. Premature infants are especially at risk of umbilical and inguinal hernias.
In Singapore’s urban environment, lifestyle factors such as sedentary habits, poor posture, and a high prevalence of obesity and smoking also contribute to hernia development.
How is a hernia diagnosed?
Diagnosing a hernia typically begins with a thorough medical history and physical examination. At Tan Siong San Surgery, we use a combination of detailed clinical assessments and imaging tools to accurately identify the type and severity of your hernia.
In most cases, especially for external hernias such as inguinal, femoral, or umbilical hernias, the diagnosis can be made based on the patient’s description of symptoms and a visible or palpable bulge.
Reviewing symptoms — including the presence of a lump, pain, heaviness, or discomfort that worsens with activity, coughing, or prolonged standing.
Performing a physical examination — the patient may be asked to stand, cough, or strain while the doctor palpates the abdomen or groin area. A reducible hernia may disappear when lying down and reappear when standing or straining.
Visible or palpable hernias are usually straightforward to identify. However, smaller hernias or those located deeper within the body may require imaging to confirm the diagnosis.
Imaging tests
Depending on the suspected type and location of the hernia, one or more of the following imaging techniques may be used:
Ultrasound — often the first-line imaging test for groin and abdominal wall hernias. It is non-invasive, widely available in Singapore, and helpful in differentiating hernias from other soft tissue masses.
CT (Computed Tomography) scan — provides detailed cross-sectional images, especially useful for detecting incisional, recurrent, or complex hernias, and identifying complications like bowel obstruction or strangulation.
MRI (Magnetic Resonance Imaging) — used in select cases when ultrasound or CT results are inconclusive, particularly for detecting small or occult hernias.
Endoscopy or barium swallow (for hiatal hernias) — for suspected hiatal hernias, these tests help visualise the stomach’s position relative to the diaphragm and assess associated reflux or swallowing issues.
Accurate diagnosis not only confirms the presence of a hernia but also guides the most beneficial course of treatment — whether it’s monitoring, lifestyle adjustments, or surgical repair.
What are the treatment options for hernias in Singapore?
Treatment for hernia depends on several factors, including the type of hernia, its size, associated symptoms, and the patient’s overall health. While some small, asymptomatic hernias may be safely monitored, surgery may be necessary to repair the defect in the muscle wall and prevent complications such as incarceration or strangulation.
Conservative management (Monitoring)
In cases where the hernia is small, causes minimal or no discomfort, and shows no signs of complications, a watchful waiting approach may be considered. This involves regular monitoring by a doctor to assess for any changes or progression. However, patients are advised to avoid heavy lifting and manage underlying risk factors such as chronic cough, constipation, or obesity.
Monitoring and regular observation may be appropriate for:
Small inguinal or umbilical hernias without symptoms
Elderly patients or those with significant medical comorbidities
Patients who prefer to delay surgery until symptoms develop
Surgical repair
Surgical repair is recommended for most hernias that cause symptoms or have a risk of complications. There are two main approaches to hernia surgery:
1. Open Hernia Repair
In open surgery, the surgeon makes an incision near the hernia site, pushes the protruding tissue back into place, and repairs the weakened area of the muscle wall. A synthetic mesh is usually placed to reinforce the repair and reduce the risk of recurrence.
Suitable for most types of hernias
Often performed under local or general anaesthesia
Allows direct access to the hernia, particularly useful for large or complex cases
2. Laparoscopic (Keyhole) Hernia Repair
This minimally invasive approach uses several small incisions and a camera (laparoscope) to guide the repair. The hernia is reduced, and mesh is inserted to strengthen the muscle wall.
Less postoperative pain
Faster recovery and shorter hospital stay
Smaller scars and reduced risk of wound complications
Laparoscopic repair is often preferred for bilateral hernias, recurrent hernias, or in patients seeking quicker return to daily activities. However, it may not be suitable for all patients — your doctor will recommend the most ideal option based on your condition and medical history.
Emergency surgery
If a hernia becomes incarcerated (trapped) or strangulated (cut off from blood supply), emergency surgery is required. This is a potentially life-threatening situation and should be treated without delay.
Common signs requiring urgent intervention include:
Sudden, intense pain at the hernia site
Redness or tenderness over the lump
Nausea, vomiting, or signs of bowel obstruction
Summary
A hernia happens when tissue pushes through a weak spot in the muscle wall, often forming a visible bulge. It can cause discomfort and, if left untreated, may lead to serious complications. At Tan Siong San Surgery, we diagnose hernias through physical examination and imaging, and offer both open and laparoscopic surgical options tailored to each patient. Early treatment ensures better outcomes and prevents risks such as incarceration or strangulation.
If you suspect a hernia or have been diagnosed with one, consult us today at Tan Siong San Surgery for a personalised treatment plan tailored to your needs.
Frequently Asked Questions (FAQs)
Yes, hernias can recur, especially if the repair site doesn’t heal properly or if the patient resumes strenuous activities too soon. However, with proper surgical technique and adherence to post-operative care, the risk of recurrence is significantly reduced.
Hernia repair is generally considered a routine procedure and is often performed on an outpatient basis. The invasiveness depends on the surgical method used; laparoscopic surgeries are minimally invasive, while open surgeries may require a longer recovery period.
While not all hernias are preventable, maintaining a healthy weight, avoiding heavy lifting, treating chronic coughs, and preventing constipation can reduce the risk of developing a hernia.
Yes, certain types of hernias, like hiatal hernias, can lead to digestive symptoms such as acid reflux, heartburn, and difficulty swallowing. Other hernias may cause bowel obstruction if they become incarcerated or strangulated.
Light activities may be permissible, but it’s essential to avoid exercises that strain the abdominal area. Consulting with a healthcare provider for personalised advice is recommended.
Recovery time varies depending on the type of surgery and the individual’s overall health. Generally, patients can return to light activities within a few days and resume normal activities within 4 to 6 weeks
Mesh is often used to reinforce the weakened area of the abdominal wall during hernia repair, reducing the risk of recurrence. Modern meshes are designed to be safe and effective, with complications being relatively rare.
Yes, children can develop hernias, commonly inguinal or umbilical hernias. These are often congenital and may require surgical intervention, especially if they don’t resolve on their own or cause symptoms.
Immediate medical attention is necessary if you experience sudden pain, nausea, vomiting, or if the hernia becomes tender, red, or irreducible, as these could be signs of strangulation or obstruction.
Yes, having weak or weakened abdominal muscles can increase your risk of developing a hernia. Factors that cause weak muscles could be injury, ageing, or previous surgeries.
Yes, intensive exercise or the use of improper form can cause a hernia to develop. This is possible for both weightlifting and high-impact activities. Use proper form, correct breathing techniques, and avoid straining too forcefully during your workouts to lower your risk of developing a hernia.
This article has been medically reviewed by Dr. Tan Siong San
Dr Tan is a Senior Consultant Surgeon with over 25 years of clinical experience in the field of Hepato-Pancreato-Biliary (HPB) surgery treating conditions affecting gallbladder, liver and pancreas.
