A hernia (or ‘rupture’) occurs where there is a weakness in the wall of the tummy (abdomen). As a result, some of the contents within the abdomen can then push through (bulge) under the skin.
Normally, the front of the abdomen has several layers comprising skin, then fat, then muscles, which all keep the guts (intestines) and internal tissues in place.
If, for any reason, there is a weak point in the muscles, then part of the intestines can push through. You can then feel a soft lump or swelling under the skin.
What are the types of hernia?
Different types of hernia can occur. The most common types are listed here:
This is the most common type of hernia. Males are more likely to have inguinal hernias, as they have a small tunnel in the tissues of their groins which occurred when they were developing as a baby.
This tunnel allowed the testicles (testes) to come down from the tummy (abdomen) into the scrotum. Tissue from the intestines can also pass into this tunnel, forming an inguinal hernia.
There are two main types: indirect hernias, which are usually congenital and common in boys, and direct hernias, which are more common in adult men. They can occur in both sides of the body.
This also occurs when some tissue pushes through in the groin, a little lower down than where an inguinal hernia occurs. They occur more commonly in women. They tend to be smaller than inguinal hernias.
This occurs when tissue pushes through a previous scar or wound. They are more common if you have had a scar in the past that has not healed well.
For example, if the wound had an infection after the operation. They usually occur within two years of having an operation.
Umbilical and paraumbilical hernias
These occur when some tissue pushes through the abdomen near to the belly button (umbilicus). Umbilical hernias can be present from birth and in most cases the hernia goes back in and the muscles re-seal on their own before the baby is 1 year old.
They will generally be repaired if they persist beyond 5 years of age or if they are very large.
Umbilical hernias may develop in adults with being overweight (obesity) and excessive accumulation of fluid within the peritoneum of the abdomen.
The peritoneum is a lining of the abdomen and consists of two layers, one which lines the abdominal wall and the other which covers the organs in the abdomen.
Paraumbilical hernias occur in adults and appear above the umbilicus. Although they are generally small, they usually need repairing because there is a risk of intestines contained within them becoming strangulated.
Who gets hernias?
Hernias in adults may arise as a result of the strain which raises the pressure in the tummy (abdomen), causing a weakness or tear in the abdominal wall. This can be caused by:
- Persistent coughing
- Being overweight or pregnant
- Lifting, carrying or pushing heavy loads
- Straining on the toilet
Inguinal hernias are more common in males, whereas femoral and umbilical hernias are more likely to occur in females.
What are the symptoms?
Sometimes a hernia is noticed after a strain – for example, after lifting a heavy object. Sometimes one may develop for no good reason and you may simply notice a small lump, usually in the groin area.
Usually, at first, the lump can be pushed back, but may pop out after straining again. Coughing is a common strain that brings them out. The swelling often disappears when you lie down.
Hernias are not usually painful, but many people feel an ache over a hernia, which worsens after doing any activity. In time, they might become bigger as the gap in their muscle or ligament tissue becomes larger.
Sometimes, in men, they track down into the scrotum.
When to seek medical advice
You should see your GP if you think you have a hernia, so they can determine whether you need to be referred for surgical treatment.
You should go the accident and emergency (A&E) department of your nearest hospital immediately if you have a hernia and you develop any of the following symptoms:
- sudden, severe pain
- difficulty passing stools (constipation) or wind
- the hernia becomes firm or tender, or cannot be pushed back in
These symptoms could mean that the blood supply to a section of organ or tissue trapped in the hernia has become cut off (strangulation), or that a piece of bowel has entered the hernia and become blocked (obstruction).
A strangulated hernia and obstructed bowel are medical emergencies and need to be treated as soon as possible.
Your GP will usually be able to identify a hernia by examining the affected area.
In some cases, they may decide to refer you to a nearby hospital to have an ultrasound scan to confirm the diagnosis or assess the extent of the problem.
This is a painless scan where high-frequency sound waves are used to create an image of part of the inside of the body.
Once a diagnosis has been confirmed, your GP or hospital doctor will determine whether surgery to repair the hernia is necessary.
A number of factors will need to be taken into consideration when deciding whether surgery is appropriate, including:
- The type of hernia – some types of hernia are more likely to become strangulated, or cause a bowel obstruction, than others.
- The content of your hernia – if the hernia contains a part of your bowel, muscle or other tissue, there may be a risk of strangulation or obstruction.
Your symptoms and the impact on your daily life – surgery may be recommended if your symptoms are severe or getting worse, or if the hernia is affecting your ability to carry out your normal activities.
Your general health – surgery may be too much of a risk if your general health is poor.
Although most hernias will not get better without surgery, they will not necessarily get worse. In some cases, the risks of surgery will outweigh the potential benefits.
Why do they need treatment?
Although having a hernia is not usually a serious condition, treatment to fix it is usually advised for two reasons:
It may gradually become bigger and more uncomfortable.
There is a small chance it might strangulate. A hernia strangulates when too much bowel (intestine) comes through the gap in the muscle or ligament and then it becomes squeezed.
This can cut off the blood supply to the portion of intestine in the hernia. This can lead to severe pain and some damage to the part of the intestines in the hernia.
A strangulated hernia is uncommon and is usually dealt with by emergency surgery. However, it is preferable to have the hernia fixed by routine rather than by emergency surgery.
The risk of strangulation is greater with a femoral hernia than with an inguinal hernia. The risk is also greater with smaller hernias.
There are two main ways surgery for hernias can be carried out:
- Open surgery – where one cut is made to allow the surgeon to push the lump back into the abdomen.
- Keyhole (laparoscopic) surgery – this is a less invasive, but more difficult, technique where several smaller cuts are made, allowing the surgeon to use various special instruments to repair the hernia.
Most people are able to go home the same day or the day after surgery and make a full recovery within a few weeks.
If you doctor recommends having surgery, it is important to be aware of the potential risks, as well as the possibility of the hernia recurring.
Make sure to discuss the benefits and risks of the procedure with your surgeon in detail before having the operation.