Hernias and your pelvic floor: hiatal, umbilical, inguinal

Author: Jessica Lloyd
Senior Vulvovaginal Specialist Naturopath | BHSc(N) | ISSVD, ISSWSH, BSSM, ATMS

Last reviewed: July 20, 2026

Your body has three main cavities stacked on top of each other – the chest and ribcage (thoracic), the abdomen, and the pelvis. When pressure builds up in one area, it has to go somewhere. It can push up, out, or down, shoving your organs into the neighbouring space. That is how most hernias are born, and it is also why a hernia and a grumpy pelvic floor so often turn up together.

A hernia is simply a bit of tissue or organ poking through a weak spot in the wall that is meant to contain it. Below are the three you are most likely to meet, sorted by which direction the pressure went.

When pressure goes up

Pressure pushing upwards presses on the diaphragm, and that is how a hiatus (hiatal) hernia is born – a section of the stomach slides up through the gap in the diaphragm into the chest cavity.¹ The sliding type is by far the most common, making up around 95 per cent of hiatal hernias; the rarer para-oesophageal type, where part of the stomach rolls up alongside the gullet, is the one more likely to cause trouble.¹

Symptoms of a hiatal hernia include:

Acid reflux/heartburn
Food returning up into the mouth after swallowing
Trouble swallowing
Chest pain
Abdominal pain
Burping
Changes to voice or breathing
May need to swallow a lot of saliva
Feeling full soon after you eat, even small amounts
Feeling short of breath
Waking up gasping for air
Vomiting blood
Passing black stools (indicates bleeding in the gastrointestinal tract)
Urinary tract/bladder/pelvic issues that may seem unrelated

When pressure goes out

The belly button is one of the weakest spots on the front of your body, and when pressure is pushed outwards the result can be abdominal separation and an umbilical hernia.

An umbilical hernia in adults is caused by a build-up of abdominal pressure that forces outwards. It can be driven by pregnancy (especially several pregnancies), fluid build-up in the abdomen (ascites), previous abdominal surgery that has weakened the tissue, being significantly overweight, and long-term peritoneal dialysis for kidney failure.² In adults these are more common in women than men, and tend to show up in your forties, fifties and sixties.²

Symptoms of an umbilical hernia include:

Abdominal pain
A bulge or swelling near the belly button
Tenderness around the belly button
Discolouration around the belly button
Urinary tract/bladder/pelvic issues that may seem unrelated
Vomiting

When pressure goes down

When pressure is pushed downwards, the result is a strained pelvic floor or an inguinal or femoral hernia, where tissue pokes through into the groin.

Inguinal hernias are the big one, making up roughly three-quarters of all abdominal wall hernias.¹⁰ The lifetime chance of a groin hernia is around 27 to 43 per cent in men and 3 to 6 per cent in women, so they are far more common in men overall.³ Femoral hernias, which sit slightly lower and more towards the inner thigh, are the exception – they are the groin hernia women get more often than men, for reasons we get into below.⁴

Symptoms of an inguinal or femoral hernia include:

Bulging around the edge of the pubic bone, worse for sitting or standing upright, coughing or straining
The bulge aches or burns
Pain in the groin area, worse for bending over, lifting or coughing
Heavy feeling in the groin
Weakness in the groin
Pressure in the groin
Pain or swelling in the scrotum or testicles
Urinary tract/bladder/pelvic issues that may seem unrelated

When a hernia is an emergency

Most hernias sit there being annoying rather than dangerous, and many can be gently pushed back in. The problem is when they cannot. If a loop of bowel gets trapped in the hernia (incarceration) and its blood supply is cut off (strangulation), that tissue starts to die, and it becomes a surgical emergency.⁶

Get to an emergency department now if a hernia bulge suddenly becomes hard, very tender, or goes red, purple or dark, will not push back in, or comes with severe pain, fever, nausea, vomiting, or you stop passing wind and stool.⁶ Femoral hernias in particular have a higher risk of strangulation, which is part of why they are usually recommended for repair rather than watching and waiting.⁴⁵

What hernias and pressure mean for your pelvic floor and vagina

Here is where hernias become very much a vagina-owner’s problem. Your pelvic floor is the muscular hammock at the bottom of that stack of cavities – it is the down valve for every bit of pressure your abdomen generates. Your diaphragm at the top and your pelvic floor at the bottom work like two ends of a piston, moving together with each breath to manage the pressure in between.⁸⁹ When that pressure is repeatedly forced downwards – chronic coughing, straining on the toilet, heavy lifting with a held breath – it lands on the same tissues that hold your bladder, uterus and vaginal walls in place.

That shared plumbing is why a hernia and pelvic floor dysfunction so often travel together, and why pelvic organ prolapse (where the bladder, uterus or vaginal walls sag downward) sits on the same spectrum of raised intra-abdominal pressure. If you already have one pressure problem, it is worth having the whole system looked at. You can read more in our guides to the pelvic floor and vaginal and pelvic organ prolapse.

Femoral hernias are the one groin hernia that turns up more in women than men, roughly four times as often, and they are most common in women over 65. The reason is anatomical – the wider female bony pelvis leaves a slightly larger, weaker gap for tissue to slip through.⁴ They can be easy to miss because the bulge sits lower, near the crease of the groin and inner thigh, so any new lump there deserves a look.⁵

Pregnancy is its own pressure event. A growing uterus, plus the relaxin-softened connective tissue of pregnancy, raises the odds of umbilical and groin hernias, and repeated pregnancies stack the risk.² One thing worth knowing: a tender groin lump in pregnancy is not always a hernia. Swollen veins around the round ligament (round ligament varicosities) can mimic an inguinal hernia almost exactly, and usually settle on their own within a few weeks of giving birth – so this is a job for an ultrasound rather than a guess, because the two are managed very differently.⁷

Why is pressure unbalanced?

When your organs and cavities are in the right position and everything is working well, pressure is spread evenly. When something is off – breathing, alignment, posture – one section of organs cannot fully sit in its own space, and the pressure gets shunted somewhere it should not go.

Breathing

Breathing feels automatic, but how you do it affects your whole trunk. Stand up and take a breath – if only your upper chest heaves, or you brace and bear down into your belly on the way in, you are not making the most of the system. The aim is a relaxed breath that fills your lower ribs and lets them widen out to the sides.

This matters because the diaphragm and pelvic floor move together. A breath that expands your lower ribs lets the diaphragm drop and the pelvic floor lengthen and rise in coordination, rather than dumping pressure downward onto the pelvic floor, an existing hernia, or the abdominal wall.⁸⁹ Breath-holding and constant belly-clenching during effort are the habits that keep pushing pressure the wrong way.

Alignment of shoulders, ribs and pelvis

If you sit in front of a computer all day, or use equipment that keeps your arms out in front of you, you tend to end up with rounded shoulders, a tight chest and a head that pokes forward.

If you sit with your tailbone tucked under you on the back of your pelvis, you can end up with tight pelvic floor muscles. A tight muscle is not a strong muscle – it is a dysfunctional one, so a tight pelvic floor can quietly become a weak pelvic floor.

When you slump, sitting or standing, you often lift the chest to reset your position, known as rib thrusting. Pushing the base of the rib cage forwards and out upsets the whole abdominal system. The result can be back pain from moving the rib cage away from the pelvis, which stops your deep core from switching on properly.

How to get help with hernias, pelvic floor dysfunction and alignment

The best people to help are a pelvic physiotherapist or an osteopath. Find one locally who has experience with what ails you, if you have such luxuries. If you live somewhere without access to osteopathic, chiropractic or pelvic physiotherapy services, find someone online who can advise you on the next best steps. Pelvic floor work and breathing retraining will not close an existing hernia, but they help control the pressure that made it, and support you before and after any repair.⁵ Our pelvic floor exercises overview is a decent place to start.

Deal with these problems reasonably quickly. They usually do not fix themselves, and can lead to worse problems down the track.

Frequently asked questions

Are hernias more common in women or men?

It depends on the hernia. Inguinal (groin) hernias are far more common in men, with a lifetime chance of around 27 to 43 per cent, compared with 3 to 6 per cent in women.³

Women flip the script on two: femoral hernias, which sit lower in the groin, turn up around four times more often in women, and adult umbilical hernias are also more common in women.²⁴

Can pregnancy cause a hernia?

Pregnancy raises the pressure inside your abdomen and softens your connective tissue, which makes umbilical and groin hernias more likely, and several pregnancies add to the risk.²

Most hernias that appear in pregnancy are watched rather than rushed to surgery, unless they become painful or trapped. Your maternity team can point you to the right assessment.⁵

I have a groin lump in pregnancy – is it always a hernia?

No. Swollen veins around the round ligament can look and feel almost exactly like an inguinal hernia during pregnancy, and they usually settle on their own within a few weeks of birth.⁷

Because the two are managed differently, any new groin lump in pregnancy is worth an ultrasound rather than a guess. Get it checked promptly if it becomes hard, very painful or discoloured.⁶⁷

When is a hernia an emergency?

Go to an emergency department if the bulge suddenly becomes hard, very tender or discoloured, will not push back in, or comes with severe pain, fever, vomiting, or you stop passing wind and stool.⁶

These are signs the hernia may be trapped and losing its blood supply, which needs surgery quickly. Femoral hernias carry a higher risk of this, so they are taken seriously even when small.⁴⁶

Will pelvic floor exercises fix a hernia?

Not on their own – an actual hole in the abdominal wall needs surgical repair to close, and pelvic floor exercises will not stitch it shut.⁵

What they do help with is the pressure system that caused it. Breathing retraining and pelvic floor work reduce the downward strain, ease overlapping symptoms like leaking or prolapse, and support you around any repair.⁸⁹

This article is for general information and is not a substitute for personal medical advice. If you have a hernia, a new lump, or any of the emergency signs above, see a doctor. Anything sudden, hard, very painful or discoloured needs urgent care.

References

Smith RE, Shahjehan RD. Hiatal Hernia. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK562200/
Coste AH, Jaafar S, Parmely JD. Umbilical Hernia. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK459312/
Anatomy, Abdomen and Pelvis: Inguinal Ligament (Crural Ligament, Poupart Ligament). StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK542321/
Goethals A, Adams CT. Femoral Hernia. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK535449/
Institute for Quality and Efficiency in Health Care (IQWiG). Hernias: How are inguinal and femoral hernias treated in women? InformedHealth.org. https://www.ncbi.nlm.nih.gov/books/NBK553372/
Pastorino A, Alshuqayfi AA. Strangulated Hernia. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK555972/
Ijpma FFA, et al. Is round ligament varicosity in pregnancy a common precursor for the later development of inguinal hernias? PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC7210230/
Talasz H, et al. Breathing, (S)training and the Pelvic Floor – A Basic Concept. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC9222935/
Effect of the correlation between the contraction of the pelvic floor muscles and diaphragmatic motion during breathing. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC4540829/
Merck Manual Professional Version. Hernias of the abdominal wall. Rahway (NJ): Merck & Co.