An abdominal hernia is a condition in which part of an internal organ, such as the intestine, protrudes through an opening or a weak area of the muscle layer that holds the organs in place. Below are the definition, types, mechanism, signs of strangulation, and the diagnostic process.
What an abdominal hernia is
A hernia is a protrusion of the contents of a cavity through natural openings or a defect in the abdominal wall together with all its connective tissue layers. The edges of the defect in the musculoaponeurotic layer are called the hernia gate, and the parietal layer of the peritoneum is called the hernia sac. External hernias account for about 98% of cases, internal ones for about 2%. By reducibility, hernias are reducible and irreducible; by strangulation, strangulated and non-strangulated; by origin, congenital and acquired.
Types of abdominal hernia
- Inguinal — the gate is in the inguinal canal, in the area where the leg joins the abdomen; it can be indirect or direct.
- Femoral — the gate is in the femoral canal, below the inguinal ligament; it occurs more often in women.
- Umbilical — the gate is in the umbilical ring.
- Postoperative — the gate is formed by the edges of a surgical incision that have separated; a bulge in the area of the scar.
- Hernia in the chest area — causes heartburn and reflux.
Why a hernia appears
It is not always possible to prevent a hernia; the risk is associated with excess weight, smoking, and a persistent cough.
With an umbilical hernia, the bulge usually reduces easily into the abdominal cavity.
What a hernia looks like and what you feel
The main sign is a bulge or lump at the site of the hernia: in the groin area, on the thigh, or on the abdomen. The lump may enlarge when you cough, sneeze, or cry, and shrink when you lie down. The skin over it looks stretched. There may be a feeling of heaviness in the leg with a femoral or inguinal hernia and heartburn with a hernia in the chest area.
A large hernia may look uncomfortable but not hurt: the weak area of muscle stretches. Pain in or around the hernia area occurs more often with smaller hernias and may be a sign of strangulation.
Strangulation: when a hernia becomes an emergency
Strangulation is a condition in which the muscle tightens around an internal organ that has entered the hernia sac. The contents stop reducing, bowel obstruction may occur due to the blocked intestine, and the blood supply to the strangulated area may stop. To prevent these complications, planned surgery is performed also when the hernia causes symptoms.
Signs of strangulation: pain in or around the hernia area; the bulge becomes irreducible and does not move from side to side. Constipation, high fever, or a feeling of heat, cold, or chills also require urgent examination.
Call 103 or 112 immediately if, with a hernia, severe pain occurs in the hernia area, the abdomen is bloated, nausea or vomiting appears, including with blood or resembling coffee grounds, or the person suddenly becomes confused.
Diagnosis and when to see a surgeon
See your family doctor on a planned basis if you suspect a hernia: the doctor will examine the area and, if needed, refer you for examination or treatment. During the examination, the doctor palpates the area: with an umbilical hernia, the finger feels the edges of the umbilical ring. The list of examinations is determined by the doctor.
If the hernia causes no symptoms, treatment may not be needed. For an inguinal hernia, surgical treatment is performed via two approaches: laparoscopically — through several small incisions in the abdomen, or openly — through one larger incision in the groin area. The choice depends on the location and size of the hernia and general health. The main steps are: 1) incisions; 2) during laparoscopy, air is pumped into the abdomen and a camera is inserted; 3) the contents are returned to place and covered with a thin mesh; 4) the incisions are closed and a dressing is applied. For an inguinal hernia, the procedure usually lasts from 30 to 90 minutes, and you can usually return home the same day.
Recovery after an inguinal hernia usually takes up to 4–6 weeks, sometimes longer. Before surgery, the doctor explains possible complications. A healthy weight, physical activity, and quitting smoking reduce the risk of some types of hernia; a cough that persists or returns should be discussed with a doctor.
This material is for reference and does not replace consultation with a doctor who assesses your specific situation.
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This content is for reference and does not replace a doctor's consultation. Medical disclaimer