You may notice a lump in your groin or abdomen while standing only for it to become smaller or disappear when you lie down. Yet, when you get back up or move around, the lump returns.
If your hernia disappears when lying down, this may indicate that the hernia is reducible. This means the tissue protruding through a weakness in the abdominal wall can move back through the opening. Changing position can alter the pressure on the area, which allows the bulge to reduce.
However, just because the lump disappears, it doesn’t necessarily mean that the hernia itself has gone away. Understanding why this happens, what a reducible hernia means and which changes warrant medical attention can help you know what to do next.
How Does a Hernia Come and Go?
A hernia develops when tissue or part of an internal organ protrudes through a weakness or defect in the tissue that normally contains it. In abdominal hernias, this can involve fat or part of the intestine pushing through a weakened area of the abdominal wall.
The bulge can change depending on your position and the amount of pressure inside your abdomen. So when you are standing, gravity can encourage the tissue to protrude through the defect. Additionally, coughing or straining during a bowel movement can also increase abdominal pressure, which makes the lump noticeable.
When you lie down, the pressure on the area changes. The protruding tissue may then move back through the defect and into its usual position.
This is why a hernia comes and goes for some people. What has changed is the position of the protruding tissue, not the weakness that allowed the hernia to form in the first place.
What Is a Reducible Hernia?
A reducible hernia is a hernia in which the protruding tissue can return through the defect. It may reduce by itself when you lie down. In some cases, it may also be possible for a doctor to gently reduce the hernia during an examination.
When might you notice the lump come and go:
- It appears when you stand up
- It becomes more noticeable when you cough or strain
- It becomes smaller when you rest
- It disappears when you lie flat
- It causes discomfort that comes and goes
Hernias can occur in several locations. Not all of them present in exactly the same way. In fact, there are different types of hernia, which include inguinal, femoral, umbilical and incisional hernias. They develop and present differently.
The word reducible describes how the hernia is behaving. It’s important to understand that this doesn’t mean that the hernia has fully and permanently reduced or that the weakness in the abdominal wall has healed.
Does a Hernia That Disappears Still Need Medical Assessment?
While it can be tempting to assume that there is nothing to worry about if the lump disappears when you rest, a reducible hernia should still be medically assessed.
A doctor can examine the lump and consider its location, size, symptoms and whether it is truly reducible. Your medical history and any changes you have noticed can also help with diagnosis. In some cases, imaging may be recommended if the diagnosis is not clear from an examination.
Hernias generally don’t resolve by themselves because the underlying defect remains. The appropriate management will depend on different factors:
- Type of hernia
- Symptoms
- Individual health circumstances
Even if your hernia disappears when lying down, if it repeatedly returns when performing certain activities and when standing up, you should arrange an assessment to establish what type of hernia you have and discuss suitable management options.
What If the Hernia Suddenly Stops Going Back In?
Any change in the behaviour of a hernia deserves attention, especially if a lump that previously used to disappear or could be reduced becomes stuck.
Why does this happen? When protruding tissue becomes trapped and can’t return through the defect, this is a sign that the hernia is incarcerated. In some cases, the blood supply to the trapped tissues can become compromised. This is known as a strangulated hernia and it requires urgent medical treatment.
It is crucial to seek prompt medical attention if a previously reducible hernia suddenly can’t be reduced. This can also be accompanied by worsening pain. You may experience symptoms such as nausea, vomiting, constipation or abdominal swelling when part of the intestine becomes trapped.
Do not try to force a painful or stuck hernia back into place yourself.
What Are the Treatment Options for a Hernia?
Treatment depends on the type of hernia you have, its location, your symptoms and your overall health. In other words, a surgeon will carefully assess these factors and discuss the appropriate approach with you.
Hernia repair involves returning the protruding tissue to its appropriate position and repairing the defect. This is a surgical treatment that can include a variety of different approaches:
- Open repair
- Laparoscopic hernia surgery
- Robotic-assisted repair
Which method is suitable will depend on the individual hernia and patient, as well as the risks and other considerations.
What to note: A reducible hernia may seem less concerning because the lump can disappear. However, reducibility alone doesn’t tell you whether or when surgery may be appropriate. Remember that this is a decision that requires clinical assessment, which is why you need to arrange for a medical appointment when you notice a hernia.
Worried About A Hernia That Disappears When Lying Down?
If you suspect that you have a reducible hernia, a.k.a a hernia that comes and goes depending on gravity and the pressure applied to the abdominal wall, your priority should be to request a medical evaluation. This will help determine whether you have a hernia, the type of hernia you are dealing with and the most suitable approach to treat it.
Remember that hernias do not resolve themselves in general, which means that a disappearing hernia when you lie down has simply shifted position. It hasn’t disappeared for good.
Our clinic is open Monday to Saturday for appointments and consultations. So, do not hesitate to reach out to book an appointment and get your hernia that comes and goes looked at.
References:
- https://my.clevelandclinic.org/health/diseases/strangulated-hernia
- Bittner J. G., 4th (2016). Incarcerated/Strangulated Hernia: Open or Laparoscopic?. Advances in surgery, 50(1), 67–78. https://doi.org/10.1016/j.yasu.2016.03.006