All about hernias

Hernias are an uncomfortable and sometimes painful condition that can require urgent treatment.  Mr Martin Sinclair, a consultant general surgeon that sub specialises in upper gastrointestinal and hepatobiliary surgery, has created a guide to hernia types, associated risks, pandemic advice, surgical treatment and latest developments in hernia repair. 

What are the different types of hernia?

A hernia is an abnormal protrusion of an organ or tissue through the muscle that usually contains it.  In some cases, the bowel can become trapped in the hernia causing a blockage (obstruction) or perforation, causing serious illness. 

Hernias can occur in many areas of the body but the most common types of hernia affect the abdominal wall. 

Within the abdominal wall, hernias mainly occur in the groin (inguinal and femoral hernias) and in the midline (ventral hernias).  Midline hernias include epigastric (below the breastbone), umbilical and incisional hernias (from previous surgery). 

What can put you at risk of developing a hernia?

Although hernias can occur for no specific reason, increased pressure within the abdomen and things that cause abdominal weakness such as obesity, coughing and pregnancy, are often associated with hernias.  Abdominal weakness is more common as we get older, can be caused by smoking and areas of natural weakness are also predisposed to hernia formation. 

What should I do if I think I have a hernia during the pandemic?

You should contact your doctor or specialist during the pandemic to examine and ensure that the lump you have found is a hernia. They will help you to decide on the most appropriate treatment.  Sometimes tests such as a CT scan are needed to clarify the diagnosis. If a hernia is confirmed, it may be possible to treat it with simple measures such as a hernia support or observation.  However, some hernias need more urgent surgery to prevent complications and this should not be delayed for any reason.  Your specialist can advise on the best course of action.

Is it ok to get surgery to treat them during this time?

The risks of surgery during the pandemic will be taken into consideration when you and your specialist make a shared decision about the best treatment option.  It may be reasonable to wait until the pandemic subsides and/or you have been vaccinated before embarking on surgery.  If surgery is chosen as the best course of action, then your specialist will ensure that the risks associated with Covid-19 are minimised. 

What are the best ways to ease symptoms in the meantime?

Simple measures such as avoiding strenuous activity and heavy lifting may help relieve symptoms.  Over-the-counter painkillers may also help.  Hernia supports can reduce symptoms by keeping the hernia within the abdomen whilst standing; these can be bought online or in some pharmacies.

When would it be absolutely vital to have surgery?

If the hernia becomes very painful, will not go back into the abdomen or you experience abdominal pain and vomiting, this may indicate that the hernia is incarcerated (stuck) or obstructed (blocked).  This is an emergency. You need very urgent surgery and you should attend a hospital immediately.

What are the latest developments in hernia repair?

The most commonly performed hernia repairs are open and laparoscopic (keyhole) surgery.  Your specialist will discuss the various options available depending on the type of hernia you have. 

Most hernia repair operations involve the insertion of artificial mesh that helps to strengthen the abdominal wall.  Mesh is very safe for abdominal wall hernias and is recommended by the British Hernia Society. 

Inguinal hernias can be treated by open-mesh repair under local or general anaesthetic. Laparoscopic (keyhole) inguinal hernia repair is also possible but always requires a general anaesthetic.  Keyhole repair has some advantages for bilateral and recurrent (after a previous repair) inguinal hernias. 

Femoral and midline hernias may be repaired by open or laparoscopic methods depending on factors such as size and previous surgery. 

Your specialist will discuss all of the options with you, to allow you to make an informed choice.

If you require hernia repair advice or assistance, Mr Martin Sinclair can provide an expert service. Find out more by visiting his Top Doctors profile here