Everything you need to know about Abdominal Hernias
Abdominal wall hernias are a condition in which the abdominal lining (known as the peritoneum) protrudes into a sac outside the abdomen. These sacs commonly referred to as “hernias,” can be caused by injury or physical strain on the abdominal wall or by anything that causes repeated pressure on an area of weakened tissue.
Hernias usually start small and painless, which is why they’re often discovered incidentally when a doctor notices them during routine examinations. Pain is an early sign of a hernia and will often wake the patient up in the middle of the night.
The name “hernia” refers to the fact that normally, there’s an area of unused or weakened tissue (i.e., a portion of the abdominal wall) in between two other areas of the abdominal wall that are used to support things such as the intestines, bladder, and uterus.
Abdominal wall hernias can occur in any portion of the abdominal cavity, though they are most often associated with the diaphragm on either side of the abdomen.
Where a hernia is located isn’t necessarily where it will eventually cause symptoms, meaning that large hernias in the lower abdomen could lead to symptoms years later, for instance. Most large internal hernias occur near the umbilicus (belly button) or the groin without causing symptoms.
Classification Of Abdominal Hernias
Abdominal wall hernias are divided into incisional (through previous incisions), umbilical, and femoral hernias.
1) Incisional hernias
Hernias occur at the site of an existing abdominal incision from previous surgery or an injury. Although the location of a previously performed abdominal surgery is a risk factor in developing an abdominal wall hernia, a hernia can also form at other sites.
2) Umbilical (or abdominal wall) hernias
Most umbilical or abdominal wall hernias are caused by repeated strain on tissues surrounding the abdomen – pressure from lifting heavy objects, straining during bowel movements and childbirth, and pressure from pregnancy (the second stage of labor). External forces that prevent normal bowel movement also sometimes play a role.
3) Femoral (or groin) hernias
Hernias in the groin are usually caused by irritation from sports, straining during bowel movement, or repetitive lifting. These are generally not medical emergencies but should be evaluated and treated if symptoms occur.
Hernias can range in size from a small defect of the abdominal wall to one that involves the complete herniated portion of the abdominal wall. Most hernias are small enough not to be noticeable without medical attention – however, you may feel pressure on your abdomen or notice a bulging area in your lower waistline.
Hernias that bulge from the abdominal wall are usually not painful unless they become strangulated and inflamed, in which case surgical repair becomes necessary.
Hernias are also divided into three classes based on their size: small (less than 7 centimeters), medium (7-15 centimeters), and large (> 15 centimeters). Hernias can also be classified in terms of the extent of herniation, which describes how much of the peritoneum has been pulled through the defect. Hernias can be partial (i.e., only part of the abdominal wall herniates into a sac), complete (i.e., all of the abdominal walls herniates into a sac), or total (i.e., the abdominal wall is completely outside of the abdomen).
Other terms associated with hernias are reducible and irreducible. Reducible hernias can be pushed back inside the abdominal cavity by compressing them, while irreducible ones can’t. Finally, there are strangulated and incarcerated hernias, which develop when a large portion of tissue gets caught in a narrow area, such as a loop of the intestine. Strangulated hernias are immediately life-threatening because they cut off blood supply to the part of the body trapped within the hernia sac; strangulated hernias require surgical intervention as soon as possible to prevent permanent damage.
Treatment Of Abdominal Hernias
Treatment for abdominal wall hernias usually involves one of two options: repair or non-surgical treatment. A surgeon as an outpatient performs repair surgery. Using standard laparoscopic techniques, the surgeon trims out part of the abdominal wall and then uses sutures to re-attach the margins of the defect to the rest of the abdominal wall. After surgery, the patient is asked to put on a surgical garment (stoma) that should be worn for several weeks post-op.
Non-surgical treatment can include medication, which may control symptoms but is not typically curative, and physical therapy, in which patients work on strengthening their abdominal muscles.
Most abdominal wall hernias can be treated non-surgically, but if a patient has symptoms of a strangulated or incarcerated hernia, surgery should be performed immediately.
How to avoid symptoms of Abdominal Hernias
Abdominal wall hernias can often be prevented by:
For pregnant women who are at risk for abdominal wall hernias (e.g., those who’ve had one in the past or have a history of trauma), it can be reduced by wearing a support belt during pregnancy and the second stage of labor, which is when pressure on the abdomen causes the majority of damage to abdominal walls.
If a hernia is located in the lower abdomen and straining during a bowel movement or at the gym leads to irritation of the surrounding tissues, it can be reduced by not straining when doing these things.
The reduced activity also helps prevent abdominal wall hernias. However, this is only half the story – decreased activity only reduces the risk of small-sized hernias; larger ones tend to happen regardless of activity level. These large-sized hernias can be reduced by avoiding light liftings, such as holding a small child or pet. Larger hernias are usually operated on laparoscopically, but non-surgical treatment can also reduce symptoms for these types of hernias.
Symptoms of Abdominal Hernias
A hernia that is located in the lower abdomen may produce symptoms such as:
When abdominal wall hernias occur, they usually cause pain in the defect region and can be prevented by wearing a support belt around your waist. A hernia in the lower abdominal tissue may produce swelling and tenderness felt on the pressure against the abdomen. In contrast, an abdominal wall hernia may produce a bulge and pain. A strangulated hernia causes feelings of constriction or fullness. In addition, some types of hernias are more likely to develop symptoms than others, which gives physicians essential clues as to specific types of abnormalities.
The risk of Abdominal Hernias
The lifetime risk of having an abdominal wall hernia is around 12%, but this varies depending on the type. Those with a family history of hernias are at a higher risk than women who have been pregnant or had children (especially multiple births).