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 of abdominal hernia?
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 for abdominal hernia?
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 abdominal hernias 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.
