Do you have a hernia?

Many people may develop an abdominal wall lump and be unaware that it represents an underlying hernia. Whether you have just noticed a hernia, or it has been present for a while, specialist hernia surgeons can help you to treat the problem. It is important to establish the diagnosis so that the potential for complications related to a hernia are minimised.

What is a hernia?

Hernias are common. Most adults (especially men) are likely to develop one. They occur when there is a weakness in the abdominal wall that allows an internal part of the body to push through, presenting as a lump.

Often they can be pushed in and may disappear when lying down; straining or coughing can make the lump appear again. The lump may simply contain fatty tissue or it may represent the protrusion of a loop of bowel through the weakened abdominal wall. The latter can be a potentially dangerous problem if left untreated.

Consultation with a specialist that can conduct the necessary diagnosis tests is the first step.

Whilst many hernias cause no symptoms and can be left untreated, there are cases where it is dangerous to leave a hernia, which is why diagnosis is essential. There are many types of hernia, the most common are located in the groin, but essentially a hernia can appear anywhere between your chest and hip.

These are the commonest groin hernias, and are usually seen in men as it can be linked to repetitive straining from activities such as weight lifting or demanding sports. Ageing can weaken the abdominal wall and lead to an inguinal hernia.

These hernias are the second commonest type and result from previous abdominal surgery.

The type of previous surgery (elective vs emergency) and length of incision can influence the size of the subsequent hernia.

These herniae are much less common than inguinal hernias and also occur in the groin somewhat lower than an inguinal hernia. They are more commonly seen in women than men.

A lump around the belly button may represent an umbilical hernia. This can be the result of increased weight, heavy lifting and straining

These types of hernia appear between your belly button and lower end of the central chest bone.

These are very commonly seen in association with stomas formed in patients who have undergone major colonic surgery for conditions such as bowel cancer or diverticular disease.

Hernia symptoms

Symptoms associated with a hernia are very variable and dependent on their size, location and contents. Typically, you would notice a lump that may change in size during the course of the day.

There may be an associated ache or discomfort. In an acute episode, if bowel was involved, you may experience nausea and vomiting. The more significant latter symptoms may give rise to the need for emergency treatment, so it is important to seek prompt diagnosis from a specialist hernia surgeon.

Symptoms may include:

  • Severe pain
  • Vomiting
  • Constipation
  • Tenderness when pressing the hernia
  • Inability to press the hernia back in

These symptoms may indicate that an organ, or tissue, has had its blood supply cut off due to the hernia, a condition called strangulation. It could also indicate that a part of the bowel has become blocked, known as obstruction.

If strangulation or obstruction occurs, it requires you to visit an A&E department or attend an emergency appointment with a specialist hernia surgeon, although your GP may be your first point of contact.

Consultation with a specialist, who can conduct the necessary diagnostic tests, is the first step to better understanding your symptoms.

Hernia diagnosis

A hernia can typically be diagnosed by a simple physical examination. It is usually obvious from looking and touching the area as to the type of hernia and the extent.

A hernia can typically be diagnosed by physical examination. Ian experienced surgeon will be able to determine the type of abdominal wall hernia by carefully feeling for the defect and its location in relation to key landmarks. An ultrasound scan or CT scan may be required to confirm exactly the type of hernia.

Following diagnosis, a hernia surgeon can offer advice if surgery is appropriate. This may depend on:

  • Type of hernia
  • Content of the hernia (eg bowel loop or abdominal fat)
  • Severity of symptoms of pain and discomfort
  • Impact on your day-to-day living
  • General background health

Hernias will not repair themselves and can get worse with time. The hernia surgeon will assess the risks of surgery against the risks of managing the hernia without surgery.

Hernia treatment

If a hernia requires surgery, there are a several options available:
  1. Open surgery, where a cut is made into the skin to enable the surgeon access to push the hernia back into position and repair the defect using stitch or a piece of reinforcing synthetic mesh.
  2. Laparoscopic surgery (or keyhole surgery), where tiny (5mm or 10mm) incisions are made to allow the surgeon to repair the hernia using special keyhole instruments. Keyhole surgery is generally a more attractive option for the patient, as there reduced scarring and recovery times are much faster. The technical skill of the surgeon is important.
  3. Complex hernias (e.g. incisional hernias) may require advanced abdominal wall reconstruction techniques using a combination of bridging synthetic or biological mesh, and release techniques to separate abdominal wall components, aiding the process of closure of the defect.

Typically following uncomplicated surgery, you can go home within 24 hours. You will be advised to avoid all forms of lifting for at least six weeks.

Your surgeon will discuss all the risks and benefits of the hernia repair as part of the consultation before your surgery.

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