Understanding abdominal hernias: Types, symptoms, and when to seek medical help

In his latest online article, Mr Vanash Patel gives us his insights into hernias. He discusses the most common types and how they differ in terms of presentation, risk factors and treatment options, what the most common symptoms are and when to seek medical attention.

What are the most common types of hernias that can occur in the abdominal region, and how do they differ in terms of presentation, risk factors, and treatment options?

Hernias occur when an organ, fatty tissue, or a part of an organ protrudes through a weak spot or tear in the wall of the cavity that normally contains it. In the abdominal region, there are several common types of hernias, each with distinct presentations, risk factors, and treatment options. Here are some of the most common types:

Inguinal hernia:

• Presentation: This is the most common type of hernia, and it occurs in the groin area. It presents as a bulge or swelling in the groin or scrotum, which may be more noticeable when standing, coughing, or straining. •
• Risk factors: Factors such as male gender, advancing age, family history, obesity, chronic cough, and heavy lifting increase the risk of inguinal hernias.
• Treatment: Surgical repair is the most common treatment. It can be done via open surgery or minimally invasive laparoscopic techniques.

Femoral hernia: 

• Presentation: Similar to inguinal hernias, femoral hernias also appear as bulges in the groin or upper thigh region. They are more common in women and often have a higher risk of complications due to their location.
• Risk factors: Risk factors include female gender, obesity, pregnancy, and previous abdominal surgeries. 
• Treatment: Surgical repair is the primary treatment for femoral hernias, typically through surgical mesh placement.

Incisional Hernia:

• Presentation: Incisional hernias develop at the site of a previous surgical incision. They appear as bulges or protrusions through the scar tissue.
• Risk factors: Risk factors include obesity, poor wound healing, infection, and inadequate closure of the surgical incision.
• Treatment: Surgical repair involves reinforcing the weakened abdominal wall with mesh. The repair can be done through open surgery or laparoscopic methods.

Umbilical Hernia:

• Presentation: This type of hernia occurs near the navel (umbilicus) and appears as a bulge or swelling at that location.
• Risk factors: Risk factors include obesity, pregnancy, and conditions that increase abdominal pressure.
• Treatment: Small umbilical hernias in infants often resolve on their own. In adults, surgical repair may be considered if the hernia is causing discomfort or if it becomes incarcerated (trapped) or strangulated.

Hiatal Hernia:

• Presentation: Hiatal hernias occur when part of the stomach protrudes through the diaphragm into the chest cavity. They can cause symptoms like heartburn, regurgitation, and difficulty swallowing. •
• Risk factors: Risk factors include obesity, aging, and conditions that weaken the diaphragm.
• Treatment: Treatment ranges from lifestyle changes (diet, weight loss) to medications that reduce stomach acid. Severe cases may require surgical repair. It's important to note that surgical repair is a common treatment approach for most hernias, and the type of surgery (open or laparoscopic) and the use of mesh will depend on factors such as the size and location of the hernia, the patient's overall health, and the surgeon's expertise. 

What are the common symptoms of a hernia, and when should a patient seek medical attention for their hernia symptoms?

The symptoms of a hernia can vary depending on the type and location of the hernia. However, some common symptoms that individuals with hernias might experience include:

1. Visible bulge or swelling: One of the most noticeable symptoms of a hernia is the appearance of a bulge or swelling in the affected area. The bulge might become more prominent when coughing, straining, or standing.

2. Pain or discomfort: Pain or discomfort is another common symptom. The pain might be sharp or aching and could worsen with physical activity, lifting, or straining. The discomfort might also be relieved when lying down or resting.

3. Aching or heaviness: Some people describe a sensation of aching or heaviness at the site of the hernia, particularly after prolonged periods of standing or physical exertion.

4. Burning or pressure: There might be a sensation of burning or pressure at the hernia site, which can sometimes be associated with acid reflux or indigestion in the case of hiatal hernias.

5. Difficulty swallowing or indigestion: Hiatal hernias can cause symptoms such as difficulty swallowing (dysphagia), heartburn, regurgitation, and chest pain.

6. Nausea and vomiting: In more severe cases of hernia, especially when a portion of the intestine becomes trapped (incarcerated) or its blood supply is compromised (strangulated), symptoms can include nausea, vomiting, and severe abdominal pain.

 7. Changes in bowel habits: Some hernias, particularly those involving the intestines, can cause changes in bowel movements, such as constipation or difficulty passing stool.

8. Difficulty urinating: Hernias in the groin area can sometimes cause difficulty with urination or a sensation of pressure in the lower abdomen. It's important to note that not all hernias cause symptoms, and some are discovered incidentally during routine medical examinations.

However, if you suspect you have a hernia or are experiencing any of the symptoms mentioned above, it's advisable to seek medical attention.

In particular, you should seek immediate medical care if you experience:

• Sudden and severe abdominal pain
• Nausea and vomiting 
• Inability to pass gas or have a bowel movement
• Pain or tenderness at the hernia site that worsens rapidly
• Redness, warmth, or discoloration of the hernia site, which could indicate a possible incarcerated or strangulated hernia

Mr Vanash Patel is a distinguished consultant colorectal and general surgeon with over 20 years of experience. You can schedule an appointment with Mr Patel on his Top Doctors profile.