Hernia

Hernias often don’t cause any symptoms, but you may notice a lump. It can often be pushed back in when pressed and then straining or coughing can cause it to reappear again. It may disappear if you lie down.

More concerning hernia symptoms include severe pain, vomiting, constipation, redness, hardness of the defect, or stomach bloating. If it’s a bowel protruding from the opening in the muscle wall, this can indicate an obstruction or strangulation, and you should go to the emergency department immediately.

Many types of hernias can develop from the chest, abdomen, or groin.

An inguinal hernia is the most common and occurs when part of the bowel or fatty tissue protrudes out of the inner groin. It is more common in men, with age, and if there is repeated strain on the abdomen, such as weight-lifting or heavy manual labor.

A femoral hernia is more common in women, where bowel or fatty tissue pokes through the groin at the top of the inner thigh.

Umbilical hernias occur near the belly button and are common in babies after birth. Given time and growth, they can spontaneously disappear.

Hiatus hernias occur when parts of the stomach push through the diaphragm at the bottom of your rib cage and into the chest cavity where the lungs are. It is typically found incidentally on a chest X-ray but can cause heartburn-type symptoms in some.

If you have had an operation on your abdomen before, you may get an incisional hernia at the site of the surgery, although it's not common.

Hernias don’t usually cause any bother, provided they remain small. If a hernia grows and becomes more painful, you may risk complications if it’s not treated. The biggest risk is if bowel tissue gets stuck outside the abdominal wall, cutting off blood supply to the tissue and causing it to die off (strangulation) or if the gut contents can’t pass freely (obstruction). You may require emergency surgery to treat this, and it can become life-threatening in the most severe of cases.

Firstly, you are advised to avoid activities that might exacerbate the hernia, such as heavy lifting in the gym or your job, and avoid constipation, as straining can put pressure on the hernia. You may be advised to lose weight if obese. A hernia can resolve itself, so this may be the best option, and waiting to see if it repairs.

If this doesn't work or the hernia is causing concern, you may be offered surgery. Surgery for hernias depends on the severity of symptoms and how it impacts your daily life. Surgery may be recommended if your symptoms are worsening or complications have developed.

Surgery aims to repair and strengthen the weak side in a muscular wall like that of the abdomen, and various techniques may be used for this, such as a mesh or stitching. It may be an open incision, where a surgeon has direct access via the skin and tissues, or keyhole or laparoscopic surgery, where small incisions allow access via tubes with a camera, a light, and instruments, and they can repair the defect from there.

Your surgeon will advise on the best treatment, depending on the type and extent of the hernia and your circumstances.