What is a hernia?

A hernia is when some of your internal organs, often the intestines, protrude through a tear in the muscular lining of your abdominal wall. The muscles of the abdominal wall are used to hold in your organs (intestines). When a tear is present, the intestines, along with the lining of the abdomen (peritoneum) can protrude from the abdominal wall causing a sac like bulge.

There can be different reasons why you may have a weakness in your abdominal wall. The weakness can be inherent, as in the case of inguinal, femoral and umbilical hernias. On the other hand, the weakness may be caused by a previous surgical incision through the muscles of the abdominal wall. These types of hernia are called incisional hernias.

When the hernia is small, the sac is only seen when the patient is straining or standing. However, as the hernia increases in size, it will gradually be noticeable during most activities of daily living. The majority of hernias can be pushed back into the body when the patient is relaxed and lying down.

Occasionally people can develop "non-reducible" hernias. This is when it is no longer possible for the hernia sac and contents to be pushed back into the abdominal cavity. In these situations, the patient is at risk of "strangulating" the intestines as blood supply is comprised.

Some infants are born with hernias and your paediatrician/paediatric surgeon can best advise you and your child on the most appropriate management .

The majority of hernias develop over time with straining. This straining can be due to heavy lifting, chronic coughing, constipation, or those who put their body under heavy physical stress.

Hernias are more common in men than in women. It is estimated that 1/20 adults will develop a hernia during their lifetime. Most hernias occur in the groin area (inguinal and femoral) but other common sites include:

• Belly button (umbilical)
• Previous surgical scar site (incisional)
• Between belly button and breast bone (epigastric)

When the hernia is small you may not feel any symptoms at all. The majority of patients seek medical advice when they notice a bulge or when the hernia causes pain. Your GP will often refer you to a surgeon for advice on further management.

Once present, the hernia will never disappear or heal spontaneously. Unfortunately no amount of exercise or physiotherapy will make it better, conversely it may make the situation worse. There are special belts available to support the hernia but the best treatment is surgery.

If neglected, a hernia can increase in size, cause pain or even cause strangulation of the bowel. This is an extremely serious condition requiring urgent surgery.

Types of hernia

Inguinal

Hernias occurring in the groin area are the most common. They are more common in males than females. You may not feel any pain but simply a dull ache in the groin are or testis.

Umbilical

This is a hernia occurring in your belly button. The belly button is an area of natural weakness as it is the last part of your abdominal wall to form (part of umbilical cord which is clamped and cut by your doctor when you were born).

Femoral

Femoral hernia are much more common in females than males. It occurs just beneath the inguinal ligament and is often difficult to detect. This is particularly dangerous in the elderly due to increased strangulation risk.

Incisional

These hernias are the result of incompletely healed surgical wounds. These can occur after any incision in the abdomen.

Surgery

Open surgery

This is the traditional technique where your surgeon makes an incision at the site of the hernia. The hernia and its contents are usually pushed back into the abdomen.