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Health condition · Clinically reviewed

Groin and abdominal wall hernias, from a small groin bulge to complex ventral repair.

The common ones - inguinal, femoral, umbilical, incisional - and the ones that are easy to miss. When to watch, when to repair, and when a hernia is an emergency.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against the British Hernia Society, the European Hernia Society and NICE guidance you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice, including laparoscopic and robotic repair, and shared decisions on mesh.

Key facts

Hernias at a glance.

The essentials, in plain English. What a hernia is, the main types, and how they are managed in UK practice today.

  • What it is

    A protrusion of abdominal contents through a weakness in the groin or abdominal wall, felt as a bulge that comes and goes with straining.

  • Inguinal hernia

    The most common groin hernia. Lifetime risk is roughly 27 per cent in men and 3 per cent in women, with a male predominance of around seven to one.

  • Femoral hernia

    Less common but more likely in women, sitting below the inguinal ligament, with a much higher risk of strangulation. Repair is usually recommended.

  • Umbilical and epigastric

    Umbilical hernias in children often close by age five. Adult umbilical, paraumbilical and epigastric hernias are usually repaired if symptomatic.

  • Incisional hernia

    A hernia through a previous surgical wound. Increasingly common and often complex to repair, with a specialist hernia team.

  • Emergency signs

    Sudden severe pain, a bulge that will not go back in, redness or vomiting suggests strangulation, a surgical emergency.

Why this guide matters

A shared decision, not a one-size fix.

Hernias are common and mostly manageable. The three points below shape everything else on this page, and every specialist conversation.

  • Type of hernia changes the plan

    Inguinal, femoral, umbilical, epigastric and incisional hernias each behave differently and are managed on their own terms.

  • Not every hernia needs surgery

    Small, minimally symptomatic inguinal hernias can sometimes be watched. Femoral hernias almost always need repair.

  • Emergencies are time-critical

    Strangulation, obstruction and a lump that will not go back in are surgical emergencies. Do not sit on them.

Types

The hernias you might hear about.

Some are common, some are rare. The management differs, but the principles - shared decision, specialist review, red-flag safety-netting - stay the same.

  • Inguinal

    The most common groin hernia. Direct or indirect, and much more common in men. Lifetime risk around 27 per cent in men, 3 per cent in women.

  • Femoral

    Below the inguinal ligament, more common in women and more likely to strangulate. Repair is almost always recommended.

  • Umbilical

    In children, most close by age five. In adults, persistent or paraumbilical defects are usually repaired if symptomatic.

  • Paraumbilical

    The adult form of umbilical hernia, just next to the umbilicus. Repair is offered for symptoms or risk of enlargement.

  • Epigastric

    Small midline defects between umbilicus and sternum. See our full guide at /conditions/epigastric-hernia/ for detail.

  • Incisional

    A hernia through a previous surgical scar. Increasingly common and often complex, best managed by a specialist hernia team.

  • Spigelian

    A rare hernia at the lateral edge of the rectus muscle (the semilunar line). Easy to miss without imaging.

  • Lumbar

    Petit and Grynfeltt hernias occur through the back wall. Rare, and usually diagnosed by CT.

  • Obturator

    A rare hernia through the obturator canal in thin, frail, elderly women. The Howship-Romberg sign points to it.

  • Sports hernia

    Also called athletic pubalgia or inguinal disruption. Not a true hernia. Managed by a specialist groin-pain service.

  • Hiatus and paraoesophageal

    Stomach herniating through the diaphragm. Covered in our guide at /conditions/gastro-oesophageal-reflux-disease-gord/.

  • Sliding and Littre

    A sliding hernia contains part of a viscus in its wall. A Littre hernia contains a Meckel diverticulum in the sac.

How the diagnosis is made

From a first bulge to a clear plan.

The steps a UK GP or general surgeon will normally follow, in order. So you know what to expect, and why.

  1. 01

    Assessing

    History and impact

    A careful story of the bulge, activities that bring it out, discomfort, drag, and any obstructive symptoms.

  2. 02

    Assessing

    Examination standing and supine

    A structured groin and abdominal wall exam, including cough impulse, in both positions to reveal reducible defects.

  3. 03

    Assessing

    Rule out mimics

    Lipoma of the cord, lymph nodes, saphena varix, hydrocele and sports-related groin pain can look similar and are considered.

  4. 04

    Confirming

    Dynamic hernia ultrasound

    A specialist scan with straining views is the first-line test for an occult hernia, and helps map the defect.

  5. 05

    Confirming

    CT for complex or occult cases

    CT of the abdomen and pelvis is used for complex ventral, incisional, obturator and spigelian hernias, and for pre-operative planning.

  6. 06

    Deciding

    Specialist surgical review

    A general surgeon or specialist hernia service confirms the diagnosis, weighs the risks, and discusses whether repair is right for you.

  7. 07

    Deciding

    Shared decision on repair

    Elective repair versus watchful waiting is a shared choice, with mesh, technique and rehabilitation set out in plain terms.

Typical timeline: a first visit to a settled plan in weeks, not months.

Symptoms

What a hernia actually feels like.

A bulge that comes and goes, a drag or an ache, and sometimes the sudden signs of obstruction or strangulation that need same-day surgical assessment.

  • Groin or abdominal bulge

    A lump that appears with standing, coughing or lifting and often goes back in on lying flat.

  • Discomfort and dragging

    A dull ache, drag or heaviness in the groin or over the defect, worse at the end of the day.

  • Sharp pain with strain

    A sudden catching pain when lifting, coughing or straining, easing when the bulge reduces.

  • Non-reducible lump

    A hernia that will not push back in is incarcerated and needs a same-day surgical opinion.

  • Signs of strangulation

    Severe pain, redness over the bulge, vomiting or a tender, tense lump suggests strangulation. Treat as an emergency.

  • Bowel obstruction

    Colicky abdominal pain, distension, vomiting and no wind or stool can be the first sign of an obstructed hernia.

  • Post-surgical bulge

    A new bulge along an old scar suggests an incisional hernia, which is best assessed by a specialist hernia team.

  • Red flag - femoral or obturator

    A tender lump below the groin crease in a woman, or unexplained bowel obstruction in a thin elderly woman, needs urgent review.

Treatment

How hernias are treated in the UK.

From watchful waiting to open, laparoscopic and robotic repair. Complex ventral and incisional hernias sit within a specialist commissioned hernia service.

  • Watchful waiting

    Selectively used for small, minimally symptomatic inguinal hernias in low-risk adults, with clear safety-netting for red flags.

  • Open mesh repair (Lichtenstein)

    A well-established open technique for inguinal hernias, done under local, regional or general anaesthetic, by a general surgeon.

  • Laparoscopic repair (TEP or TAPP)

    Totally extraperitoneal or transabdominal preperitoneal keyhole repair, with a shorter recovery for many bilateral or recurrent hernias.

  • Robotic repair

    Increasingly used for complex inguinal, ventral and incisional hernias, offering fine control in expert hands.

  • Femoral hernia repair

    Repair is recommended for almost all femoral hernias because of the higher strangulation risk, even when symptoms are mild.

  • Umbilical and epigastric repair

    Small defects are often repaired with sutures or a small mesh. Larger or recurrent defects usually need a specialist plan.

  • Complex ventral and incisional

    Large or recurrent wall hernias may need transversus abdominis release, component separation and a specialist hernia service.

  • Emergency surgery

    Strangulated or obstructed hernias need urgent operative repair, sometimes with bowel resection, by emergency general surgery.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or general surgeon knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • British Hernia Society. Groin hernia guidelines and standards.

  • European Hernia Society and HerniaSurge. International guidelines for groin hernia management.

  • NICE. Laparoscopic surgery for inguinal hernia repair (TA83) and related guidance.

  • Royal College of Surgeons of England. Commissioning guide for the management of abdominal wall hernia.

Red flags

When a hernia is an emergency.

Most hernias are elective work. These are the situations that are not, and where same-day surgical assessment is needed.

  • Strangulation

    Severe pain, a tender, tense, non-reducible lump, redness and systemic upset. A surgical emergency, needing same-day assessment.

  • Bowel obstruction

    Colicky pain, vomiting, distension and no wind or stool with a known or new hernia is a red flag for obstruction.

  • Femoral hernia in a woman

    Any tender lump below the groin crease in a woman deserves urgent surgical review because of the higher strangulation risk.

  • Obturator hernia

    Elderly, thin, frail women with unexplained bowel obstruction and inner-thigh pain on hip movement (Howship-Romberg sign) need urgent imaging.

  • Rapidly enlarging incisional hernia

    A quickly growing bulge over an old scar, or new obstructive symptoms, needs specialist hernia review.

  • Systemic illness with a hernia

    Fever, tachycardia or peritonism in someone with a known hernia should be treated as strangulation until proven otherwise.

  • Persistent post-repair pain

    New or persistent groin pain after hernia surgery deserves a specialist opinion, not reassurance alone.

  • Sports hernia not settling

    Athletic pubalgia or inguinal disruption that fails structured rehabilitation deserves a specialist groin-pain service.

  • Suspected mesh complication

    Chronic pain, infection or bowel symptoms after mesh repair warrants review by a specialist hernia team.

Living with it

A treatable condition, with a clear pathway.

Four things make the biggest difference before and after surgery. Recognising red flags, optimising fitness, a gradual return, and bringing back new symptoms early.

A quiet reminder

Small, steady progress beats a heroic week.

A structured rehabilitation plan, kept up for weeks, does more than a sudden return that costs recovery.

  1. 01 Recognise

    Know the emergency signs

    A bulge that will not go back, severe pain, vomiting or systemic upset needs urgent assessment, not a wait-and-see.

  2. 02 Prepare

    Optimise before surgery

    Where possible, address weight, smoking, blood sugar and fitness before elective repair. Outcomes are better and recurrence lower.

  3. 03 Recover

    A gradual return to activity

    Most people are back to light activity within days and full activity within four to six weeks, guided by a specialist rehabilitation plan.

  4. 04 Escalate

    Bring back new symptoms

    New pain, a returning bulge or unusual swelling after repair deserves review, sometimes with imaging, by your surgical team.

Frequently asked

Everything we get asked about hernias.

Quick answers on types, repair options, mesh and when a hernia becomes an emergency.

  • What is a hernia?

    A hernia is a protrusion of abdominal contents through a weakness in the groin or abdominal wall. It is usually felt as a bulge that appears with standing, coughing or lifting and often reduces on lying flat.

  • Which types of hernia are most common?

    Inguinal hernias are by far the most common in the groin, especially in men. Femoral hernias are less common but more likely in women, and carry a higher risk of strangulation. Umbilical, paraumbilical, epigastric and incisional hernias make up most of the abdominal wall hernias seen in UK practice.

  • Do all hernias need surgery?

    No. Small, minimally symptomatic inguinal hernias in low-risk adults can sometimes be watched, with clear advice on red flags. Femoral hernias, symptomatic groin hernias and most incisional hernias are usually offered elective repair to reduce the risk of complications.

  • What is the difference between open and laparoscopic repair?

    Open mesh repair, such as the Lichtenstein technique, uses a groin incision and a flat mesh. Laparoscopic repair, such as TEP or TAPP, uses keyhole surgery to place mesh behind the muscle layer. Both are effective. Laparoscopic and robotic repair are often chosen for bilateral or recurrent hernias, and are usually done by a specialist minimally invasive general surgeon.

  • Is mesh safe?

    For most hernias, mesh reduces recurrence and is the standard of care. It is not right for every patient. A specialist hernia surgeon will discuss the type of mesh, the technique and any specific risks with you as a shared decision.

  • What are the signs of a hernia emergency?

    Sudden severe pain, a lump that will not go back in, redness, vomiting or a distended abdomen suggests strangulation or obstruction. These are surgical emergencies and need same-day assessment, usually by emergency general surgery.

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