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Hernias: Why They Develop & Why You Should Get Them Fixed

A hernia is a hole in a muscle anywhere in the abdominal wall that is either natural or due to an injury or surgery. When a hernia develops, it is important to seek medical attention.  Dr. Ian Villanueva, a surgeon with WakeMed Physician Practices – General & Bariatric Surgery, sees and treats many patients who have hernias, and offered the following information.

Why do hernias develop?

Hernias develop for a number of reasons. Some of these include:

  • Natural weak areas in abdominal wall
  • Genetics
  • Prior surgery
  • Habits
    • Tobacco use
    • Any increase in pressure
      • Cough
      • Constipation
      • Difficulty urinating
      • Job/Work

What do hernias feel like?

Hernias can feel like bulges, bumps or lumps. They can sometimes be painful, and you may actually be able to push the lump “back in”. However, sometimes the lump stays out.

Physicians are usually able to diagnosis a hernia through a physical exam. In some cases, additional imaging, such as an ultrasound, is required.

Types of hernia. Epigastric, Lateral, Umbilical, Inguinal, femoral, incisional hernia. intestinal hernia. Infographics. Vector illustration on isolated background.

Types of Hernias

There are three common types of hernias, which are outlined below.

Inguinal Hernia

  • Occurs in the groin area
  • Most common in men

Umbilical/Ventral Hernia

  • Occurs anywhere in the abdominal wall
  • Belly button becomes an “outie” instead of an “innie”

Diastasis Recti

  • Is not a hernia but similar symptoms
  • Causes a bulge, but is not a hole, and therefore not a hernia

Diastasis Recti

Why should I get my hernia fixed?

Hernias do not heal – they either stay the same size or get bigger with time. It should be repaired when the hernia is:

  • Limiting normal daily activities
  • Limiting work related activities

You should also have your hernia repaired if there is:


  • Bulge is stuck and cannot be reduced
  • Very painful
  • If intestine is involved, can have bowel obstruction
  • Sometimes an emergency surgery

Strangulated Hernia


  • Bulge is stuck and cannot be reduced
  • Whatever is in the bulge starts to die off
  • Extremely painful
  • If intestine involved, can be life-threatening
  • Always an emergency surgery

Hernia Surgery

The goal of hernia surgery is to identify the source of the bulge, examine the contents of the bulge, and repair the hole. Surgeons either use an open repair or laparoscopic repair.

Open Hernia Repair


  • Can be done with heavy sedation (general anesthesia is not needed)
  • Non-mesh repair techniques available
  • Can be done in emergencies
  • Lower costs, in general


  • More painful
  • Mesh is on the outside of the dam
  • Smaller mesh sizes may lead to hernia recurrence
  • Longer time to return to strenuous activity

Laparoscopic Hernia Repair


  • Less painful
  • Larger sized mesh can cover all hernia spaces
  • Quicker return to strenuous activity
  • Easier to repair double hernias


  • Needs general anesthesia
  • Always requires mesh
  • Rarely used in emergencies
  • Higher costs

Umbilical hernia repair surgery

Stitches vs Mesh

In surgery, the hole can be repaired with either stitches or mesh. Your physician will make the decision based on several factors.

Mesh is a medical device that serves as a patch to cover the area of a repaired hernia, and increases the strength of the repair for lower hernia recurrences.  It is typically used in non-emergency surgery and with larger hernias, (larger than a nickel).

About Dr. Ian Villanueva, MD

Dr. Ian A. Villanueva is a board-certified general surgeon with WakeMed Physician Practices – General & Bariatric Surgery. Dr. Villanueva’s clinical interests include advanced laparoscopic and DaVinci surgical robot-assisted techniques in all areas of gastrointestinal surgery, bariatric weight loss surgery, and minimally invasive hernia surgery. Request an appointment with Dr. Villanueva today by calling 919-350-1604 or by filling out our online form.