A hernia is a hole or weak spot in the abdominal wall that lets tissue push through. Almost every patient with an inguinal (groin) hernia notices a bulge that comes and goes. It may be painless or mildly uncomfortable, better lying down, worse with long standing or sitting. Discomfort from a hernia is rarely sharp.

An umbilical hernia is a bump at or near the belly button, at the natural opening left by the umbilical cord. It is common in men after weight gain and in women during or after pregnancy, and in almost all cases it is not dangerous.

Usually not. The physical exam is the most important part of the evaluation, and imaging is needed in fewer than 5% of patients. We recommend against ultrasound for inguinal hernia workup because it misleads more often than it helps. A CT scan is useful before surgery for complicated or recurrent hernias, like a GPS for the operation.

Think of a hernia like a hole in a bicycle tire with the inner tube pushing through. A patch on the inside of the tire is the strongest fix, because the tire's own pressure holds the patch against the hole. Placing mesh behind the abdominal wall uses the same physics, and it keeps the mesh away from two of the three groin nerves that cause most chronic pain.

In our published registry data, this repair showed better patient-reported outcomes than the standard on-top-of-muscle (Lichtenstein) repair over 10 years [2], and matched laparoscopic and robotic repair for recurrence with slightly better early quality of life, without general anesthesia [3].

We offer the Shouldice repair, about 100 times per year, after Dr. Reinhorn trained with the team at Shouldice Hospital in Toronto. The hernia is repaired by suturing the abdominal muscles together in four separate layers to close the defect, with no mesh. Best candidates are thin, healthy patients with small to moderate hernias.

Honest data: done at high volume, tissue repair works well, with recurrence near 1.2% at the dedicated Shouldice Hospital [4]. Our own matched comparison found the mesh repair gave less pain and better quality of life through one year, with no difference in recurrence [5]. We walk through both at your consult.

Mesh is implanted in over one million people each year with few complications. The real issue is chronic pain, which affects roughly 10 to 12% of patients across all techniques, severe in a smaller group [6]. The main driver is mesh or fixation near the groin nerves in on-top repairs. Placing mesh behind the muscle avoids two of the three nerves, which is a large part of why we prefer it, and why our patients report a minimal incidence of chronic pain.

Two options. A mesh repair: through a small incision at the navel, tissue is reduced, a small mesh goes under the abdominal wall, and the hole is sewn closed over it, a durable two-layer repair. Or a suture-only repair, reserved for thin, healthy patients, especially women with hernias from pregnancy.

The data is clear: for hernias 1 to 4 cm, mesh cut recurrence from about 12% to about 4% in a randomized trial [7], and international guidelines recommend a flat preperitoneal mesh for most [8].

Yes. Women more often have femoral hernias, which carry higher risk, so guidelines advise timely repair rather than watchful waiting [1]. This video covers what women should know.

Usually not. Two randomized trials found men with minimally symptomatic inguinal hernias could safely wait: no extra complications, similar pain and quality of life at 2 years [9,10]. The honest follow-up: about two thirds of the waiting group chose surgery within roughly a decade, usually because symptoms grew [11].

In my opinion the takeaway is this: little or no discomfort means you have time to pick your surgeon, your technique, and a date that fits your life. Growing discomfort or an enlarging bulge means it is time to move.

Generally yes, if symptoms allow. Exercise did not cause the hernia; the weakness in the abdominal wall did. A truss can offer temporary comfort but fixes nothing.