Hernia

A hernia occurs when an organ or tissue pushes through a weak point in the muscle or connective tissue that normally contains it. Most are felt first as a bulge that appears on standing, coughing or lifting, and disappears on lying down.

What a hernia is

The abdominal wall is a layered structure of muscle and fascia. Where that wall is naturally weaker — the groin, the navel, the site of a previous incision — pressure from inside can push a sac of tissue through the defect. The contents may be fat, or a loop of bowel.

Common types include:

• Inguinal — in the groin; the most common type overall
• Femoral — also in the groin but lower, more common in women, and with a higher risk of complication
• Umbilical and paraumbilical — at or near the navel
• Incisional — through the scar of a previous abdominal operation
• Epigastric — in the midline between navel and breastbone

Symptoms patients usually notice

• A lump or bulge, often more obvious on standing, straining, coughing or lifting
• A dragging, aching or burning sensation at the site
• Discomfort that worsens through the day or with activity
• In groin hernias, discomfort extending into the scrotum or upper thigh
• Sometimes no symptoms at all — some hernias are found incidentally

When a hernia becomes an emergency

If a hernia becomes trapped, its blood supply can be compromised. This is uncommon but serious.

How a hernia is assessed

Most hernias are diagnosed clinically — by examination standing and lying, with and without coughing. Imaging is not always needed. Where the diagnosis is uncertain, where the hernia is not easily felt, or where planning a complex repair, an ultrasound or CT scan may be used.

Assessment also covers the things that affect whether and how to operate: general health and fitness for anaesthesia, chronic cough, constipation, smoking, weight, and any previous abdominal surgery.

Treatment options

Watchful waiting

For a small, easily reducible inguinal hernia causing no symptoms, monitoring rather than immediate surgery can be a reasonable choice in selected patients. Most people in this group eventually come to surgery because symptoms develop, but the decision is not urgent.

Surgical repair

Repair involves returning the contents to the abdomen and closing or reinforcing the defect. Most adult repairs use a mesh to reinforce the weakened area, because mesh repairs are associated with lower recurrence than suture-only repair for most hernia types.

Repairs are performed either through an open incision or by minimally invasive technique — laparoscopic or robotic. Each has trade-offs in recovery, post-operative pain and suitability, and the right choice depends on hernia type, size, whether it is a first or repeat repair, and the individual.

When surgery may be considered

• The hernia causes pain or limits activity
• It is enlarging
• It is a femoral hernia, which carries a higher complication risk and is generally repaired
• It has become difficult to reduce
• There has been an episode of obstruction or trapping

Risks and considerations

• Recurrence — possible after any repair, and more likely with larger defects, smoking, obesity and chronic straining
• Chronic pain or numbness at the site, particularly after groin repair
• Seroma or haematoma — collections of fluid or blood, usually settling without intervention
• Wound infection, and rarely mesh infection
• Injury to nearby structures, which is uncommon
• The general risks of anaesthesia and of any abdominal operation

These are weighed individually against the risks of leaving the hernia alone, which include gradual enlargement and the small but real chance of an emergency presentation.

Recovery and aftercare

Many hernia repairs are performed as day-case or short-stay surgery. Recovery generally involves gradual return to normal activity, with heavier lifting restricted for a defined period. Minimally invasive repairs are often associated with a faster return to activity, though this varies with the individual and the hernia.

Addressing the factors that contributed — constipation, chronic cough, smoking, weight — is part of aftercare, because they are also the factors most associated with recurrence. The specific restrictions and timeline come from the operating team and take precedence over any general schedule.

Frequently asked questions