An abdominal wall hernia is a weakness in the muscles of the abdominal wall, which may be congenital or acquired. When this occurs, it can cause pain, and sometimes fat or intestines from the abdominal wall can bulge out. Many hernias are asymptomatic, but some become incarcerated or strangulated, causing pain and requiring immediate surgery.
Abdominal hernias are very common, especially in men. Around 700,000 hernia operations are performed in the United States each year.
The abdominal wall is made up of muscle and tissues that attach those muscles to each other and to bone, it’s thick and tough in most places but sometimes there is an opening in the wall that allows what’s inside to push through to the outside. This is a hernia.
What are the Types of Abdominal Wall Hernias?
Abdominal wall hernias include:
• Umbilical hernias occur around the navel (umbilicus) and for the most part are congenital, but some are acquired in adulthood because of obesity, ascites, pregnancy, or excess fluid in the abdomen.
• Epigastric hernias occur through the linea alba.
• Spigelian hernias occur through defects in the transversus abdominis muscle lateral to the rectus sheath, usually below the level of the navel.
Incisional (ventral) hernias occur through an incision from previous abdominal surgery. This type of hernia may develop many years after the surgery.
Incarceration and Strangulation
Sometimes, a piece of intestine becomes trapped in the hernia, leading to a condition called incarceration. An incarcerated hernia can obstruct the intestine. On rare occasions, the hernia can trap the intestine so tightly that it cuts off the blood supply, a condition called strangulation. With strangulation, the trapped piece of intestine can develop gangrene in as little as 6 hours. With gangrene, the intestinal wall dies, usually causing rupture, which leads to inflammation and usually infection of the abdominal cavity (peritonitis), shock, and, if left untreated even death.
What are the Symptoms of Abdominal Wall Hernias?
Most people usually notice only a bulge at the site of the hernia, which may cause slight discomfort or show no symptoms. Sometimes the hernia appears only with lifting, coughing, or straining. Most hernias, even large ones, can be reduced manually by persistently applying gentle pressure.
• A doctor’s examination
• Sometimes imaging tests
Because the hernia may be apparent only when abdominal pressure is increased, the patient should be examined in a standing position. If no hernia is palpable, the patient should cough or perform a Valsalva maneuver as the examiner palpates the abdominal wall. Examination focuses on the umbilicus, the inguinal area (with a finger in the inguinal canal in males), the femoral triangle, and any incisions that are present.
What Should You Do If You Have a Hernia?
If you have a hernia, it is best to avoid straining and heavy lifting and should be evaluated by a physician to determine if the hernia needs to be repaired.
Hernias are surgically repaired. The surgeon will repair the hernia either by pulling the muscles at the edge of the hernia together with stitches (sutures) or by placing synthetic mesh material over the defect. Although most hernias should be repaired, if you are not experiencing any pain or there is little risk of damage to the intestines because of the hernia, surgery can be avoided.
However, an incarcerated or strangulated hernia of any kind requires urgent surgical repair.