Abdominal hernia | Mate whaturama

Key points about abdominal hernia

  • An abdominal hernia (mate whaturama) is when an internal part of the body, commonly a piece of bowel, pushes through a weak part of your abdominal (tummy) wall muscle and creates a bulge or lump.
  • Usually, you can push the hernia back in or it disappears when you lie down, but assessment and treatments may be recommended so it doesn’t get larger or become painful.
  • Hernias can become stuck or strangulated, where the tissue poking out gets trapped by the muscle.
  • If your hernia is firm or tender and can’t be pushed back in, or you have sudden severe pain, vomiting or difficulty passing stools (constipation) or wind, seek immediate medical help.

 

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The word hernia means ‘something coming through’. The most common place for a hernia is the abdominal wall – a large sheet of muscle and tendon that helps hold all the abdominal content in place.

If there is an area of weakness in the wall, pressure from inside the wall can cause part of the abdominal contents (eg, the intestines) to be pushed through the opening. This resulting bulge is known as a hernia.


Image credit: 123rf

There are several common types of hernia:

  • Inguinal hernias occur near your groin and are more common in men.
  • Femoral hernias occur where your leg joins your body and are more common in women.
  • Incisional hernias occur where you have a scar from surgery.
  • Umbilical hernias occur near your naval (belly button) and are more common in newborns or people who are obese.
  • Hiatus hernias occur when part of your stomach pushes up into the chest.

Hernias can affect anyone and many babies are born with hernias.

Abdominal hernias are caused by straining that puts pressure on that abdominal (tummy) area. Pressure may come from:

  • constant coughing or sneezing
  • being overweight
  • lifting, carrying or pushing heavy loads
  • constipation, leading to straining on the toilet
  • pregnancy.

Some people have weaker abdominal walls which makes them more prone to hernias.

You may have no symptoms, or you may feel the following:

  • a lump or bulge in your abdomen (tummy) or groin
  • a heavy or uncomfortable feeling in your gut, particularly when bending over
  • pain or aching after exertion, eg, after lifting or carrying heavy objects
  • digestive upsets, eg, constipation.

Your healthcare provider will be able to make a diagnosis based on your symptoms and a physical examination. If the belly button (umbilicus) becomes red, hot, tender or your baby becomes unwell, irritable or is not passing bowel motions (poo), seek urgent medical help. 

Image credit: 123rf

Your healthcare provider may try supportive therapies or wait to see if your hernia gets worse.

Occasionally, they may recommend a small operation to fix the muscle wall. This is usually day surgery under local or general anaesthesia. An incision (cut) will be made in your abdomen (tummy/puku) around the hernia, and stitches or surgical mesh will be used to close the weak section of muscle or provide reinforcement. Inguinal hernias may be repaired using laparoscopic (keyhole) surgery. 

Seeing your healthcare provider is the best way of helping yourself if you have a hernia. Some devices (eg, hernia trusses, support belts) and therapies are available (eg, physiotherapy and medication for cough and constipation) to reduce symptoms and ease discomfort. Talk to your healthcare provider about whether they are suitable for you.

You can reduce your chances of getting a hernia if you:

  • eat lots of high fibre foods to stop you getting constipated
  • maintain a healthy weight
  • take care when lifting heavy object by bending from your knees, not your waist
  • get treatment if you have a persistent cough or sneeze
  • quit smoking as this can cause persistent coughing, which can put pressure on your abdominal wall. 

Talk to your healthcare provider and, if you need additional support, they can help you to access other healthcare professionals such as physiotherapists and counsellors. 

Constipation | Mate tūtae kore
Pregnancy topics
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Weight loss – a healthy approach

Hernia(external link) Patient Info,  UK
Hernia(external link) Better Health, Australia
Umbilical hernia in kids – pre-referral guidelines(external link) Royal Children's Hospital, Australia
Hernia(external link) What is a hernia video, NHS, UK

References

  1. LeBlanc KE, LeBlanc LL, LeBlanc KA. Inguinal hernias – diagnosis and management(external link) Am Fam Physician 2013;87(12):844-48
  2. Brooks DC, Hawn, M. Classification, clinical features and diagnosis of inguinal and femoral hernias in adults(external link) UpToDate, US, 2022
  3. Inguinal Hernias(external link) Patient Info, UK 2022

Clinical diagnosis and treatment

  • Identify the source of the hernia and describe pertinent features, eg:
    • inguinal, umbilical, abdominal, femoral
    • traumatic, post-operative or spontaneous
    • direct versus indirect inguinal hernia
    • reducible versus non reduceable
    • history of ‘red flag’ symptoms such as severe pain, constipation and vomiting.
  • Consider urgent medical assessment of hernia with red flag symptoms or signs of shock, peritonitis etc.
  • Ultrasound is not required for diagnosis of hernia and is unlikely to change the surgical management (see HealthPathways(external link)). Use POCUS or refer for ultrasound if source of lump is unclear.
  • Post-operative (incisional) hernia may be covered by ACC (see ACC Abdominal Wall Hernia as Treatment Injury; Guide to Cover(external link)).
  • Hernias may be the underlying cause of other conditions such as severe GORD, see Gord BPAC 2014(external link) or urinary incontinence, see Urinary incontinence BPAC 2014(external link)
  • Hernia may be exacerbated by other health conditions such as high body weight, separation of the abdominal muscles, chronic cough or respiratory disease, chronic constipation, urinary obstruction, pregnancy and postpartum.
  • Differential diagnoses may include hydrocele, lipoma, femoral lymphadenopathy and more.

Property Inguinal hernia Femoral hernia
Sex More common in male patients More common in female patients
Defect Pass through inguinal canal Pass through femoral canal
Site Above and medial to pubic tubercle
Above the crease of the groin		 Below and lateral to pubic tubercle
Below the crease of the groin
Strangulation Less common More common because of rigid neck – Ricter's hernia
Treatment Can be treated without surgery Surgery is essential because of risk of strangulation
Reduction Can be reduced completely Cannot be reduced completely
Cough impulse Cough impulse usually present Many do not have cough impulse

Source: Table from Southern Health Pathways – Hernia in adults (2022)

There are two issues to consider regarding treatment:

  1. Watchful waiting versus early elective surgical repair. See management policy for asymptomatic inguinal hernias(external link) NSMJ, 2015
  2. The use of mesh versus sutures in surgery. See: open mesh repair is more effective than open suture repair for incisional hernia(external link) NZ Doctor, 2008 and long-term recurrence and complications associated with elective incisional hernia repair(external link) JAMA, 2014 

Summary

  • Refer when concern for red flag symptoms and include these in your assessment.
  • Inguinal hernia are common and one third are asymptomatic or minimally symptomatic.
  • Most centres will prioritise referrals where the hernia is large and the patient is significantly symptomatic (Bagshaw, NZMJ 2015).
  • Before referring for surgery, give patient advice on what to expect after surgery.

Resources

For useful information on post-operative care after hernia surgery, see Post-operative care(external link) British Hernia Society. 

What to expect after surgery

  • Most patients recover without complications. Mesh rarely causes complications in hernia repair, and 1 in 3,000 patients get local mesh infection. See New Zealand Association of General Surgeons Position Statement: Mesh Hernia Repair(external link).
  • It is normal for the scrotum and groin to be black and bruised.
  • You can return to driving once you feel able to press pedals.
  • Expect some pain for up to 1 week.
  • To enhance recovery, 1–2 weeks of time off will be required (1 week if sedentary work, 2 weeks if physical labour).
  • Return to your general practice if you develop a lump.

Source: Southern Health Pathways – Hernia in Adults (2022)

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Dr Bryony Harrison

Last reviewed:

Page last updated:

Read more at: https://healthify.nz/health-a-z/h/hernia-abdominal/
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