An abdominal hernia occurs when a small piece of intestine and connective tissue pushes out through a weakness in the muscles that make up the body wall. The hernia is felt as a lump; if it can be pushed back gently into the body, it is said to be a reducible abdominal hernia; if it cannot be pushed back, it is termed a non-reducible abdominal hernia. Both types can occur at weak points anywhere in the abdominal wall.
Recognising an abdominal hernia is important because prompt treatment can prevent the hernia becoming strangulated. When this happens, the protruding intestine gets trapped and the blood supply to the piece of tissue outside the body wall can get cut off, causing tissue death. This can lead to infection, it is extremely painful and it can be life-threatening. Fortunately, abdominal hernias can be repaired very successfully using different surgical techniques.
Are there different types of abdominal hernia?
Abdominal hernia are classified according to where they occur:
- An umbilical hernia arises when a small piece of intestine and associated tissue pushes through a weak part of the body wall near to the navel. All sorts of people get this type of abdominal hernia – even newborn babies.
- Inguinal hernias are the most common type of abdominal hernia in men – they occur in the weakened part of the body wall where the testicles have passed out of the body when they descended into the scrotum during puberty. In men, inguinal hernias are felt as lumps in the scrotum. They can also occur in women, and the intestine bulges into the outer part of the vagina.
- An epigastric hernia is an abdominal hernia that is positioned above the navel in the upper abdomen.
- A femoral hernia pushes through a weakness between the abdomen and the thigh, causing bulges inside the upper part of the thigh.
- An incisional hernia is different to the other types of abdominal hernia in that it is not associated with a particular fixed position – it arises anywhere on the abdomen where there is a weakness due to a previous surgical incision. Common sites include an appendix scar or a caesarean scar.
Am I at risk?
Anyone can develop an abdominal hernia at any age but there are some genetic disorders that make hernias more likely, even at relatively young ages. In the general population, if you are male, overweight, have chronic constipation and a smoker’s cough, you are a very good candidate for developing an abdominal hernia. Women who have multiple pregnancies, very large babies or who are also overweight when pregnant are also at high risk. Lifting heavy objects using the wrong technique can increase the risk of hernia, but then so can sneezing constantly because of an allergy.
What are the treatment options?
A hernia can be felt as a bulge but it is also felt because of the discomfort it produces, which is worse after standing for long periods, if you try to lift anything heavy, or even if you strain on the toilet. Strangulation of an abdominal hernia can cause intense pain and can actually block the bowel, so it is important that the hernia is treated sooner rather than later.
The main surgical treatment is laparoscopic surgery to repair the abdominal hernia. This is a form of keyhole surgery – it does not need a large incision and a fibre optic camera and keyhole surgery instruments are used to carry out the repair internally. The surgeon makes three small incisions, one on each side of the abdomen and one around the navel and then makes a three-pronged manoeuvre to locate the abdominal hernia with the camera through one incision and use the surgical instruments through the other two entrance points.
He or she then makes an internal cut at the site of the abdominal hernia, so that the organs and tissue that are sticking through the body wall can be brought back inside. Stitching is done, if necessary, but the major part of the repair involves inserting a piece of tough synthetic mesh to cover over the weakness in the body wall. Over time, connective tissue grows through this mesh and it becomes a more natural part of the body wall.
Can it recur?
After surgery to repair an abdominal hernia, it will take a few days for the bruising, swelling and soreness to go down and then it is important to take things easy, to avoid straining the abdominal muscles and to particularly avoid any lifting. Once the wound has healed and the mesh has become integrated, the repair is very strong but the first few weeks are crucial.
In the longer term, such a repair prevents a hernia occurring at the same point but it is still possible for an abdominal hernia to arise elsewhere in the body wall at a different weak point. Losing weight, stopping smoking and avoiding straining generally, again particularly lifting, is a good idea to prevent a second hernia.