A hernia is where an internal part of the body pushes through a weakness in the muscle or surrounding cavity wall. A hernia usually develops between the chest and hips, often seen as a lump in the abdomen or groin which can be pushed back in or disappears when lying down. The lump can reappear or get bigger when coughing or straining.
There are many types of hernia, usually named by the place they occur:
- Inguinal hernias – part of the bowel comes through, appearing as a lump at the groin at the top of the inner thigh
- Femoral hernias – fatty tissue or part of the bowel comes through, appearing as a lump at the groin at the top of the inner thigh
- Umbilical hernias – fatty tissue or part of the bowel comes through, appearing as a lump near the belly button
- Hiatus hernias – part of the stomach pushes up into the chest through the diaphragm. It is not usually visible; the main symptom is heartburn
- Incisional hernias – where tissue comes through a surgical wound that is healing
- Epigastric hernias – where tissue comes through, appearing as a lump above the belly button but below the breastbone
- Spigelian hernias – where part of the bowel comes through at the side of the abdomen
- Diaphragmatic hernias – where organs in the abdomen move up into the chest through an opening, seen most often in babies
- Muscle hernias – where part of the muscle comes through, appearing as a lump. Often seen in the legs after injury.
A hernia can usually be diagnosed by a doctor by examination alone. In some cases, an ultrasound scan might be done to assess the extent of the problem and what type of tissue is causing the lump.
Most hernias will not get better without surgery, however they will not necessarily get worse. The need for treatment will be decided based on a number of factors-
- The type of hernia – some types are more likely to cause serious complications
- The content of the hernia – if the hernia contains part of the bowel or muscle tissue, serious complications are more likely
- The symptoms and their impact on life – if you have severe symptoms or the hernia is stopping you from doing something
- Your general health – if you are fit enough to have surgery to repair the hernia
Surgery can be done either through one bigger cut (open surgery) or through several small cuts (keyhole or laparoscopic surgery) to push the lump back into the abdomen and repair the weakness that let it push through.
Serious complications of hernias can occur, so if you have a hernia and you have sudden or severe pain, vomiting, difficulty passing stool or wind, or the hernia becomes hard and painful or cannot be pushed back in, then you should seek urgent medical attention. These symptoms can mean that the blood supply to the organ or tissue in the lump has been cut off (strangulation) or if there is a piece of bowel in the hernia it can become blocked (obstruction). Both of these are life threatening complications so need treatment as soon as possible.