| What We Treat
Hernia
A lump in the groin that appears when you cough or strain? Hernias are a surgical matter rather than a physiotherapy one — but the groin pain that often comes with them is worth sorting out properly.
Overview
What Is a Hernia?
A hernia is a protrusion of tissue through a weakness in the abdominal wall, most commonly in the groin. It typically appears as a lump that becomes more obvious on standing, coughing or straining, and often reduces when lying down. Hernias do not resolve with exercise and cannot be treated by physiotherapy — they are a surgical question. Physiotherapy is relevant for the overlapping groin pain presentations, and for recovery after repair.
Inguinal Hernia
The most common type, appearing in the groin crease. Far more common in men. Presents as a lump that becomes prominent on standing or straining and often disappears on lying down, sometimes with a dragging ache. Repair is the definitive treatment.
Symptoms
How It Tends to Feel
Hernias have a fairly characteristic presentation:
A Lump in the Groin
Often appearing on standing, coughing or straining, and reducing when lying down.
A Dragging Ache
A heavy or dragging sensation in the groin, worse towards the end of the day.
Worse With Straining
Coughing, sneezing, lifting and straining all make the lump and the discomfort more prominent.
Better Lying Down
Symptoms and the lump itself frequently settle when you lie flat.
Gradual Enlargement
Hernias tend to become larger over months to years rather than staying static.
Sudden Severe Pain
A hernia that becomes painful, hard and irreducible is an emergency and needs immediate assessment.
Causes & Risk Factors
What Drives It
Hernias result from a combination of a weakness in the abdominal wall and pressure pushing against it.
Anatomical Weakness
Natural weak points in the abdominal wall, some of which are present from birth.
Raised Abdominal Pressure
Chronic coughing, straining with constipation, heavy lifting and obesity all increase pressure against the wall.
Previous Surgery
Incisional hernias develop through the weakened tissue of a previous surgical scar.
Age and Sex
Incidence rises with age, and inguinal hernias are considerably more common in men.
Connective Tissue Factors
Conditions affecting collagen structure increase the likelihood of hernia formation.
How We Can Help You
Treatment & Management
A confirmed hernia needs a surgical opinion. Where physiotherapy contributes is in sorting out overlapping groin pain, and in the graded return to loading after repair.
What the evidence says
Surgical repair is the definitive treatment for symptomatic inguinal hernia. For small, minimally symptomatic hernias in men, watchful waiting has been shown to be a reasonable option, though a substantial proportion eventually cross over to surgery because symptoms progress.
The Doha agreement on groin pain in athletes distinguishes inguinal-related groin pain from a true hernia, which matters because the former is managed with rehabilitation in the first instance rather than surgery.
When to Seek Help
Red Flags — Don’t Wait
A hernia that becomes trapped is a surgical emergency:
⚠ Attend A&E immediately if you notice:
- A hernia that becomes painful, hard, or cannot be pushed back in
- Redness or discolouration of the skin over the lump
- Nausea, vomiting, or an inability to pass wind or open your bowels
- Severe or rapidly worsening abdominal pain
- Fever or feeling generally unwell alongside a groin lump
A strangulated hernia cuts off the blood supply to the trapped tissue and is a surgical emergency. If a hernia becomes painful and cannot be reduced, attend A&E immediately rather than waiting.
Common Questions
Frequently Asked Questions
Can exercise fix a hernia?
No. A hernia is a physical defect in the abdominal wall, and no amount of strengthening closes it. Core work may help with associated discomfort and general function, but the hernia itself needs surgical repair if it is symptomatic.
Do all hernias need surgery?
Not immediately. For small, minimally symptomatic inguinal hernias in men, watchful waiting is a recognised option. However, a substantial proportion progress to needing repair over time, and any hernia causing pain or enlarging should be assessed surgically.
Is my groin pain a sportsman’s hernia?
Possibly, though the name is misleading — inguinal-related groin pain usually involves no true hernia at all. It sits alongside adductor and hip-related groin pain and frequently coexists with them. Rehabilitation is the right first step, with surgical assessment if it doesn’t respond.
When can I return to sport after repair?
Most surgeons allow light activity within a week or two and a graded return to full loading over six to twelve weeks, though protocols vary. Following your surgeon’s timeline matters, and the return should be progressive rather than straight back to previous loads.
Sort Out What’s Actually Causing the Groin Pain
Careful assessment to distinguish hernia from the several other causes of groin pain — and rehabilitation where that’s the right answer.
Book Your Initial AssessmentThis page is for general information only and isn’t a substitute for individual medical advice. If you’re experiencing any of the warning signs above, contact your GP or seek emergency medical care as appropriate.