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Abdominal hernia


Expert reviewer, Mr Simon M Phillips, Consultant Colorectal Surgeon
Next review due February 2020

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.

You may have no symptoms from your hernia, or you may notice pain or a bulge appearing. This can happen especially when you cough or strain and it may disappear when you lie down.

You may need an operation, although not everyone who has an abdominal hernia needs to have surgery. This may depend upon your symptoms and your risk of getting complications.

Seek urgent medical help if your hernia suddenly becomes painful or tender, especially if you can’t push it back in. This may mean that some of the hernia contents have become trapped inside. You’ll need surgical treatment as soon as possible.

Doctor talking to a patient

Types of abdominal hernia

The abdominal wall is made up of sheets of tough muscles and tendons that run between your ribs and 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.

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. It happens when you have a weakness in the inguinal canal. This is an area in your groin where nerves and blood vessels that supply the genital area pass through the muscle layers. Inguinal hernias are more common in men. They are by far the most common type of hernia – three out of four abdominal hernias are inguinal.
  • 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 (through which large blood vessels travel in and out of your leg). 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 you have a weakness in your abdominal wall caused by previous surgery. An incisional hernia can occur many years after surgery. It happens after about one in 10 operations on the abdomen.
  • Umbilical hernia (also known as paraumbilical 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’re most common in women during and after pregnancy, and in people who are overweight. For more information see our topic on umbilical hernia repair.

You may have also heard the term ‘hiatus hernia’. Unlike the hernias listed above, this isn’t due to a weakness in your abdominal wall. It happens when part of your stomach slides up into your chest. You can get more information from our page on hiatus hernia.

Symptoms of abdominal hernia

The main sign of an abdominal hernia is having a bulge appear somewhere on your abdomen (tummy) or in your groin. 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.

Some people can say that they noticed discomfort starting or first noticed the bulge at a specific time when they strained or lifted something.

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

Sometimes the contents of a hernia can get stuck inside (incarcerated), and the blood supply can get cut off (strangulated). These are serious medical conditions. Seek urgent medical attention if:

  • your hernia becomes increasingly painful
  • you’ve usually been able to gently push your hernia back, but now you can’t
  • the hernia bulge is tender (hurts to the touch)
  • the skin over your hernia bulge becomes red

Diagnosis of abdominal hernia

To diagnose an abdominal hernia, your GP will ask about your symptoms and examine you. They may also ask you about your medical history.

Your GP will examine your abdomen (tummy). This may be both when you're standing up and lying down. They’ll 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

Most hernias can be diagnosed by your GP when they examine you. However, depending on your symptoms, your GP may refer you to a surgeon. Your surgeon may recommend that you have further tests to confirm the diagnosis.

Treatment of abdominal hernia

Umbilical hernias in young children usually get better on their own as the abdominal muscles get stronger. If the hernia is large, or if your child still has it by the time they’re four, your doctor may recommend a surgical repair.

However, abdominal hernias in adults may get larger with time and won't go away without treatment.

Your GP can discuss with you whether surgical repair of your hernia is likely to be an option for you. This will depend upon your symptoms, your general health, which type of hernia you have and whether it’s getting bigger.

Watchful waiting

If your hernia isn’t causing many symptoms, your GP may suggest monitoring your condition, but not treating your hernia straightaway. This is known as ‘watchful waiting’. Watchful waiting means you may be able to avoid having an operation unless you need it. The idea is that you contact your GP if you have any change in your symptoms. (But see our section on symptoms above for when to seek urgent medical attention).

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 discuss with you which operation is the most suitable for you in your particular circumstances.

For more information about the operations, see our videos on femoral hernia repair and inguinal hernia repair below.

How open femoral hernia repair surgery is carried out

This video shows one way the surgery may be carried out. Your operation may differ in some ways. Your surgeon will explain what the operation will involve in your case, and will answer any questions you have.


How keyhole femoral hernia repair surgery is carried out

This video shows one way the surgery may be carried out. Your operation may differ in some ways. Your surgeon will explain what the operation will involve in your case, and will answer any questions you have.


How open inguinal hernia repair surgery is carried out

This video shows one way the surgery may be carried out. Your operation may differ in some ways. Your surgeon will explain what the operation will involve in your case, and will answer any questions you have.


How keyhole inguinal hernia repair surgery is carried out

This video shows one way the surgery may be carried out. Your operation may differ in some ways. Your surgeon will explain what the operation will involve in your case, and will answer any questions you have.


Causes of abdominal hernia

Anything that increases the pressure in your abdomen (tummy) can increase your chance of getting an abdominal hernia. This includes:

  • coughing, especially if you have a chronic (long term) cough
  • straining on the toilet (for example, if you have constipation)
  • lifting heavy objects (for example, weight training)
  • being very overweight
  • multiple pregnancies (for example twins) 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 of abdominal hernia

If the hernia becomes impossible to push back in, it’s called an incarcerated or irreducible hernia. When this happens, there’s a small 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.

Seek urgent medical attention if:

  • your hernia becomes increasingly painful
  • you’ve usually been able to gently push your hernia back, but now you can’t
  • the hernia bulge is tender (hurts to the touch)
  • the skin over your hernia bulge becomes red

Prevention of abdominal hernia

Anything that increases the pressure in your abdomen (tummy) can increase your chance of getting an abdominal hernia. (See our section on causes above.) Some examples of what you can do to reduce these causes are listed below.

  • If you have recurrent coughing – 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.
  • If you’re 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. For more information, see our topic on constipation.
  • Try to maintain a healthy weight and if you're overweight, get help to lose any excess weight
  • If you have to lift heavy objects – make sure you use a correct lifting technique and if possible try to find ways to reduce heavy lifting.


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Related information

    • Abdominal hernias. Medscape. emedicine.medscape.com, updated 22 December 2016
    • Abdominal wall hernias. PatientPlus. patient.info/patientplus, last checked 4 January 2013
    • Inguinal hernias. PatientPlus. patient.info/patientplus, last checked 17 February 2016
    • Chronic persistent cough in adults. PatientPlus. patient.info/patientplus, last checked 29 November 2016
    • Hiatus hernia. PatientPlus. patient.info/patientplus, last checked 15 February 2017
    • Hernias of the abdominal wall. The MSD Manuals. www.msdmanuals.com, last full review/revision June 2014
    • Abdominal wall. Oxford handbook of clinical surgery (online). Oxford Medicine Online. oxfordmedicine.com, published Mar 2013
    • Map of Medicine. Groin hernias in adults. International View. London: Map of Medicine; 2014 (Issue 1)
    • Commissioning guide: Groin hernia. The Royal College of Surgeons of England, 2013. www.rcseng.ac.uk
  • Reviewed by Dr Kristina Routh, Freelance Health Editor, February 2017
    Expert reviewer, Mr Simon M Phillips, Consultant Colorectal Surgeon
    Next review due February 2020



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