An abdominal wall hernia can be painful and uncomfortable. It occurs when body tissue pushes through an opening in the wall of the abdomen, which is a muscular structure. This causes the lining of the abdomen (the peritoneum) to push through the space created by the weakness and creates a bulge. This is usually made much worse when the muscles in the abdomen are tightened or put under pressure. Things like lifting, bending and even coughing can exacerbate the problem.
What are the symptoms of this type of hernia?
If you have a hernia in the abdomen then you may notice swelling or a bulge, often in the groin area. It will not necessarily be painful and the swelling may come and go. If the pain is constant, intense and very swollen, please contact a doctor immediately.
Diagnosis and treating hernias
How will your hernia be diagnosed?
In order to check on whether or not you have a hernia, your doctor will need to examine your abdomen carefully. He may be able to see the hernia protruding quite easily, or he may have to gently palpate the abdominal area to see if he can detect an opening or a bulge in the wall. If the physical exam is not conclusive then an abdominal ultrasound will be carried out, particularly for a femoral hernia. The doctor may also recommend doing an x-ray or ultrasound scan if he suspects any complications such as bowel obstructions or blockages.
What is the treatment for a hernia?
If you have a hernia and it is beginning to create problems such as pain and discomfort which are preventing you living your life normally, then surgery will probably be needed. This operation is called a herniorrhaphy. However, do not think that surgery is the only option. If the hernia is a minor one you may be able to live with it if you are careful about what physical activities you carry out and do not irritate it. However, this does carry some risk as if the organ that is protruding loses its blood supply, the tissue can start to die off and become ‘strangulated’. Undetected this can lead to infection, severe problems and can even be fatal if not dealt with quickly. You will need to take your doctor’s advice on the best way forward to cope with your particular hernia.
Please note that a strangulated hernia can be a surgical emergency. If you suffer with severe abdominal pain, vomiting, fever or absolute constipation (where you are unable to pass stool or wind), you should contact your doctor urgently. Please note that in this situation, you are usually best served by an NHS hospital. It is very difficult to get emergency treatment for strangulated hernias performed in the private sector.
If you are waiting for surgery and your hernia is problematic then your surgeon may issue you with a belt (truss) to hold the hernia in place until the operation can be performed.
The surgical procedure
Abdominal wall surgery will be carried out under a local or general anaesthetic. It is usually possible to do the operation laparoscopically (using ‘keyhole’ surgery) although sometimes the surgeon will need to make a small cut – open surgery – to find out where the weakness or hole is within the abdominal area.
The surgeon will then return the hernia sac (protruding tissue) back to its original location and make use of the necessary technique to close up the hole using either suture, plastic mesh or a combination of both.
What types of abdominal hernia are there?
There are several different types of hernia that can appear in the abdominal area. They are named differently according to which space they occupy. You may hear them referred to as:
This type of hernia can is found when a gap in the muscles of the upper abdomen opens up due to weakness or injury. The tissues within the abdomen can then poke out through the muscle. This is the type of hernia that a patient can be born with. As we grow and the abdomen strengthens, it may heal itself.
Similar to the epigastric hernia, this type of hernia can also be present when a baby is born. The difference is that in this case, tissue pushes its way through the abdomen in the area of the umbilicus (belly button). Again, this can heal itself as we grow and the muscles strengthen.
If you have scars or wounds on the body in the area of the abdomen then it is also possible for tissue to find its way through the scar by pushing it open, particularly if the wound has not healed very well. This happens most often in the early years after an operation has been carried out.
One of the rarer forms of hernia is the lumbar hernia. This is found in the lower region of the back where there is a group of muscles running from the lower section of the ribcage to the top of the pelvic area. Although it is more commonly found on the right hand side, it can appear on either side of the body.
We can suffer from an internal hernia when internal organs, usually bowel, becomes trapped in an unusual space within the abdominal cavity. We can be born with this unusual space or it can result from abdominal surgery.
This is the most common type of hernia and most usually develops in men. It occurs within the groin area where there is a small ‘tunnel’ like structure. This is a remnant from when you were a baby. This ‘tunnel’ allowed the testicles to come down from the abdomen into the scrotum. It normally closes itself, but sometimes re-opens. This typically occurs in people who have been doing heavy exercises. If you are unlucky, material from the intestines finds its way into this tube and forms this type of hernia.
This type of hernia develops via a slit in the anterior lower abdominal wall. It is not only very rare but also quite difficult to identify.
If you have a femoral hernia then you will find some tissue pushing up into your groin area but lower in position and smaller than the inguinal hernia. These are more commonly found in women.
A hiatal hernia (sometimes called hiatus hernia, particularly in the UK) develops through the diaphragm, which is a wall of muscle which separates the chest from the abdomen. Under normal circumstances, the oesophagus (tube from the throat to the stomach) passes through the hiatus (a hole in the diaphragm muscle) and attaches to the stomach.
New approaches to treating abdominal wall hernias
Advance in surgical meshes
Currently, the most commonly used meshes are made of derivatives of polypropylene. Where there is a possibility that a mesh will be directly in contact with bowel, it may be better to use a mesh with a specially treated surface that decreases the possibility of adhesions. These meshes are called composite meshes and are often used for large abdominal incisional hernia repairs.
Laparoscopic, or keyhole surgery can now be used to repair hernias and the principle advantage is reduced pain and quicker recovery. The reason why keyhole surgery has not replaced open surgery in all cases is that it is not always possible and it carries a risk of damage to organs and structures in the abdomen. Although this risky is tiny, the consequences can be catastrophic – damage to a major blood vessel or peritonitis from damage to bowel. Since keyhole surgery usually requires at least three small incisions (one for the telescope and two for left and right hand instruments) there is no advantage to it if the open operation only requires one small incision, as in the repair of a small umbilical (bellybutton) hernia.
There are various techniques now used to repair complex recurrent hernias, such as the ‘component separation’ technique. As a result there are very few cases nowadays where a repair cannot be offered, even when previous repairs have failed.