Abdominal hernia
A hernia is the protrusion of an internal part of the body through a weakness in the surrounding tissue or muscle wall.
Abdominal hernias result from local weakness in the internal abdominal wall and usually present as a lump or bulge arising in the abdomen or groin area. Whilst they are not usually painful, many people describe an ache in the region of the hernia which may worsen after activity.
Sometimes a hernia occurs after a strain – for example, after lifting a heavy object. Sometimes they develop for no good reason, and you may simply notice a small lump in the tummy or groin. Abdominal hernias can also result from weakened scar tissue at the site of previous abdominal surgery.
The lump created by the hernia can often be pushed back in or disappears when lying down. Coughing or straining may make the lump appear or protrude.
Over time, hernias can become bigger as the gap in the muscle or tissue lining gets larger. It may also become more difficult to push them back in (known as “reducing” the hernia). Sometimes, in men, they track down into the scrotum.
Initially abdominal hernias contain internal fat but if they increase in size, the bowel can occasionally push through and may even become trapped (“incarcerated”), leading to increased pain or discomfort. When this happens the blood supply to the bowel can become pinched off or reduced (“strangulation”). Whilst incarceration and/or strangulation of the bowel are rare, they can be life-threatening and may require urgent surgical treatment.
Most abdominal hernias are harmless and represent little more than a nuisance.
Types of hernias
There are various types of hernias, these are the more common ones:
- Inguinal hernias – part of the bowel or abdominal fatty tissue poking through the groin, sometimes entering the male scrotum
- Femoral hernia – part of the bowel or pelvic fatty tissue poking through the groin or inner thigh. Less common than inguinal hernias.
- Umbilical hernias & Paraumbilical hernias – fatty tissue or part of the bowel poking through the abdominal wall close to the belly button
- Incisional hernias – where tissue pokes through weakened scar tissue from a previous surgical wound in your abdomen.
- Hiatus hernia – Whilst technically arising from the abdomen, this form of hernia is unlike the other types of abdominal hernia described above. It is an internal hernia where part of the stomach protrudes upwards into the chest cavity through an opening in the diaphragm (the muscle separating the chest cavity from the abdominal cavity), causing digestive problems & heartburn. Hiatus hernias rarely require any form of surgical intervention.
- Divarication of Recti – is a condition where the abdominal (tummy) muscles become separated in the middle, often as a result of pregnancy. Whilst rectus divarication produces the same appearances as an abdominal hernia, it is not technically a hernia, and it does not carry any of the associated risks of bowel incarceration or strangulation.
Why do hernias occur?
Abdominal hernias may occur from activities or conditions which raise the pressure in the tummy (abdomen), such as:
- Chronic or persistent cough.
- Being overweight or pregnant.
- Lifting, carrying or pushing heavy loads.
- Straining on the toilet.
- Previous abdominal surgery.
Treatment
For most forms of abdominal hernia, the risk of serious complications is low.
In Devon, the surgical treatment of abdominal hernias isn’t considered necessary if the hernia isn’t causing many symptoms and a “watchful waiting” approach may be the most appropriate course of action.
The use of a truss to manage hernias of the groin is best avoided as they are rarely effective in holding the hernia in place and may lead to complications when incorrectly fitted.
Surgery may be advised if the hernia is considered at greater risk of strangulation or if it is having a significant impact on your daily life.
The surgical repair of abdominal hernias may be performed laparoscopically (keyhole surgery) or by the more traditional “open surgical” approach. The type of surgery used will depend on the nature of the individual hernia and the surgeon will discuss your options in this regard if surgery is felt to be appropriate for you.
Local commissioning policies are in place for this condition
Please be aware that there are local commissioning policies in place for this condition. This means that certain treatments may not be available to you on the NHS.
Please click here for more information.
When to consult your GP
It is important that any new lump or swelling of the abdomen is correctly diagnosed and if in doubt you should always consult your GP for advice and guidance in the first instance.
You should seek early review with your GP if you experience any changes in an established abdominal hernia such as increased pain, localised tenderness or firmness or associated nausea, vomiting or altered bowel habit.
Under local commissioning guidelines the specialist assessment and/or treatment of abdominal hernias is only routinely commissioned for femoral and inguinal hernias as these carry a small but significant risk of complications. However, for inguinal hernias in men that are not producing significant symptoms a watchful waiting approach may be equally valid.
In all other instances your GP may consider referring you onto a specialist service if your symptoms impact on your daily life and surgery may be recommended if your symptoms are severe or getting worse, or if the hernia is affecting your ability to carry out your normal tasks.
You can view the local commissioning advice they will follow by clicking here.
The specialist assessment and/or treatment for divarication of the rectus muscles (see above) is not routinely funded in Devon.
Selfcare and more information
Managing my condition
By reducing the strain and pressure on your tummy you prevent or minimise your chances of getting a hernia.
Lifestyle advice
Hernias can be helped by improving your general health where possible by:
- Maintaining a healthy weight
- Stopping smoking will help your general health by improving your physical fitness and will help with things like wound healing and may increase your potential treatment options. OneSmallStep provide local support and services to help you stop smoking.
Useful information about hernias
Videos about hernias
- You can watch a helpful animation video from the NHS website by clicking here. (Scroll to the bottom)
Waiting for a specialist opinion
If you have been referred for a specialist opinion your details will be reviewed and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.
How long will I wait?
If a hospital assessment and/or treatment is clinically recommended your information will be sent to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.
What support is available
For links to specialist healthy lifestyle advice, including support to stop smoking, maintaining a healthy weight, moving more or drinking less please see the Health, Lifestyle & Wellbeing section of our website. For services in other areas please see the following links: