A hernia is an abnormal protrusion of a loop of intestine, or other internal organs, through a weak area of the abdominal wall.
The most obvious symptoms of a hernia are:
- A noticeable bulge in the groin area, or around the navel, which reduces when pressed
- An aching sensation
- Pain, especially on coughing, bending, or straining
- A sense of fullness
- Abdominal wall hernias are most common in men.
Around 4 out of 5 hernias occur in the groin crease (inguinal hernia), but they can also occur through the navel (umbilical hernia), above the navel (para-umbilical or epigastric hernia), below the groin crease (femoral hernia) and through an old surgical incision (incisional hernia).
What causes a hernia?
Hernias usually occur due to natural weakness in the abdominal wall. However, there are some predisposing factors, such as heavy lifting, straining, persistent coughing and carrying excess weight.
Are hernias dangerous?
Abdominal wall hernias are not necessarily dangerous, although they do not get better without surgery. However, they can cause life threatening complications if they cause obstructions or cut off the blood flow, so it may be best to have them surgically repaired.
What is incarceration and strangulation of a hernia?
Abdominal wall hernias can contain a loop of intestine, usually the small intestine, which may become stuck or trapped in the hernia. This is known as incarceration.
Occasionally the loop of intestine is trapped so tightly that its blood supply gets cut off, referred to as strangulation and this can lead to bowel gangrene within 6 hours. If untreated, this can cause bowel perforation, peritonitis and ultimately death.
What are the possible signs and symptoms of hernia strangulation?
Generally, you should be able to gently push a hernia back in.
If you are unable to do this and you develop any of the symptoms below, you must seek immediate medical attention:
- Sudden, intense and persistent abdominal pain
- Nausea and vomiting
- Hernia bulge that becomes tender and turns red or purple in colour
- Fever and fast heart rate
- Abdominal distension
How are abdominal wall hernias diagnosed?
Abdominal wall hernias are usually diagnosed based on the history and examination of the individual patient. Other conditions in the groin, such as enlarged lymph glands, undescended testis and abnormally swollen blood vessels, need to be excluded by your GP.
Your doctor may ask you to stand up and cough, as the pressure of coughing helps push out a hernia and appear more obvious.
Occasionally an ultrasound scan, or computed tomography (CT) scan, may be required to help diagnose abdominal wall hernias.
How are abdominal wall hernias treated?
Not all abdominal wall hernias require surgical repair. Hernias through the navel (umbilical hernias) in babies occur because the opening for the umbilical cord did not completely close and some of these may resolve spontaneously. They may just need monitoring.
However, it is normally recommended that adult hernias are repaired surgically, especially if they are causing problems. A mesh material is used to reinforce the weak area of the abdominal wall and reduce the risk of a hernia recurring. This is done using a laparoscopic (keyhole) technique, which allows faster physical recovery, smaller incisions, less pain and can usually be performed as a day case.
Please ensure you consult a healthcare professional before making decisions about your health.