Inguinal Hernia: Symptoms, Causes, and When Surgery Is Needed
Updated: Nov 3
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
An inguinal hernia happens when tissue pokes through a weak spot in the abdominal muscles, creating a bulge near the groin. It doesn't heal on its own and can lead to life-threatening strangulation. Men are 8 to 10 times more likely than women to develop one. Diagnosis usually takes only a physical exam, and repair is a common surgery [1] [2].
Quick Answer: What is an inguinal hernia?
An inguinal hernia is tissue, often part of the intestine, pushing through a weak spot in the abdominal muscles near the groin, causing a bulge that is more obvious when standing or straining. It never resolves on its own and can become life-threatening if tissue gets trapped and loses blood flow. Painful or growing hernias are typically fixed with surgery. [1] [2]
What the research says
Watching and waiting was a reasonable option for men over 50 with few symptoms, but about a third eventually had surgery. In a randomized trial of 496 men aged 50 or older with mildly symptomatic or asymptomatic inguinal hernias (234 assigned to elective repair, 262 to watchful waiting), the average pain/discomfort score at 24 months was slightly higher with watchful waiting (0.58 vs 0.35 on a 4-point scale). In the watchful-waiting group, 93 men (35.4%) eventually had elective surgery and 6 (2.3%) needed emergency surgery for strangulation or incarceration. The authors concluded that watchful waiting is a reasonable alternative to surgery in this group (de Goede et al., Annals of Surgery, 2018 [3]).
Over 12 years, most men who chose to wait ended up having surgery. In the long-term follow-up of that trial (488 of 496 patients evaluable, median follow-up 12 years), the estimated cumulative crossover rate to surgery was 64.2%, higher in mildly symptomatic men (71.7%) than in asymptomatic men (60.4%). Incarceration occurred in 10 of 255 men (3.9%) in the watchful-waiting group, and regret was higher with waiting than with early surgery (37.7% vs 18.0%) (Van den Dop et al., EClinicalMedicine, 2023 [4]).
The two main keyhole (laparoscopic) techniques looked similar. A Cochrane review of 23 randomized trials (1,156 people treated with TAPP and 1,110 with TEP) found little to no difference between the two approaches in serious adverse events (0.4% vs 0.7%) or hernia recurrence (1.2% vs 1.1%). Conversion to another repair method was more likely with TEP (2.5% vs 0.7%). The evidence was low to very low certainty, so the choice mostly reflects surgeon and patient preference (Andresen & Rosenberg, Cochrane Database of Systematic Reviews, 2024 [5]).
What Is an Inguinal Hernia?
An inguinal hernia happens when tissue, such as part of the intestine, pokes through a weak spot in the abdominal muscles. The resulting bulge can be painful, especially when coughing, bending over or lifting a heavy object. However, many hernias do not cause pain.
An inguinal hernia isn't necessarily dangerous, but it doesn't get better on its own. It also can lead to life-threatening complications. A healthcare professional is likely to recommend surgery to fix an inguinal hernia that's painful or getting bigger. Inguinal hernia repair is a common surgical procedure. The hernia often develops along the inguinal canal, which carries the spermatic cord in men [1].
Key fact | What it means |
What happens | Tissue pokes through a weak spot in the abdominal muscles |
Where it appears | A bulge on either side of the pubic bone |
Pain level | Can be painful, but many hernias cause no pain |
Self-healing | Never heals on its own |
Long-term risk | Can lead to life-threatening complications |
Standard fix | Surgery is a common procedure for painful or growing hernias |
Inguinal Hernia Symptoms
Inguinal hernia symptoms typically center on a visible or palpable bulge and the sensations around it. The most common signs include a bulge in the area on either side of the pubic bone, which becomes more obvious when upright, especially when coughing or straining.
Many people also feel a burning or aching sensation at the bulge. Pain, discomfort or pressure in the groin is common, especially when bending over, coughing or lifting. Occasionally, pain and swelling occur around the testicles when the protruding intestine descends into the scrotum [1].
Symptom | When it appears |
Bulge near the pubic bone | More obvious when upright, coughing or straining |
Burning or aching sensation | At the bulge itself |
Groin pain, discomfort, pressure | When bending over, coughing or lifting |
Testicular pain and swelling | When intestine descends into the scrotum |
Symptoms in Children
Inguinal hernias in newborns and children result from a weakness in the abdominal wall that's present at birth. Sometimes the hernia will be seen only when a baby is crying, coughing or straining during a bowel movement. The baby might be irritable and have less appetite than usual.
In an older child, a hernia is likely to be more noticeable when the child coughs, strains during a bowel movement or stands for a long period [1].
Age group | How the hernia shows up |
Newborns and babies | Visible when crying, coughing or straining during a bowel movement |
Babies' behavior changes | Irritability and less appetite than usual |
Older children | More noticeable when coughing, straining or standing long periods |
Signs of Trouble: Incarcerated and Strangulated Hernias
If a hernia can't be pushed in, the contents of the hernia may be trapped in the abdominal wall. This is known as an incarcerated hernia. An incarcerated hernia can become strangulated, which cuts off the blood flow to the tissue that's trapped. A strangulated hernia can be life-threatening if it isn't treated.
Symptoms of a strangulated hernia include:
Nausea, vomiting or both.
Fever.
Sudden pain that quickly gets worse.
A hernia bulge that turns red, purple or dark.
Not being able to move the bowels or pass gas.
Warning stage | What happens |
Incarcerated hernia | Contents get trapped in the abdominal wall and can't be pushed in |
Strangulated hernia | Blood flow to the trapped tissue is cut off |
Consequence | Can be life-threatening if not treated |
When to See a Doctor
Seek care right away if a hernia bulge turns red, purple, or dark or if you notice any other symptoms of a strangulated hernia.
See a healthcare professional if you have a painful or noticeable bulge in your groin on either side of your pubic bone. The bulge is likely to be more noticeable when you're standing, and you usually can feel it if you put your hand directly over the affected area [1].
Situation | What to do |
Bulge turns red, purple or dark | Seek care right away |
Nausea, vomiting, fever, sudden worsening pain | Seek emergency care: possible strangulation |
Painful or noticeable groin bulge | See a healthcare professional |
What Causes an Inguinal Hernia?
Some inguinal hernias have no apparent cause. Others might happen because of:
Increased pressure within the abdomen.
A preexisting weak spot in the abdominal wall.
Straining during bowel movements or urination.
Strenuous activity, such as heavy lifting and standing or walking for many hours each day.
Pregnancy.
Coughing or sneezing often.
In many people, the abdominal wall weakness that leads to an inguinal hernia happens before birth when a weakness in the abdominal wall muscle doesn't close properly. Other inguinal hernias form later in life when muscles weaken or break down due to aging, strenuous physical activity or coughing that accompanies smoking. Weaknesses also can happen in the abdominal wall later in life, especially after an injury or abdominal surgery.
In men, the weak spot usually occurs in the inguinal canal, where the spermatic cord enters the scrotum. In women, the inguinal canal carries a ligament that helps hold the uterus in place, and hernias sometimes happen where connective tissue from the uterus attaches to tissue surrounding the pubic bone [1].
Cause type | Examples |
Present from birth | Abdominal wall muscle that never closed properly |
Developed later in life | Aging, strenuous activity, smoking-related coughing |
Pressure-related | Heavy lifting, standing/walking many hours, straining, pregnancy, frequent coughing or sneezing |
After injury or surgery | Weakness following abdominal surgery or injury |
Inguinal Hernia Risk Factors
Factors that contribute to forming an inguinal hernia include several that can't be changed and several related to health habits. Being male is the strongest risk factor: men are 8 to 10 times more likely to have an inguinal hernia than women. Being older matters too, since muscles weaken as you age. Studies show that people of European ancestry may be more likely to get inguinal hernias than people of other racial or ethnic backgrounds. Having a close relative, such as a parent or sibling, who has the condition also raises your risk [1].
Risk factor | Why it matters |
Being male | 8 to 10 times more likely than women |
Being older | Muscles weaken with age |
European ancestry | Higher likelihood shown in studies |
Family history | Close relative with the condition |
Long-lasting cough | Often from smoking |
Long-lasting constipation | Causes straining during bowel movements |
Pregnancy | Weakens abdominal muscles, increases abdominal pressure |
Premature birth, low birth weight | More common in these babies |
Connective tissue conditions | Such as Ehlers-Danlos or Marfan syndrome |
Prostatectomy | Surgical removal of the prostate gland |
Previous hernia or repair | Childhood hernia raises later-life risk |
Complications of an Inguinal Hernia
Complications of an inguinal hernia range from gradually worsening pressure to medical emergencies.
Pressure on surrounding tissues. Most inguinal hernias enlarge over time if not repaired surgically. In men, large hernias can extend into the scrotum, causing pain and swelling.
Incarcerated hernia. If the contents of the hernia become trapped in the weak point in the abdominal wall, the contents can block the bowel, leading to severe pain, nausea or vomiting, and not being able to have a bowel movement or pass gas.
Strangulation. An incarcerated hernia can cut off blood flow to part of the intestine. Strangulation can lead to the death of the affected bowel tissue. A strangulated hernia is life-threatening and requires immediate surgery.
Complication | What happens | Severity |
Pressure on surrounding tissues | Hernia enlarges over time; can extend into the scrotum in men | Gradual |
Incarcerated hernia | Contents trapped; can block the bowel | Serious: severe pain, vomiting, no bowel movement |
Strangulation | Blood flow to intestine cut off; bowel tissue can die | Life-threatening: requires immediate surgery |
How an Inguinal Hernia Is Diagnosed
A physical exam is usually all that's needed to diagnose an inguinal hernia. A healthcare professional will check for a bulge in the groin area. Because standing and coughing can make a hernia more prominent, you'll likely be asked to stand and cough or strain.
If the inguinal hernia isn't readily seen, a care professional might order an imaging test, such as an abdominal ultrasound, CT scan or MRI [2].
Diagnostic step | What happens |
Physical exam | Checks for a bulge in the groin area |
Stand and cough or strain | Makes the hernia more prominent during the exam |
Imaging (if needed) | Abdominal ultrasound, CT scan, or MRI |
Inguinal Hernia Treatment Options
If the hernia is small and isn't causing problems, a healthcare professional might recommend watchful waiting. Sometimes, wearing a supportive truss may help relieve symptoms. A health professional can help make sure the truss fits properly and is being used appropriately. In children, a care professional might try applying manual pressure to reduce the bulge before considering surgery.
Hernias that are painful or getting bigger usually need surgery to relieve discomfort and prevent serious complications. There are two general types of hernia operations: open hernia repair and minimally invasive hernia repair [2].
Approach | When it's used |
Watchful waiting | Small hernia, no problems |
Supportive truss | May relieve symptoms; professional helps with fit |
Manual pressure (children) | May reduce the bulge before surgery is considered |
Surgery | Painful hernias or those getting bigger |
Open Hernia Repair
In this procedure, the surgeon makes a cut in the groin and pushes the protruding tissue back into the abdomen. The surgeon then sews the weakened area, often reinforcing it with a synthetic mesh. This is called a hernioplasty. The opening is then closed with stitches, staples or surgical glue. Open hernia repair might be done with local anesthesia and sedation or general anesthesia.
After the surgery, you'll be encouraged to move about as soon as possible, but it might be several weeks before you're able to resume regular activities.
Minimally Invasive Hernia Repair
In this procedure requiring general anesthesia, the surgeon operates through several small cuts in the belly. The surgeon may use laparoscopic or robotic instruments to repair the hernia. Gas is used to inflate the belly to make the internal organs easier to see. A small tube with a tiny camera, called a laparoscope, is placed into one cut. Guided by the camera, the surgeon places tiny instruments through other small cuts and repairs the hernia using synthetic mesh.
People who have a minimally invasive repair might have less discomfort and scarring after surgery and a quicker return to regular activities. Long-term results of laparoscopic and open hernia surgeries are about the same.
Minimally invasive hernia surgery allows the surgeon to avoid scar tissue from an earlier hernia repair, so it might be a good choice for people whose hernias come back after open hernia surgery. It also might be a good choice for people with hernias on both sides of the body, called bilateral hernias. As with open surgery, it may be a few weeks before you can get back to your usual activity level.
Feature | Open repair | Minimally invasive repair |
Incision | One cut in the groin | Several small cuts in the belly |
Instruments | Standard surgical tools | Laparoscopic or robotic instruments, laparoscope camera |
Anesthesia | Local with sedation or general | General anesthesia |
Mesh | Often used (hernioplasty) | Synthetic mesh used |
Recovery feel | May be several weeks to resume activities | Might have less discomfort and scarring, quicker return |
Long-term results | About the same as laparoscopic | About the same as open |
Best for | First-time repairs | Recurrent hernias, bilateral hernias |
How to Reduce Your Risk and Protect Your Abdominal Muscles
You can't prevent the congenital defect that increases your risk of an inguinal hernia. You can, however, reduce strain on your abdominal muscles and tissues:
Maintain a healthy weight. Talk to a healthcare professional about the best exercise and diet plan for you.
Emphasize high-fiber foods. Fruits, vegetables and whole grains contain fiber that can help prevent constipation and straining.
Lift heavy objects carefully or avoid heavy lifting. If you must lift something heavy, always bend from your knees, not your waist.
Stop smoking. Besides its role in many serious diseases, smoking often causes a long-lasting cough that can lead to an inguinal hernia or make an existing one worse.
Habit | Why it helps |
Maintain a healthy weight | Reduces abdominal strain |
High-fiber foods | Helps prevent constipation and straining |
Lift from the knees, not the waist | Reduces abdominal wall pressure |
Stop smoking | Eliminates the coughing that strains abdominal muscles |
Preparing for Your Appointment
You'll likely start by seeing someone on your primary healthcare team. Making a short list before you go can make the visit more useful [2].
What You Can Do
Make a list of:
Your symptoms, including when they started and how they may have changed or worsened over time.
Key personal information, including recent life changes and family medical history.
All medicines, vitamins or supplements you take, including doses.
Questions to ask during your appointment.
Take a family member or friend along, if possible, to help you remember the information discussed during the appointment. For an inguinal hernia, some basic questions to ask include:
What's the most likely cause of my symptoms?
What tests do I need?
What treatments are available, and which one do you recommend for me?
If I need surgery, what will my recovery be like?
I have other health conditions. How can I best manage these conditions together?
What can I do to prevent another hernia?
Don't hesitate to ask other questions you may have.
What to Expect From Your Doctor
You'll likely be asked a few questions, such as:
When did your symptoms begin?
Have your symptoms stayed the same or gotten worse?
Do you have pain in your abdomen or groin? Does anything make the pain feel worse or better?
What physical activity do you perform on your job? What other physical activities do you regularly engage in?
Do you have a history of constipation?
Have you had a previous inguinal hernia?
Do you or did you smoke? If so, how much?
What You Can Do in the Meantime
Get emergency medical care if you have nausea, vomiting or fever or if your hernia bulge turns red, purple or dark.
Bottom Line
An inguinal hernia is a common condition where tissue pushes through a weak spot in the abdominal muscles near the groin. It never heals on its own, and while many hernias aren't painful at first, the condition can grow and, in the worst case, cut off blood flow to trapped tissue, which is a life-threatening emergency. The good news is that diagnosis usually takes only a physical exam, and repair is a common, well-established surgery with two effective approaches.
Your next step: if you've noticed a bulge near your groin, especially one that aches when you cough, bend, or lift, don't wait for it to get worse. Schedule an evaluation with a healthcare professional today.
Frequently Asked Questions
What is an inguinal hernia?
An inguinal hernia occurs when tissue, such as part of the intestine, pokes through a weak spot in the abdominal muscles. The resulting bulge often appears near the groin on either side of the pubic bone. It can be painful when coughing, bending over, or lifting, though many hernias cause no pain.
What does an inguinal hernia feel like?
An inguinal hernia typically feels like a bulge near the pubic bone that becomes more obvious when upright, especially when coughing or straining. People commonly describe a burning or aching sensation at the bulge, plus pain, discomfort, or pressure in the groin when bending over, coughing, or lifting.
How do you know if you have an inguinal hernia?
The main sign is a bulge on either side of the pubic bone that is more noticeable when standing. You usually can feel it by placing your hand directly over the affected area. A physical exam, often including standing and coughing, is usually all that's needed to confirm it.
What causes an inguinal hernia?
Some have no apparent cause. Common contributors include increased pressure within the abdomen, a preexisting weak spot in the abdominal wall, straining during bowel movements or urination, strenuous activity like heavy lifting, pregnancy, and frequent coughing or sneezing. In many people, the weakness is present from birth.
Is an inguinal hernia dangerous?
An inguinal hernia isn't necessarily dangerous at first, but it doesn't get better on its own and can lead to life-threatening complications. If trapped tissue loses its blood supply (strangulation), the affected bowel tissue can die, which requires immediate surgery.
Can an inguinal hernia heal on its own?
No. An inguinal hernia never resolves by itself. Painful or growing hernias usually need surgery, while small, symptom-free hernias may be managed with watchful waiting.
Who is most at risk of an inguinal hernia?
Men are 8 to 10 times more likely than women to have an inguinal hernia. Other risk factors include older age, European ancestry, family history, long-lasting cough, chronic constipation, pregnancy, premature birth or low birth weight, connective tissue conditions, prior prostatectomy, and a previous hernia or repair.
What is the difference between incarcerated and strangulated hernias?
An incarcerated hernia means the hernia contents are trapped in the abdominal wall and can't be pushed in. A strangulated hernia means the trapped tissue has lost its blood supply, which can kill bowel tissue and is life-threatening without immediate surgery.
How is an inguinal hernia treated?
Small, symptom-free hernias may be watched or managed with a supportive truss. Painful or growing hernias usually need surgery. The two main operations are open hernia repair (one cut in the groin, tissue pushed back, weakened area sewn with mesh) and minimally invasive repair (several small cuts, laparoscopic or robotic tools, general anesthesia).
Which surgery is better: open or minimally invasive?
Long-term results of both are about the same. Minimally invasive repair may mean less discomfort and scarring and a quicker return to activities, and it may suit people with hernias on both sides or hernias that recurred after open surgery. Open repair can be done with local anesthesia and sedation, while minimally invasive repair requires general anesthesia.
Related Reading
Trusted Resources
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): U.S. government overview of inguinal hernia
References
Mayo Clinic Staff. Inguinal hernia: symptoms and causes. Mayo Clinic. September 10, 2025. https://www.mayoclinic.org/diseases-conditions/inguinal-hernia/symptoms-causes/syc-20351547
Mayo Clinic Staff. Inguinal hernia: diagnosis and treatment. Mayo Clinic. September 10, 2025. https://www.mayoclinic.org/diseases-conditions/inguinal-hernia/diagnosis-treatment/drc-20351553
de Goede B, Wijsmuller AR, van Ramshorst GH, et al. Watchful waiting versus surgery of mildly symptomatic or asymptomatic inguinal hernia in men aged 50 years and older: a randomized controlled trial. Annals of Surgery. 2018;267(1):42-49. PMID: 28350567. DOI: 10.1097/SLA.0000000000002243
Van den Dop LM, van Egmond S, Heijne J, et al. Twelve-year outcomes of watchful waiting versus surgery of mildly symptomatic or asymptomatic inguinal hernia in men aged 50 years and older: a randomised controlled trial. EClinicalMedicine. 2023;64:102207. PMID: 37936657. DOI: 10.1016/j.eclinm.2023.102207
Andresen K, Rosenberg J. Transabdominal pre-peritoneal (TAPP) versus totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair. Cochrane Database of Systematic Reviews. 2024;7(7):CD004703. PMID: 38963034. DOI: 10.1002/14651858.CD004703.pub3
Medical disclaimer
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. The clinical information in this guide reflects source material last reviewed in September 2025.
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