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Abdominal hernia, everything you need to know – Hernia

A hernia is a bulge of tissue from one anatomic space to another. Abdominal hernias are the most common kind of them; here, all you need to know.

Abdominal hernias are among the most common surgical condition in the world. Around 10% of the world’s population will develop some type in their lifetime. Also, hernia repair surgery is the most common surgical procedure, with 1 million performed each year. Within them, almost 700,000 of the cases correspond to inguinal hernia repair surgery. The most frequent type of abdominal hernia is the inguinal hernia, with 75% of all cases. Then, it is followed by umbilical, incisional, and femoral hernias, respectively.

In the following article, you will find all your need to know about this common condition. All of it, explained in a simple way, directly from a doctor. Keep reading, and you will find the answers to common questions like: “can you live with this disease?” and “what to do if you have one?”

What is this disease?

Sometimes, it can be a little hard to explain what a hernia is. Basically, it is an abnormal protrusion of tissue from one anatomic space to another. This protruded tissue usually is contained in a sac, formed by the membrane that lines this cavity.

You must know that the term “hernia” is more used to talk about tissues’ protrusions in the chest and abdomen. You may also hear the term “herniation,” which often refers to protruding brain tissue. Additionally, herniations of the spinal discs are common too.

However, in this article, we will be focusing on abdominal hernias since they are a more frequent surgical condition.

What are the different types of abdominal hernias?

There are many types of abdominal wall hernias. They are grouped according to their anatomical or specific location.

Inguinal or groin hernia

It is the most common type of abdominal hernia. In this type, the protrusion goes through the inguinal canal, in the groin. Normally, the inguinal canal only contains blood vessels, nerves, and spermatic cord (men) or round ligament of the uterus (women).

File:A man with an Inguinal Hernia.png
Source

There are two types of inguinal hernias: direct and indirect. Direct inguinal hernias protrude through the posterior wall of the inguinal canal. It usually occurs because of lifting heaving weights. Indirect hernias protrude through the deep inguinal ring and result from the lousy closing of this canal during its embryonic development.

Femoral

They are not so common; its location to appear is just above the thigh. This type protrudes through the femoral canal, containing the blood vessels and nerves that supply to the lower limbs. It is most common in women because they have a wider pelvis.

Umbilical

They are a type of ventral hernias. As the name says, they appear in the navel or belly button. They usually appear at birth and can close spontaneously in the first five years of life. This type is not likely to strangulate itself so that you, most of the time and depending on the case, can live with it with no worries, as we will see further.

Epigastric

It is also a type of ventral hernia. This type appears in the midline of the abdominal wall, also called the linea alba. They mostly present as small lumps that do not cause further complications.

Spigelian

A rare type of ventral hernia. It is also known as a ventral lateral hernia. This type appears between fascia tissue (the tissue that connects the muscles of the abdomen). The risk for this type to complicate or strangulate is high. So, if you have a lump in the side of your abdomen, you should probably have that checked out.

Hiatal

Also called diaphragmatic hernia. It’s called this way because this type protrudes from the abdomen, through the diaphragm, to the chest. In this case, the content of the bulge is a portion of the stomach. It causes symptoms like reflux, heartburn, or bad breath. This type can also be present at birth, being a congenital diaphragmatic hernia.

How does it feel like?

Hernias can be asymptomatic, meaning that you may not even realize you have one. When symptoms appear, they depend on the location and the size of the lump. For most hernias, the most common symptom is the appearance of a lump. This lump may be painless, but sometimes it can cause a dull ache or burning pain.

Hernia’s bulge can be intermittent, meaning that you can feel it, and then sometimes you don’t. This happens because it may go back inside the abdomen. Also, the lumps may change in size so that they can get bigger. An increase in size often happens after exercise or maneuvers that increase the intraabdominal pressure, like coughing.

What are the causes of abdominal hernias?

The leading cause of this disease is a weakness in the abdominal wall. This weakness may result in a defect in the muscles of your abdomen. This way, a small portion of your intestine, or the fatty tissue surrounding it, can protrude outside of the abdominal cavity.

These defects of the abdominal wall can be a congenital condition. This means that you have it since birth. Also, many conditions contribute to the development of abdominal hernias.

Some risk factors for developing this disease are:

  • Age: The older you get, the more likely you are to develop them.
  • Previous abdominal surgeries.
  • Intense exercise or lifting weight.
  • Pregnancies: The more pregnancies, the higher the chances of having abdominal hernias.
  • Being overweight or obese.
  • Chronic Obstructive Pulmonary Disorder (COPD) or diseases that cause chronic coughing: This is because coughing increases intra-abdominal pressure, chronic cough represents a risk factor for them.
  • Constipation: A higher effort at straining when you go to the bathroom increases abdominal pressure, developing them.
  • Urinary obstructions: Like prostatic enlargement, it can cause patients to strain for urinating, increasing the risk of developing them.

What are the symptoms of abdominal hernias?

Abdominal hernias are often asymptomatic. This means that they do not cause any symptoms, and they may go unnoticed. Often, abdominal hernias are only found in routine physical examinations.

Asymptomatic hernias usually have these characteristics:

  • Aching that radiates from the area of the disease.
  • Lump, bulge, or enlargement that increases with higher intra-abdominal pressure. Maneuvers that increase intra-abdominal pressure include coughing, straining, and standing up.
  • Swelling in the area of the disease.
  • No pain or tenderness during physical examination.
  • Increased pain during straining or physical exercise.
  • In small children, hernias may go unnoticed until they are visible. Sometimes children can have increased irritability as the only symptom.

Other types of abdominal hernias will have other specific symptoms. This is due to the location and the structures affected by each one of them. For example:

  • Femoral hernia: Medial thigh pain or groin pain.
  • Incisional hernia: Usually asymptomatic, but it can appear as a bulge in a previous incision. May become larger when standing up.

What are the symptoms of an inguinal hernia?

Because of its location, the symptoms of an inguinal hernia include the following:

  • A bulge or lump in the groin area, on either side of the pubic bone. It can become more evident while standing up, straining, and coughing.
  • Pain or discomfort in all the areas of the groin. Also, burning sensation or aching in the bulge. This feeling can increase while bending over or lifting weight.
  • Weakness or pressure in your groin.
  • Feeling of weight or dragging in the groin.
  • A bulge or lump that could even reach one of your testicles. Swelling and pain can be present there too.

Who is more likely to have an inguinal hernia?

The chance of developing any type of hernia increases with age. This occurs because older people are more likely to have a weakened abdominal wall. Also, older people have a higher chance of having other conditions that increase the chances of developing them.

However, in the case of inguinal hernias, it’s also common that small children develop them. For example, indirect hernias usually present in the first year of life, but they don’t appear until you’re older.

The incidence of inguinal hernias also changes, whether they are direct or indirect. On one side, direct hernias are more common in older age. This happens as a result of a thinner fascia and weaker abdominal muscles. On the other side, indirect inguinal hernias are more common in infants, especially premature ones.

Inguinal hernias are the most common type in both men and women. However, men have a higher risk of developing indirect inguinal hernias than women. In fact, the male-to-female ratio is 7:1. This occurs because the testicles descend from the abdomen to the scrotum through the inguinal canal. When the testicles descend completely, the inguinal canal should close. But sometimes, this does not happen, and this area stays weak.

Also, as with other diseases, inguinal hernias are more likely to appear when the patient has an underlying predisposing condition, like COPD.

Conditions that especially increase the pressure in the abdominal cavity, such as:

  • Heavy lifting
  • Obesity
  • Chronic Obstructive Pulmonary Disease: It is because of chronic coughing.
  • Constipation/Urinary obstructions: Straining for defecation or urination increases intra-abdominal pressure.
  • Conditions with increased fluids in the abdominal cavity: like ascites or peritoneal dialysis.

People born prematurely or with a low birth weight are more likely to develop inguinal hernias. If you happen to have a relative who had them, you have a higher chance of having them also.

What are the complications of abdominal/inguinal hernia?

The most common complications of abdominal hernias are bowel obstruction, incarceration, and strangulation.

Abdominal hernias are the leading cause of bowel obstruction. This happens if the lump contains a portion of the intestine, and then it gets incarcerated or strangulated. In consequence, the bowel movement is impaired, producing the obstruction. Also, when this happens, this portion of the intestine can have poor blood flood, compromising the tissue’s health.

Some symptoms of bowel obstruction include:

  • Nausea and vomiting,
  • Abdominal pain.
  • Constipation or impossibility to defecate.

Thankfully, hernia complications can be easily identified with a physical examination. A doctor can tell if you have incarcerated or strangulated hernia by trying to reduce it. To minimize it, doctors try to push the lump’s content back into the abdominal cavity. If the content is not easily reduced, it is incarcerated.

The characteristics of incarcerated hernias are:

  • Impossibility to manipulate or reduce the lump.
  • Enlargement (usually painful) of a pre-existing hernia or defect.
  • Symptoms of bowel obstruction: nausea, vomiting, and constipation.

If the hernia sac’s content cannot be reduced at all, the hernia is considered irreducible. Irreducible hernias have a higher risk of becoming strangulated.

The characteristics of strangulated hernias include:

  • Pain out of proportion with findings at physical examination.
  • Symptoms of an incarcerated hernia with toxic appearance: like changes in the color and severe swelling.
  • A reduced incarcerated hernia can be strangulated if the pain remains after the reduction.
  • Signs of systemic toxicity or infections: like fever resulting from an intestine without enough blood flow.

What can be mistaken for this disease?

Usually, identifying them is quite simple, especially for a doctor. However, some conditions can be mistaken for this disease.

Most of these diseases are mistaken for a hernia because they also cause enlargement and pain in the testicles or groin.

Some of these conditions include:

  • Acute epididymitis
  • Lymphogranuloma venereum
  • Testicular torsion
  • Hydrocele
  • Groin abscess

Other diseases that can mimic other types of abdominal hernias are:

  • Lipomas
  • Tumors
  • Undescended or retracted testicle

What to do if you get a hernia?

If you have one, you should go to the doctor. The doctor that specializes in hernias is the surgeon. A surgeon will establish if you need to get surgery right away.

Most of the time, if the disease has no complications, you can plan your surgery with time. But keep in mind that, even if it doesn’t bother you, they have a chance of developing severe complications. You should pay attention to your hernia changes, like changes in size, color, and pain.

Can you live with a hernia?

Actually, yes. Most of the time, they are asymptomatic or without symptoms. You can spend most of the time without even noticing you have one.

In fact, doctors have changed the approach of hernia management. A few decades ago, anyone with this disease would get surgery as soon as possible. Now, doctors prefer to watch it while it is not causing too much trouble.

However, there is always the chance that it grows or develops complications. So yes, you can live with it, but do not forget you have it.

How do you diagnose a hernia?

The doctor can diagnose this disease only with a medical history and physical examination. First, your doctor may ask questions about this lump that you started to notice. They will ask about how long ago it appeared, if it hurts and if you experienced other symptoms.

Some important questions include if you exercise a lot or if your job includes lifting weight. Then the doctor will move on to physical examination. First, they will inspect the area in which the bulge appears.

Then, they will feel your abdomen or groin, looking for the bulge. Once they find it, you can be asked to push or cough to see if it gets bigger with these maneuvers. If this bulge is identified as a hernia, your doctor will probably try to reduce it.

If you have a reducible hernia, your doctor can put the hernia sac back into your abdominal cavity. Reducible hernias have less chance of getting strangled and causing other complications.

Most of the time, doctors don’t need further tools to diagnose this disease. However, when in doubt, they can indicate imaging studies.

The most useful study for this case is ultrasonography. This helps your doctor see the bulge’s content, helping them determine if it is this disease or not. Also, CT scans with contrast can determine if the hernia has a portion of the bowel inside it.

Laboratory tests are not useful in diagnosing them. They are indicated only as a part of the preoperatory profile.

What is the treatment for this disease?

Basically, the definite treatment for this disease is surgical repair. In surgery, doctors can repair the defect that makes the hernia protrude. However, some measures can be taken, so you do not have to get surgery right away.

These measures variate in the different types of hernias, so you will need a doctor to decide what is best for you. In the umbilical and epigastric hernias in children, doctors sometimes wait for the hernia to close itself. This usually happens until five years of age. After this, surgery is recommended.

The first thing doctors usually do is to try to reduce it. This means they will try to push the hernia sac back into your abdomen. If it reduces, you can keep calm for a while. However, there is still a risk that it gets incarcerated or strangulated, so you should keep an eye on it. Your doctor may ask you to come by their office occasionally so that they can check for complications too.

There are other medical treatment options for hernias. They would not make the disease go away, but they will lower symptoms and prevent hernias from getting larger. These options include trusses, corsets, and compression dressings.

On the other side, if you have a high risk of developing complications, your doctor may indicate surgery as soon as possible. Depending on your case, your doctor can choose to perform open surgery or laparoscopic surgery.

Open surgery or laparoscopic surgery?

If the hernia is big, your doctor may perform open abdominal surgery. If it is small, it’s most likely that your doctor chooses to perform laparoscopic hernia repair.

Laparoscopic repair uses a small camera and surgical instruments to repair it. Sometimes, doctors just close the abdominal wall, so the lump does not protrude anymore. This is what is usually done for umbilical hernia repair. Depending on the situation, they use a surgical mesh that strengthens the abdominal wall. This is commonly done for inguinal hernia repair.

What is the chance for this disease to come back?

When a previously repaired hernia comes back, it is called a recurrence. Most of the time, the outcome of hernia surgery is really good. However, there is always a rate of recurrence that variates depending on many different factors.

These factors include:

  • Factors related to the patient: Like obesity and other conditions that make people keener to develop this disease.
  • Factors related to the hernia: Like the size or if it has been already repaired. Larger and previously repaired hernias have a more significant chance of recurring.
  • Other factors: Like the surgical technique and the patient’s tissue.
    Recurrence rates also depend on the type. For example, inguinal hernias have a rate of recurrence around 1-3%. On the other side, abdominal hernias (ventral, umbilical, and epigastric) have a 5-10% rate. Finally, incisional hernias have a higher recurrence rate, of 10-15%.

Do you have symptoms of this disease?

This tool is an Abdominal Hernia Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for this disease. Therefore, it would tell anybody who uses it the likelihood of having symptoms because of an abdominal hernia. Using it is free and would only take a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.

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