Abdominal hernia

About abdominal hernia

The abdominal wall is a sheet of tough muscles and tendons that run between your ribs and your groin (upper part of your leg). It acts like a natural corset holding all the abdominal organs in place. Sometimes, a weakness in your abdominal wall can open up, so whatever is on the inside (usually part of your gut) pushes through. This causes a bulge or swelling called a hernia.

Types of abdominal hernia

Abdominal hernias are named according to the position of the weakness in the abdominal wall. The most common types of abdominal hernia are listed below.

  • Inguinal hernia. This is when a bulge appears in your groin or, if you're a man, in your scrotum. It happens when your gut pushes through a weakness in the inguinal canal (an area in your groin where nerves and blood vessels pass through the muscle layers that supply the genital area). Inguinal hernias are more common in men.
  • Femoral hernia. This bulge also appears in your groin. It happens when your gut pushes into the femoral canal (a channel through which large blood vessels travel in and out of your leg). The femoral canal is close to, but separate from, the inguinal canal. Women are more likely to have a femoral hernia than men.
  • Incisional hernia. This is when a bulge appears near an old surgical scar. It happens when tissue or part of your gut pushes through a weakness in the muscles, which was caused by a pervious surgery. An incisional hernia can occur months or years after surgery and is more common in adults than children. It can happen after about one in 10 abdominal surgeries.
  • Umbilical hernia. This is when a bulge appears around your navel (belly button) because of a weakness in the muscle layer in or around it. Umbilical hernias are very common in young children but often disappear as they get older. In adults, they are most common in women during and after pregnancy, and in people who are overweight.

Symptoms of abdominal hernia

The main sign of an abdominal hernia is having a bulge or swelling appear on a part of your abdomen. Often, the bulge will disappear when you lie down or push on it and then reappear when you stand, cough or sneeze. This is called a reducible hernia.

You may also have symptoms such as burning, slight discomfort and a feeling of heaviness or aching in your abdomen. When you strain or lift something, you may have a sharp pain.

If you have any of these symptoms, see your GP.

Complications of abdominal hernia

If the hernia grows and becomes impossible to push back in, it’s called an incarcerated hernia. When this happens, there is a risk that the blood supply to the protruding gut may be cut off. This is then called a strangulated hernia, which is a serious complication that requires urgent surgery.

It’s vital that you get medical help immediately when you have a hernia and it becomes incarcerated, especially if:

  • the affected area is very painful, tender and red
  • you feel weak and faint with pale, clammy skin and a fast heart rate
  • you feel sick or vomit

Causes of abdominal hernia

Anything that increases the pressure in your abdomen can cause an abdominal hernia, including:

  • coughing or sneezing
  • straining on the toilet (for example, if you have constipation)
  • pregnancy 
  • lifting heavy objects (for example, weight training)
  • being overweight

The risk of having an abdominal hernia increases with age because the older you get, the weaker your abdominal wall muscles become.

Diagnosis of abdominal hernia

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP will examine the bulge or swelling. This may be when you're standing up or lying down. He or she will check if the bulge can be pushed back in, and may ask you to cough while placing a finger over the hernia to see if there is a change in the swelling. Your GP may also refer you for an ultrasound scan to confirm a diagnosis.

Treatment of abdominal hernia

Umbilical hernias in young children usually get better on their own as the abdominal muscles get stronger. However, most abdominal hernias generally get larger with time and don't go away without treatment. Surgical repair is usually recommended in adults.

Surgery

An abdominal hernia repair operation involves pushing the hernia back into your abdomen and repairing the weakened muscle. This can be done as a keyhole procedure (where the operation is done through small cuts in your lower abdomen) or open surgery (where a single, larger cut is made).

Prevention of abdominal hernia

The only way to prevent having an abdominal hernia is to limit the problems that make it more likely. Some examples are listed below.

  • Recurrent coughing or sneezing. Find out what is causing your symptoms and get help to treat them.
  • Straining on the toilet. To help ease your bowel movement, eat enough fruit and vegetables and increase your fibre intake. Also make sure you drink enough fluids.
  • Being overweight. Try to maintain a healthy weight and if you're overweight seek help to lose any excess weight.
  • Lifting heavy objects. Make sure you use a correct lifting technique and if possible try to find ways to reduce heavy lifting.

If you’re a woman and are pregnant, it may be helpful to wear a support belt to ease the pressure on your abdominal muscles. Speak to your GP or obstetrician (a doctor who specialises in pregnancy and childbirth) for more information.

 

Are there any other symptoms of an abdominal hernia apart from having a bulge?

Answer

If you have any type of abdominal hernia, as well as having a bulge, you might also have a dragging or aching feeling in the area. This may get worse when you're physically active.

Explanation

Abdominal hernias can sometimes be very small and difficult to diagnose, particularly in people who are overweight. If you suspect you have a hernia but don’t notice a bulge, you may have other symptoms, such as a dragging or aching feeling in your abdomen (tummy).

You will have more obvious symptoms if the hernia becomes strangulated (when the blood supply to your gut becomes cut off). Because you can develop complications even from small hernias, it’s important to seek medical help immediately if:

  • the affected area is very painful and tender
  • you feel weak and faint with pale, clammy skin and a fast heart rate
  • you feel sick or vomit

If the hernia is strangulated, you will need to have surgery urgently.

What can I do to prevent another hernia from happening in the future?

Answer

There is no sure way of preventing another hernia but you can take steps to reduce the chances of it happening again. These include managing factors that may put a strain on your abdominal muscles.

Explanation

After having a hernia, you're at an increased risk of having another. The likelihood of this happening will depend on the type and size of the initial hernia, your general health, weight and lifestyle.

Your general health

A chronic cough, violent sneezing or constipation can increase your risk of having another hernia. Some self-help measures to ease these problems are listed below.

  • If you smoke, stopping can help to improve your cough. If you have a persistent cough for any other reason, talk to your GP or pharmacist for advice about treatments that can help to ease the problem.
  • If you have hay fever, you can be affected by violent sneezing. Talk to your GP or pharmacist about effective treatments for hay fever to control your symptoms.
  • Eating a healthy balanced diet with enough fruit, vegetables and fibre, and drinking enough fluids can help prevent constipation.

Weight

Being overweight can put a strain on your abdominal muscles, so it’s important to maintain a healthy weight.

Lifestyle

Any physical activity that involves straining your abdominal muscles can increase your risk of getting another hernia. If your job involves heavy lifting, it’s important to look at ways to reduce or not do this type of activity.

Regular exercise is good for your general health and wellbeing; however strenuous activity can put pressure on your abdominal muscles. If you have had a hernia before, talk to your GP for advice before starting a new physical activity.

Will I need to have surgery for an abdominal hernia?

Answer

Apart from umbilical hernias in small children, abdominal hernias don’t usually go away by themselves and tend to get bigger slowly over time. You are therefore likely to need surgery.

Explanation

Most people will eventually need to have surgery for an abdominal hernia, but how soon you need to have the operation may depend on how severe your hernia is and your individual circumstances. Your surgeon will be able to advise you about your options and the right type of surgery for you.