Moderate to severe strain coupled with weakened or damaged tissue linings can result in painful hernias – the protrusion of an organ, typically the intestines, through its surrounding wall. While it sounds pretty dramatic, hernias can actually be treated without invasive procedures and often, simply by monitoring. In more serious cases, however, hernias can lead to complications that require surgery to prevent blood loss, tissue damage, or infection.

There are four main types of hernias including inguinal, hiatal, umbilical, and incisional. Understanding the causes and symptoms of hernias may help prevent you from developing one in the first place, or help you recognize the signs that you might want to see a doctor for one.

Inguinal hernia

Pain in the groin and abdomen, especially when coughing, lifting, or bending over, might indicate a an inguinal hernia where a loop of intestines has poked through the lower abdominal wall where the abdominal muscle is weakest. A bulge may appear most visible when you’re standing up accompanied by pain, aching, weakness, pressure and a semblance of heaviness in your groin. For men, if the intestines descends down into the scrotum, you may experience swelling and pain around the testicles.

A hernia may actually “slide back in” to position if you gentle push it when lying down, wear a hernia belt (like these designed for women), or ice the area to reduce swelling. Sometimes a hernia cannot be pushed back in and becomes trapped in the abdominal wall – this is referred to as “incarcerated hernia.” If this happens and blood flow to the tissue becomes trapped, doctors diagnose this as a strangulated hernia, which can be life-threatening.

Symptoms of this more serious case include fever, nausea, vomiting, discoloration of the hernia bulge (dark), and inability to move your bowels or pass gas. People of all ages from infants to adults can develop these types of hernias and should seek medical evaluation to get ahead of potential complications.

Hiatal hernia

Going the other direction now, a hiatal hernia results from an upward pushing of the intestines through the diaphragm and into the chest cavity. Your diaphragm naturally contains a small opening called the hiatal through which the esophagus passes down to the stomach. Occasionally the intestines will pop through this small opening causing food and stomach acid to back up into the esophagus.

While small hiatal hernias don’t usually require medical attention and may not even be noticeable, larger more severe ones may require surgical intervention. Symptoms of a hiatal hernia include chest or abdominal pain, difficulty swallowing, heartburn, belching, a super ‘full’ feeling following a meal, and even gastrointestinal bleeding (passing black stools or vomiting blood will indicate gastrointestinal bleeding).

Pressure on the stomach combined with a weakened diaphragm (from age or genetics) can cause a hiatal hernia as well as amplified strain from chronic coughing, vomiting, or lifting heavy objects. Most people who develop a hiatal hernia are over the age of 50 and/or obese.

Umbilical hernia

While affecting some adults, umbilical hernias are most common in infants and result in a protrusion in or near a baby’s navel (typical less than 6 months old). Weak abdominal muscles may not be able to hold in an infant’s intestines so it bulges through the umbilical opening. Most often an umbilical hernia will disappear with time, even over a couple years. If it doesn’t, doctors may recommend a simple surgical procedure to correct it.

The soft swelling of this type of hernia will appear most visible when a baby strains, coughs, laughs, or cries, but might disappear from view when they lie down flat without moving. Usually painless and not dangerous, umbilical hernias can occasional cause abdominal discomfort for adults, or if causing complications in an infant result in pain, more swelling, vomiting, and discoloration of the lump.

Incisional hernia

The site of a surgical wound on the abdomen may be a prime spot for what is known as an incisional hernia – where the intestines pokes through this weakened tissue and creates a bulge under the skin. Surgical procedures from large intestinal exploratory operations to smaller routine appendectomies can incur an incisional hernia, especially when healing of the incision site is decreased by bleeding, infection, or weakened tissues or when added strain from chronic cough or pregnancy, for example, is placed on the abdomen.

Surgery to address an incisional hernia is often recommended to also aid the original surgical wound in healing. Surgeons may place a prosthetic mesh around the wound to help reinforce the abdominal wall, or laparoscopically insert mesh into the sides of the hernia without reopening original incision points. This can potentially increase success rates and prevent further infection.