Hernias occur at weakened points in the abdominal wall most usually when the abdomen has to allow structures to pass through. In the groin blood vessels and the tube allowing sperm to exit the testes (the vas deferens) pass through the lower abdominal wall and this area is a common site for a hernia to occur (inguinal hernia). Similarly at the belly button where vessels passed through during embryonic development, umbilical hernias can occur. At the cut site from previous operations a weakness can develop to generate an incisional hernia.
Most usually patients are aware of a swelling at the site of the hernia that is intermittent and often disappears on lying flat. Coughing and physical exertion will usually cause the hernia to protrude. The bulge may or may not be painful. They may lead to an ache following standing and physical activity. Often patients will report a squelching sensation as they massage and push the hernia back inside. A hernia that becomes acutely painful, remains stuck out (none-reducible) and associated with vomiting and distention requires urgent medical review as it may herald trapped and obstructed bowel whose blood supply is at risk – this can be life threatening.
Most of the time surgery is offered to repair the hernia and minimise the risk hernia of bowel entrapment and also of the hernia enlarging. Most hernias in the UK are fixed with mesh which offers a robust repair without undue tension – this reduces the chance of the hernia returning (recurrence). Many hernias are repaired as a keyhole procedure which allows for a quicker recovery and reduces the risks from chronic pain. All this would be discussed with you at your out patient appointment with your specialist.
Hernias most usually appear as a fluctuant bulge at the site of weakness. Occasionally no bulge or swelling is evident only discomfort and the diagnosis in such cases requires radiological assessment such as with an ultrasound scan or even an MRI.
A hernia is a ‘blow out’ type of injury that occurs at sites of weakness in our abdominal wall – akin to the inner tube of a bike wheel protruding through a damaged tyre.
Lying flat and pushing the swelling back inside will help ease the discomfort from a hernia as will rest help alleviate the ache from the hernia. Those hernias that are acutely and intensely painful with a lump that will not push back constitute a medical emergency and expedient / urgent medical review is advised.
Hernias are common. Those that partake in heavy manual work including frequent gym activity are at increased risk. The risk of hernias increase with age, obesity, poor general health, previous surgery and those with family history where hernias are common. Most hernias however occur in the absence of any identifiable risk.