Abdominal Hernia

What an abdominal hernia is

The abdominal wall is made of layers of muscle and tough connective tissue (fascia) that hold the organs in place. Some areas are naturally weaker, such as the groin canals and the belly button, and surgery leaves other weak points. When pressure inside the abdomen pushes against a weak area, the lining of the abdomen (the peritoneum) bulges out like a balloon, often carrying fat or a loop of intestine with it. This sac is the hernia.

Types of abdominal hernia

"Ventral hernia" is a general term for any hernia through the front of the abdominal wall (umbilical, epigastric, incisional). A hiatal hernia is different: the stomach pushes up through the diaphragm into the chest, causing reflux rather than a visible bulge.

Symptoms

• a soft bulge that appears when you stand, cough, lift or strain, and flattens when you lie down
• an aching, burning, heavy or dragging feeling, often worse at the end of the day
• discomfort when bending or lifting
• in inguinal hernias in men, swelling extending into the scrotum

Many hernias cause no pain at all and are found during a routine exam.

Signs of incarceration and strangulation

An incarcerated hernia is stuck and cannot be pushed back. A strangulated hernia has its blood supply cut off, so the trapped bowel can die within hours. Signs:

• sudden severe pain at the hernia site
• a firm, tender lump that will not go back
• red, purple or dark skin over the hernia
• nausea, vomiting, a swollen belly and not passing gas or stool
• fever and a fast heart rate

This is a surgical emergency.

Causes and risk factors

Hernias form from a combination of a weak spot and increased pressure:

• Weakness: present from birth (such as an open canal in the groin or belly button), aging, previous surgery, smoking (which weakens connective tissue), and connective tissue disorders.
• Pressure: heavy lifting, chronic cough, constipation and straining, obesity, pregnancy, fluid in the abdomen (ascites), and straining to pass urine with an enlarged prostate.
• Separation of the abdominal muscles (diastasis recti) is not a hernia, but often occurs alongside umbilical hernias after pregnancy.

Diagnosis

Most hernias are diagnosed by examination. A doctor will feel the area while you stand and cough, and check whether the bulge can be gently pushed back. Ultrasound or CT is used when the diagnosis is unclear, the hernia is hard to feel (especially in people with obesity), or to plan repair of large incisional hernias. Lumps that do not behave like a hernia may be a lipoma, swollen lymph node or, rarely, a tumor.

Treatment

Watchful waiting

Small, painless inguinal hernias in men can safely be watched for a time. Many people eventually choose repair because symptoms develop. Femoral hernias are usually repaired promptly because of strangulation risk. Umbilical hernias in children under 4 to 5 are usually observed, as most close naturally.

Trusses and binders can relieve symptoms but do not fix the hernia and are not a long-term solution for most people.

Surgical repair

Surgery is the only cure. Options include:

• Open repair: a cut over the hernia, pushing the tissue back and reinforcing the wall, usually with a synthetic mesh.
• Laparoscopic (keyhole) or robotic repair: mesh placed from inside the abdomen through small cuts. Often less pain and a faster return to activity, and useful for hernias on both sides or recurrent hernias.
• Suture repair without mesh: for small hernias, especially in children.

Most groin and umbilical hernia repairs are day surgery. Many people return to light activities within 1 to 2 weeks and heavy lifting within about 4 to 6 weeks, depending on the repair and the surgeon's advice. Emergency surgery for strangulation may require removing a section of bowel.

Reducing the risk of a hernia worsening or recurring

• reach and keep a healthy weight
• stop smoking, ideally before surgery
• treat chronic cough and constipation
• lift with your legs, and avoid straining
• follow your surgeon's activity advice after repair

Complications

• incarceration and strangulation
• bowel obstruction
• after repair: chronic groin pain, infection, seroma (fluid collection) and recurrence

Frequently asked questions

What does an abdominal hernia feel like?

It usually feels like a soft lump under the skin that gets bigger when you stand, cough or strain, and goes back in when you lie down. You may feel aching, pressure or a dragging sensation, especially after activity. Some hernias cause no pain.

Can a hernia heal on its own?

No, except umbilical hernias in young children, most of which close by age 4 to 5. In adults the weak spot in the muscle wall stays and usually slowly enlarges. Surgery is the only cure, though small painless hernias can be watched.

When is a hernia an emergency?

A hernia is an emergency if it becomes suddenly very painful, firm or discolored, cannot be pushed back in, or comes with vomiting, a swollen belly and no bowel movements. These are signs of strangulation, which needs surgery within hours.

What is the difference between a hernia and diastasis recti?

A hernia is a hole in the muscle wall through which tissue pushes out, forming a bulge that can trap bowel. Diastasis recti is a widening and thinning of the tissue between the two vertical abdominal muscles, causing a ridge down the middle, without a hole. It does not cause strangulation.

Can I exercise with a hernia?

Gentle exercise like walking is fine and helps overall health. Avoid heavy lifting and intense straining, which can enlarge the hernia. Stop and seek care if exercise causes sharp pain or the bulge will not go back. Ask your surgeon about specific activities.