Abdominal hernia

An abdominal hernia is a bulge or swelling in your tummy (abdomen) or groin (top part of your leg). It happens when some fatty tissue or part of your bowel pushes through a weakness in your tummy wall.

About abdominal hernia

Your tummy wall is made up of sheets of tough muscles and tendons that run between your ribs and groin. If part of this wall gets weaker, whatever’s on the inside can push through, causing an abdominal hernia.

Your hernia may not cause any symptoms or you may notice discomfort or a bulge in your tummy or groin. This may be more noticeable when you cough or strain.

If you have an abdominal hernia, you may need to have surgery to repair it. But this will depend on your symptoms and how likely you are to get complications.

See a doctor as soon as you can if your hernia suddenly feels very sore or tender, especially if you can’t push it back in. This may mean that some of the hernia contents have become trapped inside. You’ll need surgery as soon as possible.

Types of abdominal hernia

The most common types of abdominal hernia include:

• inguinal hernia
• femoral hernia
• incisional hernia
• umbilical hernia

Abdominal hernias are named according to where the weakness is in your tummy wall.

Inguinal hernia

This is when a bulge appears in your groin – a groin hernia. It happens when you have a weakness in your inguinal canal. Your inguinal canal is a tunnel that allows nerves and blood vessels to pass through the muscle wall of your groin to your genital area. Inguinal hernias are the most common type of hernia and are more common in men.

Femoral hernia

This bulge also appears in your groin, but a little lower down. It happens if you have a weakness in your femoral canal. Your femoral canal contains lymph vessels and nodes, which are part of your immune system. 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 you have a weakness in your tummy wall caused by previous surgery. An incisional hernia can happen several years after surgery.

Umbilical and paraumbilical hernias

This is when a bulge appears in or around your belly button. It happens when there’s a weakness in the muscle layer in or around your belly button. Umbilical hernias are very common in babies but often disappear by the time children reach three years. In adults, paraumbilical hernias are most common, particularly in women during and after pregnancy and in people who are overweight. In adults, these hernias often need surgery – this operation is called an umbilical hernia repair.

You may have heard of hiatus hernia. Unlike the hernias above, this isn’t due to a weakness in your tummy wall. It happens when part of your stomach slides up into your chest.

Symptoms of abdominal hernia

If you have an abdominal hernia, you may have:

• a bulge somewhere on your tummy or in your groin
• slight discomfort in your tummy or groin
• a feeling of heaviness or aching in your tummy or groin

This bulge will often disappear when you lie down. It may also disappear when you push on it and then reappear when you stand or strain (such as cough). Some people first notice a hernia when they’re lifting something heavy.

If you have any of these symptoms, contact your doctor.

Sometimes the contents of a hernia can get stuck inside (incarcerated) and the blood supply can get cut off (strangulated). These are serious medical conditions and can cause a blockage in your bowel. Seek urgent medical advice if:

• your hernia pain keeps getting worse
• you’ve usually been able to gently push your hernia back, but now you can’t
• the hernia bulge hurts if you touch it
• the skin over your hernia bulge becomes red
• you feel sick or you are sick

Diagnosis of abdominal hernia

A hernia can usually be diagnosed by your doctor. Your doctor will ask about your symptoms and check your tummy. They may also ask you about your medical history.

Your doctor may check your tummy when you're standing up and lying down. They’ll check to see if they can push the bulge back in and may ask you to cough while they put their finger over the hernia. This is to see if the swelling changes.

Sometimes your doctor may refer you to a surgeon or for an ultrasound or computer tomography (CT) scan. This is usually if you have pain in your groin, but no obvious signs of a hernia.

Treatment of abdominal hernia

Abdominal hernias in adults don’t always need to be treated. Your doctor can discuss with you whether you’re likely to need surgery. This will depend on your symptoms, your general health, age, which type of hernia you have, it’s size and whether it’s getting bigger.It will also depend on whether your hernia is likely to cause complications, such as a bowel blockage.

Umbilical hernias in young children usually get better on their own. If the hernia is very big or hasn’t gone away by the time your child reaches four years, your doctor may recommend a surgical repair.

Watchful waiting

If your hernia isn’t causing many symptoms, your doctor may suggest monitoring you. This is called ‘watchful waiting’. It means you’ll only have surgery if you need it. Speak to your doctor and make sure you are comfortable with any decisions that you make. There may be things you need to consider, such as the risks of having surgery as you get older. Umbilical hernias in children often disappear on their own.But most hernias in adults get bigger over time or may cause symptoms.

If you have any tummy pain, constipation or sickness, it’s important to contact your doctor straightaway, as this could mean your hernia is getting worse.

Surgery

If your hernia is getting worse or painful, or you’re likely to have complications, you’ll be recommended to have surgery.

An abdominal hernia repair operation involves pulling the hernia back into your tummy and repairing the weakened muscle. You can have a keyhole procedure, where the operation is done through small cuts in your lower tummy. Or you can have open surgery with a single, larger cut. Both types of surgery have pros and cons and your surgeon will discuss the best type of operation for you.

Everyone recovers differently from a hernia repair operation. Most people who have inguinal hernia repair surgery will be in and out of hospital on the same day. If you have open hernia repair surgery, it may take you four to eight weeks to recover well enough to go back to work. If you have keyhole hernia repair surgery, it may take you a couple of weeks instead.

Below we have videos on open and keyhole surgery for both femoral and inguinal hernia repairs. Operations vary, so your surgeon will explain what your exact surgery will involve and answer your specific questions.

Open femoral hernia repair

Video summary: This operation may be done under a local anaesthetic or a general anaesthetic. Your surgeon will make a single cut in your groin and pull the contents of the hernia back inside. They may insert a synthetic mesh over the weak part of your groin wall to strengthen it. They’ll then close the cut using dissolvable stitches or other methods.

Keyhole femoral hernia repair

Video summary: This operation is usually done under a general anaesthetic. Your surgeon will make several small cuts in your lower tummy and groin and pass a telescopic camera through one of the cuts. They’ll pull the contents of the hernia back inside and may stitch a synthetic mesh over the weakness in the wall to strengthen it. They’ll then close the cuts with Steri-Strips (narrow strips of sticky plaster) or other methods.

Open inguinal hernia repair surgery

Video summary: This operation may be done under a local anaesthetic or a general anaesthetic. Your surgeon will make a single cut in your groin and pull the contents of the hernia back inside. They may stitch a synthetic mesh over the weak part of your groin wall to strengthen it. They’ll then close the cut using dissolvable stitches or other methods.

Keyhole inguinal hernia repair

Video summary: This operation is usually done under a general anaesthetic. Your surgeon will make several small cuts in your lower tummy and groin and pass a telescopic camera through one of the cuts. They’ll pull the contents of the hernia back inside and may stitch a synthetic mesh over the weak part of your groin wall to strengthen it. They’ll then close the cuts with Steri-Strips (narrow strips of sticky plaster) or other methods.

Causes of abdominal hernia

Anything that increases the pressure in your tummy can make you more likely to get an abdominal hernia. This includes:

• coughing, especially if your cough lasts for a long time
• straining on the loo, which may happen if you’re constipated
• lifting heavy objects or weights
• being very overweight
• being pregnant with more than one baby (such as twins) or having a difficult delivery

You’re more likely to have an abdominal hernia as you get older. This is because your tummy wall muscles get weaker as you get older.

Complications of abdominal hernia

If your hernia becomes impossible to push back in, it’s called an incarcerated or irreducible hernia. If this cuts off the blood supply to the sticking-out part of your bowel or some fatty tissue, it’s called a strangulated hernia. It’s a serious complication that needs urgent surgery.

Hernias are unlikely to rupture. But very rarely, a strangulated hernia can cause a hole in the bowel wall (called bowel perforation), which can lead to a very bad infection.

See a doctor as soon as possible if:

• your hernia pain is getting worse
• you can no longer push your hernia in
• your hernia bulge hurts if you touch it
• your hernia bulge looks red