A hernia is the exit of an organ, such as the bowel, through the wall of the cavity in which it normally resides. Hernias come in a number of different types. Most commonly they involve the abdomen, specifically the groin. Groin hernias are most common of the inguinal type but may also be femoral. Other hernias include hiatus, incisional, and umbilical hernias. For groin hernias symptoms are present in about 66% of people. This may include pain or discomfort especially with coughing, exercise, or going to the toilet. Often it gets worse throughout the day and improves when lying down. A bulging area may occur that becomes larger when bearing down. Groin hernias occur more often on the right than left side. The main concern is strangulation, where the blood supply to part of the bowel is blocked. This usually produces severe pain and tenderness of the area. Hiatus or hiatal hernias often result in heartburn but may also cause chest pain or pain with eating. Risk factors for the development of a hernia include: smoking, chronic obstructive pulmonary disease, obesity, pregnancy, peritoneal dialysis, collagen vascular disease, and previous open appendectomy, among others. Hernias are partly genetic and occur more often in certain families. It is unclear if groin hernias are associated with heavy lifting. Hernias can often be diagnosed based on signs and symptoms. Occasionally medical imaging is used to confirm the diagnosis or rule out other possible causes. The diagnosis of hiatus hernias is often by endoscopy. Groin hernias that do not cause symptoms in males do not need to be repaired. Repair, however, is generally recommended in women due to the higher rate of femoral hernias which have more complications. If strangulation occurs immediate surgery is required. Repair may be done by open surgery or by laparoscopic surgery. Open surgery has the benefit of possibly being done under local anesthesia rather than general anesthesia. Laparoscopic surgery generally has less pain following the procedure. A hiatus hernia may be treated with lifestyle changes such as raising the head of the bed, weight loss, and adjusting eating habits. The medications, H2 blockers or proton pump inhibitors may help. If the symptoms do not improve with medications the surgery known as laparoscopic fundoplication may be an option. About 27% of males and 3% of females develop a groin hernia at some time in their life. Groin hernias occur most often before the age of one and after the age of fifty. Inguinal, femoral and abdominal hernias resulted in 32,500 deaths in 2013 and 50,500 in 1990. It is not known how commonly hiatus hernias occur with estimates in North America varying from 10 to 80%. The first known description of a hernia dates back to at least 1550 BC in the Ebers Papyrus from Egypt.