Hernias occur when an organ pushes through a weak spot or tear in the muscle or tissue that holds it in place. This results in a bulge or lump under the skin. Hernias are common, especially in the abdominal region. Understanding whether a hernia lump is hard or soft can provide insight into the type of hernia that may be present.
Quick Summary
In general, hernia lumps tend to be soft and easily reducible when first forming. As the hernia progresses, the lump often becomes firmer and more difficult to push back in. The contents of the hernia sac and cause of the hernia impact whether the lump is hard or soft.
What Makes Up a Hernia Lump?
A hernia lump contains the organ or tissue that has bulged through the muscle or connective tissue. Common abdominal hernia contents include:
- Small intestine
- Colon
- Bladder
- Stomach
- Fatty tissue
The contents of a hernia can impact the feel of the lump. For example, hernias containing mostly fatty tissue often feel softer than those containing intestine. The amount of content in the hernia sac also plays a role. A sac packed full of intestine will likely feel firmer than one with just a small amount of fat.
Reducible vs. Irreducible Hernias
Whether a hernia lump can be pushed back into place, or “reduced,” provides key insight into how hard or soft it will feel:
- Reducible: Can be gently pushed back into place when lying down. Often feels soft and fluctuant.
- Irreducible: Cannot be pushed back into place. Usually feels firm, hard, and fixed in place.
When a hernia first starts to form, the contents can often still slide back into the abdomen. This makes the lump disappear when lying down and pushing on it. As the hernia opening stretches over time, the contents are more likely to become trapped outside the abdomen. This causes the lump to become irreducible and more firm.
Common Types of Hernias
The most frequent locations and types of hernias provide more clues about lump hardness:
Inguinal Hernia
- Most common type of hernia overall
- Up to 75% of all hernias
- Occurs in the inguinal canal in the groin
- Often feels soft and reducible at first
- Can eventually become firm if contents get stuck
Umbilical Hernia
- Second most common abdominal hernia
- Up to 20% of hernias
- Occurs at the belly button (umbilicus)
- Typically feels soft and fluctuant as fat pushes through
- Does not usually become firm or irreducible
Incisional Hernia
- Develops through prior surgical scar
- Feels firm to hard as intestine often bulges through defect
- Usually irreducible due to stiff scar tissue around defect
Femoral Hernia
- Develops in the femoral canal of the groin/thigh
- More common in women
- Often feels like a firm to hard lump under the skin
- Has high risk of becoming irreducible/incarcerated
Is the Lump Reducible?
Assessing whether the hernia lump can be gently pushed back into the abdomen provides key information:
- Reducible: The hernia lump feels soft and can be pushed back into place when lying down. This suggests the contents can still slide back into the abdomen through a small defect.
- Irreducible: The lump remains fixed in place when attempting to reduce it. This likely indicates a larger defect with trapped contents. The lump often feels firm and resistant to pressure.
A hernia that cannot be reduced requires prompt medical evaluation, as there is increased risk of obstruction or tissue death if the blood supply gets cut off.
Associated Symptoms
Symptoms that accompany the hernia lump also provide insight into its nature:
- Pain – Can indicate trapped contents or obstruction.
- Nausea/vomiting – Sign of obstruction or incarceration.
- Fever – Suggests possible strangulation and tissue infection.
- Difficulty urinating/passing stool – The hernia may be compressing the bladder or bowel.
Severe or concerning symptoms should prompt urgent evaluation, as they may indicate a hernia at risk for complications.
Causes and Risk Factors
Understanding what contributes to hernia development also sheds light on the nature of the lump:
- Congenital defect – Weak spot or opening in the abdominal wall at birth.
- Strain – Repeated heavy lifting, coughing, constipation.
- Pregnancy – Increased abdominal pressure.
- Obesity – Increased weight on the abdomen.
- Prior surgery – Weakness or defect in surgical scar.
Hernias due to congenital defects or pregnancy often feel soft and reducible initially. Hernias following surgery tend to feel firmer from the start.
Diagnosing a Hernia
To confirm the presence and type of hernia, the doctor will:
- Ask about symptoms and perform a physical exam of the lump
- Have you lie down then check if the hernia reduces when pressure is applied
- Examine the groin, belly button, and previous scars for bulges
- Look for signs of obstruction or tissue infection
Imaging tests such as x-rays, CT scans or ultrasound may be ordered to visualize the hernia and identify contents within the sac.
Treatment Options
Repair is recommended for most hernias to prevent complications like obstruction. Options include:
- Open surgery – Hernia contents pushed back into place and defect sewn closed.
- Laparoscopic – Minimally invasive repair through small incisions.
- Medical management – For minimally symptomatic or poor surgical candidates.
Remind your doctor if you notice any changes in your hernia, especially increasing pain, firmness, or irreducibility. Prompt surgical evaluation may be needed.
Home Care for Reducible Hernias
For reducible hernias without concerning symptoms:
- Wear supportive undergarments or trusses to keep the hernia in place.
- Avoid heavy lifting, straining, and constipation.
- Gently push the lump back into place when it appears.
- Monitor for changes in symptoms and reducibility.
See a doctor if the hernia becomes difficult to reduce, or causes pain or other distressing symptoms.
When to Seek Emergency Care
Seek emergency medical care for:
- Sudden severe pain in the area of the hernia lump
- Inability to have a bowel movement or pass gas
- Nausea/vomiting
- Fever
- Bleeding from the hernia site
- Hernia lump that quickly enlarges or becomes irreducible
These signs may indicate a portion of the intestine has become trapped or strangulated in the hernia sac. Prompt surgery is needed to restore blood flow and prevent intestinal death (necrosis).
Preventing Hernias
Methods to potentially help avert hernia formation:
- Maintain healthy weight to avoid extra pressure on the abdomen.
- Build abdominal muscle strength through exercise.
- Use proper lifting technique – lift with the legs, keep back straight.
- Treat constipation to avoid straining.
- Quit smoking, as chronic cough weakens abdominal tissues.
- Manage other medical conditions that increase abdominal pressure.
Making lifestyle changes and managing health conditions that place added strain on the abdomen may help prevent some hernias, though congenital or surgical hernias can still occur.
Conclusion
The hardness or softness of a hernia lump provides insight into the likely contents and severity. In general, a hernia is often softer when it first starts protruding through a defect. As the defect enlarges and more tissue pushes through, the lump typically becomes firmer and irreducible.
A soft, reducible hernia lump can often be managed conservatively with supportive garments and avoiding strain. But a fixed, hard lump may indicate potential complications, requiring prompt surgical evaluation.
Knowing whether a hernia feels hard or soft, and if it can be reduced, guides appropriate treatment. Speak to your doctor if you notice any changes in an existing hernia, or development of new lumps or bulges that could suggest a hernia requiring medical care.