HERNIAS

Hernias occur when an internal part of the abdomen pushes through a weakness in the muscles and connective tissue, creating a bulge. Your muscles are usually strong enough to keep your organs securely in place. A hernia may develop if any areas are naturally weak or have become weak. They usually occur between the chest and the hips and affect as many as 1 in 10 people.

Hernia Types

Inguinal hernias are bulges around the groin which occur within an anatomical region of the groin known as the inguinal region. Inguinal hernias commonly contain fatty tissue but may also contain loops of bowel. Inguinal hernias occur more commonly in males. Common symptoms are a soft swelling in the groin and pain or general discomfort particularly after activity. The hernia often appears when lifting something heavy and may disappear when lying down or after applying some gentle pressure over it. Some inguinal hernias may reach down into the scrotum. Hernias which do not cause symptoms may not require surgery. In younger patients it is likely that they will become symptomatic with age. 

Femoral hernias are another type of groin hernia which occur when fatty tissue or part of the bowel pushes through an anatomical location known as the femoral canal, which is at the top of the inner thigh. 

Femoral Hernia vs Inguinal Hernia

Femoral hernias are much less common and they occur more in women than in men. This is related to the shape of the female pelvis and the bulk of muscle around the pelvis. Surgical repair is recommended for femoral hernias irrespective of symptoms because of their greater potential for complications. 

Epigastric hernias occur when fatty tissue or part of the bowel pushes through the abdomen between the umbilicus (belly button) and the breastbone. Symptoms of an epigastric hernia in both male and female adults are the appearance of a swelling in the upper abdomen or the epigastric region which may or may not be painful.  

Umbilical and paraumbilical hernias occur when fatty tissue or part of the bowel pushes through the area of the abdomen near the umbilicus (belly button). They may be present from birth, if the opening in the abdomen through which the umbilical cord passes does not seal completely. In children they usually resolve by the age of 5. Sometimes they occur later in life and after pregnancy. Symptoms in adults may include pain and discomfort or a swelling around the belly button. 

Incisional hernias occur when fatty tissue or part of the bowel pushes through a surgical wound that has not fully healed. Incisional hernias are most likely to develop within the first year after abdominal surgery, but they can happen at any time. Incisional hernias can vary in size and symptoms. Smaller incisional hernias may be straight forward to repair, whereas larger and more anatomically complex incisional hernias may require abdominal wall reconstruction. 

Spigelian hernias occur through a weakness in the abdominal wall called the spigelian fascia which lies on either side of the rectus abdominus muscle (the 2 muscles that run vertically down the middle of the abdomen), usually below the umbilicus (belly button).  

Sports Hernias otherwise known as athletic pubalgia are not actually hernias, but the symptoms can mimic a groin hernia. They commonly occur in people that are physically active as a result of injury to a tendon or muscle in the groin region. Sports hernias are generally caused by repetitive and forceful twisting of the pelvis. 

Diastasis recti or divarication is a bulge in the upper abdomen which occurs when the rectus abdominus muscles (the 2 muscles that run vertically down the middle of the abdomen) separate. It is a common condition in pregnancy as the abdominal wall stretches to accommodate the growing uterus. It also occurs in men who are overweight. Treatment is with an exercise program that engages the abdominal muscles or core abdominal exercises and physiotherapy. Surgery is performed if there is an associated hernia or if it is required for aesthetic reasons. 

Hernia investigations

Hernias may be diagnosed after taking a clinical history and examination of the lump. Occasionally an ultrasound scan may be advised to get a better assessment of the anatomy of the hernia. For more complex hernias, a CT scan may be required. 

Hernia Treatment

Many hernia subtypes do not cause debilitating symptoms and don't require intervention. When a hernia increases in size and/or becomes more painful, it requires treatment. In hernias that contain bowel, surgery is strongly recommended because there is a risk that the bowel may become blocked (bowel obstruction) or the blood supply to it may become compromised (strangulation). There are no medicines that can correct hernias, only surgical intervention may definitively treat a hernia.

Surgery for hernias involves returning the herniated tissue back into the abdomen and repairing the weakness in the abdominal wall. Repair of the hernia may be done with strong sutures or with mesh. A hernia repair using mesh ensures that there is a much lower chance of the hernia returning. The operation may be performed open or laparoscopic 'keyhole' depending on the type, size and location of the hernia. It can be done under local, regional or general anaesthesia. The length of surgery varies depending on the type, size and complexity of the hernia. Most hernia repairs are treated as a day-case procedures and recovery is rapid. 

You may consider wearing an abdominal binder to help hold the hernia in place and support the abdominal wall while you wait for surgery. It may also be worn while you recover from the surgery to support your abdominal wall while it heals from the surgery. 

Please ask your surgeon about this. Abdominal binders may be purchased in pharmacies and online. 

Hernia Operations Performed 

I offer the following hernia repairs, using open and laparoscopic techniques: 

• Inguinal hernias
• Femoral hernias
• Epigastric hernias
• Paraumbilical & umbilical hernia repair 
• Spigelian hernias
• Incisional hernias
• Surgery for diastases recti
• Abdominal wall reconstruction