Abdominal Hernia

What is abdominal hernia?

An abdominal hernia occurs when there is a weakness in abdominal muscles allows stomach contents to bulge through the muscle wall. Abdominal hernias can occur in a number of locations:, including the lower abdomen near the groin, near the belly button, and in the area of previous surgical scars.

Abdominal hernias can cause pain but may also occur without symptoms. Some hernias are "reducible" hernias, meaning can easily be pushed back into the abdomen. Others are "non-reducible" cannot be pushed back into the abdomen. or "incarcerated" and require more surgical treatment.

Incarcerated hernias can be dangerous when the structures bulging through the muscle wall become swollen and "strangulated". This leads to decreased oxygen delivery to the tissue, leading to death of tissue cells. Strangulated hernias are serious and require emergency surgery. If they are not treated promptly, death of vital tissue, infection and even death may occur. Rapid surgical treatment is often successful in avoiding these complications.

Symptoms

In many cases, abdominal hernias cause no symptoms at all and may be discovered during a routine examination.

Pain and bulging in the affected area of the abdomen are common symptoms of abdominal hernias. Pain may occur with strenuous activity or when standing, sitting, or lying in certain positions. Hernias deep within the abdomen may not produce a noticeable bulge, but may cause abdominal pain.

When hernias are Symptoms of incarcerated or strangulated hernias: nausea, vomiting, bloating, rapid heartbeat, fever, chills, and severe pain may accompany pain. Treatment should be sought right away when abdominal pain is accompanied by any of these symptoms.

Types of abdominal hernias

1. Inguinal or groin hernias are located in the groin and occur when the bowel or other internal organs bulge through the muscle wall in groin area. Inguinal hernias can be congenital, meaning that they are present at birth, or can also occur at any point in life. Risk factors for inguinal hernias include strenuous activity (e.g., lifting heavy objects), muscle weakness due to age, and chronic coughing.

2. Umbilical hernias protrude through the belly button. They are very common in babies and young children and result when the belly button fails to close properly after the umbilical cord is cut. When present at birth, umbilical hernias usually close on its own by the time a child is 3 to 4 years of age. If umbilical hernias do not close by this age, corrective surgery may be considered. Adults can form umbilical hernias when there is too much pressure in the abdominal area, as often occurs with weight gain or pregnancy. Surgical repair is usually recommended to reduce the risk of incarceration or strangulation.

3. Ventral hernias occur in the middle of the abdomen, usually above the belly button. They result from a weakness in the lining between the major abdominal muscles. While most ventral hernias have no known cause, being overweight increases risk. Ventral hernias rarely become incarcerated

4. Incisional hernias can occur through any abdominal surgical incision. They may develop years after the original operation. Risk factors include strenuous activity and heavy lifting before the surgical incision has healed fully, obesity; post-operative wound infection, use of certain medications, and smoking. Rarely, improper closure of the incision by the operating surgeon can lead to hernia formation. Hernias are most likely to occur in incisions located in the middle of the abdomen, but can occur through any prior abdominal incision.

5. Spigelian hernias occur within between the abdominal muscles and the inner abdominal cavity. They do not typically bulge through all layers of the abdominal wall, making them difficult to detect. They can either be present at birth or acquired at any age. Women are at higher risk for this type of hernia than men. Because there is a high risk of strangulation, surgical correction is usually recommended.

6. Lumbar hernias protrude toward the sides of the abdominal wall below the rib cage. They are very rare and may either be present from birth or occur as a result of trauma or strenuous activity. Surgical correction is usually recommended for lumbar hernias.

7. Obturator hernias protrude through the either of two holes formed by the pelvic bones. They are relatively rare and occur mostly in older females. Because they are located deep within the pelvis, they can be hard to diagnose. Because they tend to strangulate and can cause blockage of the small intestine, obturator hernias are considered serious and require surgical repair.

Risk Factors

Risk factors for abdominal hernias may differ according to type. However, overall factors that can increase the risk of abdominal hernias include:

Some abdominal hernias occur as a result of defects or weaknesses in abdominal muscles that are present at birth. Women are at higher risk of developing spigelian and obturator hernias than men.

Diagnosis

Physical examination and history of symptoms are often all that is needed to diagnose inguinal, umbilical, ventral, incisional, or lumbar hernias. When people experience symptoms that suggest these types of hernias, but no hernia is felt upon examination, ultrasound or a CT scan can help confirm the diagnosis. Because they occur deep within the abdomen, spigelian and obturator hernias are usually diagnosed with CT scan.

Symptoms of abdominal hernia that occur along with nausea, vomiting, rapid heartbeat or fever suggest incarceration or strangulation, both of which are potentially serious and require prompt surgical treatment. In cases when hernias are suspected but not obvious, diagnosis using ultrasound or CT must be made right away so that surgical treatment can be performed as soon as possible.

Treatment

Some hernias are "reducible" and can be treated simply by pushing them back behind the abdominal muscle wall. However, most hernias that cause pain or discomfort will require surgery. Even when hernias do not cause symptoms, healthcare providers may recommend surgical repair in some cases to prevent the risk of incarceration or strangulation. Strangulated hernias are an emergency that always requires surgical treatment.

Surgical treatment for hernias often involves the placement of a synthetic or biologically based mesh "patch" that helps hold the bulging tissue in place after the surgery. There are two options for repairing surgical hernias:

1) Open repair - The surgeon makes an incision into the abdominal muscle, pushes the tissue back where it belongs, places a mesh to hold the tissue in place, then closes and sutures the incision.
2) Laparoscopic repair - The surgeon inserts a narrow fiberoptic tube with a camera throw a small incision. Using small tools and a fiberoptic camera, the surgeon pushes the tissue back where it belongs and places a mesh to hold the tissue in place.

Open repair can be performed when patients are under local or general anesthesia. Laparoscopic repair usually requires general anesthesia. However, laparoscopic repair can be performed more quickly and there is less recovery time required with this approach. The right option for hernia repair depends on many factors that surgeons will consider and discuss with patients and their families.

Regardless of the type of procedure performed, restricted activity is recommended during the recovery period. Recovery takes approximately two to three weeks.

NOTE: In children undergoing umbilical hernia repair, an incision is made around the belly button, the herniation is located within the underlying tissue, and is removed surgically. Stitches are then used to close up the inner tissue, and surgical tape is placed over the skin where the incision was made. The procedure is usually done under general anesthesia; mesh patches are not necessary for this type of surgery.

Complications

Infection is the common complication of a hernia repair, especially if mesh is used. Although the incidence of infection is low, it can be serious. For that reason, any signs of infection, including redness or swelling at the incision site, or fever or chills, should be reported to a healthcare provider right away. To prevent infection, antibiotics are often given during surgery and prescribed afterwards.

Hernias can also re-occur. Restricting activities as recommended and avoiding smoking or other activities that induce coughing can prevent this.

To avoid complications following hernia repair surgery, it is important to follow all post-surgery instructions. Follow your surgeon's instructions.

Tips for Patients

1. Abdominal hernias occur when tissue from inside the abdomen bulges through a weakened area of the abdominal muscle. Reducible hernias can be pushed back in place. Non-reducible, or incarcerated, hernias need to be repaired surgically.
2. When hernias become strangulated, blood supply is cut off to the herniated tissue. Immediate treatment is required to avoid serious complications.
3. Common symptoms of hernia include pain upon straining, or when standing, sitting, or lying in certain positions. Hernias close to the stomach's surface may produce a noticeable bulge in the affected area. Additional symptoms of nausea, vomiting, bloating, fever, chills, or rapid heartbeat point to a serious problem, such as strangulated hernia. If you experience these symptoms along with abdominal pain, it is important to seek medical treatment right away.
4. There are many types of abdominal hernias, depending on the location; the most common types are inguinal (groin), umbilical (belly button), ventral (in the center of the abdomen), and incisional (at the site of a previous incision). Other less common types can be more difficult to diagnose, but can be serious if untreated. For that reason, any unexplained abdominal pain warrants an examination by a doctor or other qualified healthcare provider.
5. Abdominal hernias are diagnosed through physical examination, ultrasound tests, or CT scans.
6. Most symptomatic abdominal hernias require surgery. Surgical repair can be done either through an open operation or by laparoscopy. Qualified surgeons can help you decide which option is best for you.

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