The muscles of the abdominal wall have a security function: preventing the organs within the abdomen from falling out. When a weakness or tear occurs in this wall, part of the intestine may bulge out and appear as a lump under the skin. This condition is known as a hernia. While hernias are most common in the abdomen, they can also occur in the upper thigh, belly button and groin.
A hernia is caused by a combination of pressure within the abdomen and muscle weakness. The sudden pressure from vigorous exercise, lifting heavy weights, coughing, or even straining on the toilet can lead to hernias. A hernia can also arise due to an existing congenital weakness around the umbilicus (umbilical hernia) or under the scar of an operation (incisional hernia).
The most common types of hernia are inguinal hernias. These occur when the intestines push through a weak spot or tear in the lower abdominal wall near the inguinal canal, where the lower abdomen meets the thigh. They are more common in men due to a defect. After a male’s testicles descend into the canal shortly after birth, the canal is meant to close almost completely; when the canal doesn’t close properly, the area is weak and prone to hernias.
Symptoms of an inguinal hernia include:
- Weakness, pressure, or ‘heaviness’ in the abdomen
- Pain or discomfort — usually in the lower abdomen — especially when bending over, coughing, or lifting
- A burning, gurgling, or aching feeling at the site of the bulge
A hiatal hernia is an internal hernia that occurs when part of the stomach protrudes through a rupture in the diaphragm into the chest. These are most common in those over 50 years old or in children with a congenital defect.
Symptoms of a hiatal hernia include:
- Acid reflux, which is a burning sensation in the throat or chest
- Chest pain
- Difficulty swallowing
Diagnosis and treatment
If any of these symptoms arise, see a doctor to confirm the diagnosis. All hernias — except umbilical hernias, which typically heal themselves within four years — benefit from surgery. The standard treatment is hernia repair surgery, or herniorrhaphy.
While most hernias are not immediately life threatening and can be monitored, there is a risk that an untreated hernia strangulates or has its blood supply cut off. This requires an emergency operation to prevent intestinal obstruction, intestinal perforation, shock, or even death.
Surgery involves repositioning the herniated tissue and removing the oxygen-starved part of the organ if strangulation has occurred. The damaged muscle wall is repaired with a special synthetic mesh or tissue. Surgery for hernia can be done using a laparoscope, which requires smaller incisions and has a shorter recovery period.