Abdominal hernia

An abdominal hernia is a weakness in your tummy (abdominal) wall. Some tissue or part of your bowel pushes through and creates a bulge or swelling. This may be in your tummy or groin (the area at the top of your leg). Most hernias are straightforward to repair. But they can sometimes have serious complications.

About abdominal hernia

Your tummy wall is made up of sheets of tough muscles and tendons that run between your ribs and groin. If there’s a weakness in part of the wall, the contents inside can push through. This causes an abdominal hernia.

Your hernia may be painful or you may notice a bulge in your tummy or groin. This may be more noticeable when you cough or strain. Sometimes you might not notice any symptoms at first.

If you have an abdominal hernia, you may need to have surgery to repair it. But this will depend on the type of hernia you have and how likely it is to cause complications.

See a doctor as soon as you can if your hernia suddenly feels very sore or tender, especially if you can’t push it back in. This may mean that some of the hernia contents have become trapped. You’ll need surgery as soon as possible.

Types of abdominal hernia

Abdominal hernias are named according to where the weakness is in your tummy wall. The most common types of abdominal hernia include:

• inguinal hernia
• femoral hernia
• incisional hernia
• umbilical hernia
• epigastric hernia

Inguinal and femoral hernias both develop in the lower abdomen, around the groin area.

Umbilical hernias and epigastric hernias are sometimes called ventral hernias.. Umbilical hernias are where the tummy button (umbilicus) is. Epigastric hernias are between the bottom of your breastbone (the bone between your ribs, at the centre of your chest) and your tummy button.

Incisional hernias develop where you’ve had earlier surgery, along the incision.

You may also have heard of hiatus hernia. This isn’t due to a weakness in your tummy wall. It happens when there’s a weakness in your diaphragm (the muscular wall that separates your chest cavity from your abdomen). This weakness allows the top of your stomach to poke through next to your food pipe (oesophagus).

Causes of abdominal hernia

Sometimes babies are born with an abdominal hernia. This happens as the baby develops in the womb. But most hernias develop when you’re an adult.

Abdominal hernia is more likely when there is increased pressure in your tummy. This can happen because of:

• coughing, especially if your cough lasts for a long time
• straining when you poo, which may happen if you’re constipated
• lifting heavy objects or weights
• being very overweight
• being pregnant

You’re more likely to have an abdominal hernia as you get older. This is because your tummy wall muscles get weaker as you get older. It’s also more likely after abdominal surgery.

Symptoms of abdominal hernia

If you have an abdominal hernia, you may have:

• a lump or swelling somewhere on your tummy or in your groin
• an aching, dragging or burning sensation in your tummy or groin
• a feeling of fullness or heaviness in your tummy or groin

The lump or swelling may disappear when you lie down or you may be able to push it back in. It may only appear when you strain-for example, if you cough or lift something heavy.

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

Sometimes the contents of the hernia can get stuck, and you may no longer be able to push the hernia back inside. Doctors call this an incarcerated hernia. The blood supply to the hernia can also become cut off (a strangulated hernia). These are serious medical conditions. They can cause a blockage in your bowel and lead to further complications. For more information, see our section on complications.

Signs of an incarcerated or strangulated hernia include:

• your hernia pain has got worse
• you’ve usually been able to gently push your hernia back, but now you can’t
• the skin over your hernia bulge becomes red or purple
• you feel sick or you are sick
• a decrease in bowel function – you may be unable to poo or pass wind

Seek urgent medical advice if you have any of these symptoms.

Diagnosis of abdominal hernia

A hernia can usually be diagnosed by a GP. The GP will ask about your symptoms and check your tummy or groin area. They may also ask you about your medical history.

Your GP may check your tummy or groin when you're standing up and lying down. They’ll check to see if they can push the bulge back in. They may ask you to cough while they put their finger over the hernia. This is to see if the swelling changes.

Sometimes, if the diagnosis isn’t clear, your GP may suggest you have an ultrasound or CT scan.

Complications of abdominal hernia

Incarcerated (stuck) or strangulated hernias are serious complications that need urgent surgery. Strangulated means the hernia is cutting off the blood supply to the bowel.

An untreated strangulated hernia can cause a hole in the bowel wall inside the body. Doctors call this a bowel perforation. It can lead to a life-threatening infection and needs urgent treatment. For information on the signs of an incarcerated or strangulated hernia, see our section on symptoms.

There are also potential complications associated with surgery for abdominal hernia. These include:

• infection
• adhesions (bands of scar tissue that can make tissues inside your body stick together)
• haematomas (a build-up of blood in the space where the hernia used to be)
• seromas (a build-up of clear fluid under your skin, where the hernia used to be)

There is also a chance that your hernia may come back after surgery. Modern surgical techniques reduce the risk of this happening. Your surgeon will discuss the risks and benefits of surgery with you before you decide whether or not to go ahead.

Prevention of abdominal hernia

Anything that increases pressure inside your tummy increases your risk of abdominal hernia. There are several things that can increase abdominal pressure. You may be able to reduce your risk of hernia by avoiding some of these.

• Coughing. Seek medical help if you have a long-term cough. There may be a cause for your symptoms, and you can get help to treat them. Smoking is a common cause of a persistent cough. If you’d like help to stop smoking, speak to your pharmacist or GP.
• Straining when you poo. To help prevent constipation, eat plenty of fruit and vegetables and gradually increase your fibre intake. Also make sure you’re drinking enough fluids.
• Being overweight. Try to lose excess weight by eating a healthy balanced diet and getting more active.
• Lifting heavy objects can strain your tummy muscles. Make sure you’re using a correct lifting technique and, if possible, try to find ways to reduce heavy lifting. Most surgeons ask their patients not to lift anything heavier than 10 to 15kg.