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Abdominal hernia

An abdominal hernia is a bulge or swelling. It happens when some of the contents inside your abdomen (tummy), such as fat or bowel, push through a weakness in your abdominal wall muscle.

The abdominal wall is a sheet of tough muscles and tendons that run between your ribs and your groin (upper part of your leg). Sometimes, a weakness in your abdominal wall can open up. If this happens, whatever is on the inside (such as fatty tissue or part of your bowel) can push through. It causes a bulge or swelling called a hernia.

Types of abdominal hernia

Abdominal hernias are named according to the position of the weakness in the abdominal wall. The most common types of abdominal hernia are listed below.

  • Inguinal hernia. This is when a bulge appears in your groin or, if you're a man, in your scrotum. It happens when fatty tissue or part of your bowel pushes through a weakness in the inguinal canal. This is an area in your groin where nerves and blood vessels pass through the muscle layers that supply the genital area. Inguinal hernias are more common in men.
  • Femoral hernia. This bulge also appears in your groin, but a little lower. It happens when fatty tissue or bowel pushes into the femoral canal (a channel through which large blood vessels travel in and out of your leg). The femoral canal is close to, but separate from, the inguinal canal. Women are more likely to have a femoral hernia than men.
  • Incisional hernia. This is when a bulge appears near an old surgical scar. It happens when tissue or part of your bowel pushes through a weakness in the muscles, which was caused by a previous surgery. An incisional hernia can occur months or years after surgery and is more common in adults than children. It happens after about one in 10 abdominal surgeries.
  • Umbilical hernia. This is when a bulge appears around your navel (belly button) because of a weakness in the muscle layer in or around it. Umbilical hernias are very common in babies but often disappear before the age of three. In adults, they are most common in women during and after pregnancy, and in people who are overweight.
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Details

  • Symptoms Symptoms of abdominal hernia

    The main sign of an abdominal hernia is having a bulge or swelling appear on your abdomen (tummy). Often, the bulge will disappear when you lie down. It may also disappear when you push on it and then reappear when you stand or strain, for example if you cough or sneeze. This is called a reducible hernia.

    You may also have slight discomfort and a feeling of heaviness or aching in your abdomen. When you strain or lift something, you may have a sharp pain.

    If you have any of these symptoms, see your GP.

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  • Diagnosis Diagnosis of abdominal hernia

    To diagnose abdominal hernia, your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

    Your GP will examine your abdomen (tummy). This will be both when you're standing up and lying down. He or she will check if the bulge can be pushed back in, and may ask you to cough while placing a finger over the hernia. This is to see if there’s a change in the swelling. Depending on your symptoms, your GP may also refer you for an ultrasound scan to confirm a diagnosis.

  • Treatment Treatment of abdominal hernia

    Umbilical hernias in young children usually get better on their own as the abdominal muscles get stronger. However, most abdominal hernias generally get larger with time and don't go away without treatment. Surgical repair is usually recommended in adults.

    Watchful waiting

    If your hernia isn’t causing any symptoms, your GP may suggest monitoring your condition, but not treating your hernia straightaway. This is known as watchful waiting. Watchful waiting means your treatment is delayed until you need it. The idea is that you see your GP if you have any change in your symptoms. He or she will be able to advise you on your treatment options.

    Surgery

    An abdominal hernia repair operation involves pushing the hernia back into your abdomen and repairing the weakened muscle. This can be done as a keyhole procedure, where the operation is done through small cuts in your lower abdomen. Alternatively, your operation may be carried out using open surgery, where a single, larger cut is made. Your surgeon will be able to advise you on which operation is the most suitable for you.

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  • Causes Causes of abdominal hernia

    Anything that increases the pressure in your abdomen (tummy) can cause an abdominal hernia, including:

    • coughing or sneezing
    • straining on the toilet (for example, if you have constipation)
    • lifting heavy objects (for example, weight training)
    • being overweight
    • late pregnancy or difficult delivery

    The risk of having an abdominal hernia increases with age because the older you get, the weaker your abdominal wall muscles become.

  • Complications Complications of abdominal hernia

    If the hernia grows and becomes impossible to push back in, it’s called an incarcerated or irreducible hernia. When this happens, there’s a risk that the blood supply to the protruding bowel or fatty tissue may be cut off. This is then called a strangulated hernia, which is a serious complication that needs urgent surgery.

    It’s vital that you get medical help immediately when you have a hernia and it becomes incarcerated, especially if:

    • the affected area is very painful, tender and red
    • you feel weak and faint with pale, clammy skin and a fast heart rate
    • you feel sick or vomit
  • Prevention Prevention of abdominal hernia

    The only way to prevent having an abdominal hernia is to limit the problems that make it more likely. Some examples are listed below.

    • Recurrent coughing or sneezing. Find out what’s causing your symptoms and get help to treat them. For example, smoking is a common cause of a persistent cough. If you’d like help to stop smoking, speak to your pharmacist or GP.
    • Straining on the toilet. To help ease your bowel movement, eat enough fruit and vegetables and increase your fibre intake. Also make sure you drink enough fluids.
    • Being overweight. Try to maintain a healthy weight and if you're overweight, get help to lose any excess weight.
    • Lifting heavy objects. Make sure you use a correct lifting technique and if possible try to find ways to reduce heavy lifting.
  • FAQs FAQs

    Are there any other symptoms of an abdominal hernia apart from having a bulge?

    Answer

    If you have an abdominal hernia, as well as having a bulge, you might also have a dragging or aching feeling in the area. Your symptoms may get worse when you do anything that puts strain on the area, such as lifting or coughing.

    Explanation

    Depending on what type of hernia you have, there’s a chance that the blood supply to your bowel may be temporarily cut off. The medical word for this is strangulation. If your hernia becomes strangulated, you will have more obvious symptoms. Because you can develop complications even from small hernias, it’s important to seek medical help immediately if:

    • the affected area is very painful and tender
    • you feel weak and faint with pale, clammy skin and a fast heart rate
    • you feel sick or vomit 

    If the hernia is strangulated, you will need to have surgery urgently. Speak to your doctor if you have any questions or would like any more information about this.

    What can I do to prevent another hernia from happening in the future?

    Answer

    There’s no sure way of preventing another hernia, but you can take steps to reduce the chances of it happening again. These include managing factors that may put a strain on your abdominal muscles.

    Explanation

    After having hernia surgery, there’s a chance that you could have another. The likelihood of this happening will depend on the type and size of the initial hernia, your general health, weight and lifestyle.

    Your general health

    A chronic cough, violent sneezing or constipation can increase your risk of having another hernia. Some self-help measures to ease these problems are listed below.

    • If you smoke, stopping can help to improve your cough. It’s also worth bearing in mind that stopping smoking may also improve the way your wound heals after surgery. If you have a persistent cough for any reason other than smoking, talk to your GP for advice about treatments that can help.
    • If you have hay fever, you can be affected by violent sneezing. Talk to your pharmacist or GP about effective treatments for hay fever to control your symptoms.
    • Eating a healthy, balanced diet with enough fruit, vegetables and fibre, and drinking enough fluids can help prevent constipation.
    Weight

    Being overweight can put a strain on your abdominal muscles, so it’s important to maintain a healthy weight.

    Lifestyle

    Any physical activity that involves straining your abdominal muscles can increase your risk of getting another hernia. If your job involves heavy lifting, it’s important to look at ways to reduce or not do this type of activity. Regular exercise is good for your general health and wellbeing; although strenuous activity can put pressure on your abdominal muscles. If you have had a hernia before, talk to your GP for advice before starting a new physical activity.

    Will I need to have surgery for an abdominal hernia?

    Answer

    Apart from umbilical hernias in small children, abdominal hernias don’t usually go away by themselves and tend to get bigger slowly over time. Because of this, you’re likely to need surgery.

    Explanation

    Most people will eventually need to have surgery for an abdominal hernia. How soon you need to have the operation will depend on how severe your hernia is and your individual circumstances.

    For example, if your hernia isn’t causing any symptoms, your GP may suggest watchful waiting. This means your GP will monitor your condition, but won’t recommend treatment straightaway. Watchful waiting means your treatment is delayed until you need it. The idea is that you see your GP if you have any change in your symptoms. He or she will be able to advise you on your treatment options.

  • Resources Resources

    Further information

    Sources

    • McLatchie G, Borley N, Chikwe J. Oxford handbook of clinical surgery. 3rd ed. Oxford: Oxford University Press; 2007: 320−26
    • Hole JR, Koos KA. Human Anatomy. 2nd ed. USA: Wm C Brown; 1994: 230
    • Simon C, Everitt H and van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press; 2007: 304, 386, 400, 940, 1070−2
    • Map of Medicine. Groin hernias in adults. International View. London: Map of Medicine; 2014 (Issue 1)
    • Longmore M, Wilkinson IB, Davidson EH, et al. Oxford handbook of clinical medicine. 8th ed. Oxford: Oxford University Press; 2010: 614−7
    • Abdominal wall hernias. PatientPlus. www.patient.co.uk/patientplus.asp, published 4 January 2013
    • Laparoscopic incisional hernia repair. Medscape. www.emedicine.medscape.com, published 28 April 2014
    • Abdominal hernias. Medscape. www.emedicine.medscape.com, published 28 April 2014
    • Scrotal swellings. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published February 2010
    • Hernias. Medscape. www.emedicine.medscape.com, published 30 April 2014 
    • Inguinal hernias. PatientPlus. www.patient.co.uk/patientplus.asp, published 28 March 2013
    • Femoral hernias. PatientPlus. www.patient.co.uk/patientplus.asp, published 14 January 2013
    • Hernias of the abdominal wall. The Merck Manuals. www.merkmanuals.com, published June 2014
    • Map of Medicine. Hernias in children – inguinal and umbilical. International View. London: Map of Medicine; 2014 (Issue 1)
    • Chronic persistent cough in adults. PatientPlus. www.patient.co.uk/patientplus.asp, published 22 July 2011
    • Smoking cessation in secondary care: acute, maternity and mental health services. National Institute for Health and Care Excellence (NICE), 2013. www.nice.org.uk
    • Start Active, Stay Active. A report on physical activity for health from the four home countries’ Chief Medical Officers. Department of Health, 2011. www.gov.uk
  • Related information Related information

  • Author information Author information

    Reviewed by Hemali Bedi, Bupa Health Information Team, November 2014.

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