Patient education: Abdominal wall hernias (The Basics)

What is an abdominal wall hernia? — The internal organs and tissues in the belly are held in place by a tough outer wall of tissue called the "abdominal wall." An abdominal hernia is an area in that wall that is weak or torn. Often, when there is a hernia, organs or tissues that are normally held in place by the abdominal wall bulge or stick out through the weak or torn spot.

The size of the bulge can change depending on how much pressure is put on the abdominal wall. For example, straining when coughing or having a bowel movement can make a hernia look bigger. Lying down overnight can make the hernia look smaller, or even disappear, in the morning.

There are many different kinds of abdominal wall hernias (figure 1).

What are the symptoms of abdominal wall hernias? — Abdominal wall hernias do not always cause symptoms. When they do, they can cause some or all of these symptoms:

●A bulge somewhere on the trunk of the body – This bulge can be so small that you don't even realize it's there.

●Pain, especially when coughing, straining, or using nearby muscles

●A pulling sensation around the bulge

●Nausea or vomiting if part of the intestine is blocked in the hernia

Abdominal wall hernias can balloon out and form a sac. That sac can hold a loop of intestine or a piece of fat that should normally be tucked inside of the belly. This can be painful and even dangerous if the tissue in the hernia gets trapped and unable to slide back into the belly. When this happens, the tissue does not get enough blood, so it can become swollen or even die (figure 2).

Should I see a doctor or nurse? — Yes. See a doctor or nurse if you have any of the symptoms of a hernia. In most cases, doctors can diagnose a hernia just by doing an exam. During the exam, the doctor might ask you to cough or bear down while pressing on your hernia. This might be uncomfortable, but it is necessary to find the source of the problem.

Most of the time, the contents of the hernia can be "reduced," or gently pushed back into the belly. But sometimes, the hernia gets trapped and won't go back in. If that happens, the tissue that is trapped can get damaged.

If you develop severe pain around a hernia bulge or feel sick, call your doctor or surgeon right away.

How are hernias treated? — Not all hernias need treatment right away. But many do need to be repaired with surgery.

Surgeons can repair most hernias in 1 of 2 ways. The right surgery for you depends on the size of your hernia, where on the abdominal wall it is, whether this is the first time it is getting repaired, what your general health is like, and your surgeon's experience.

The 2 types of surgery are:

●Open surgery – During an open surgery, the doctor makes 1 large cut near the hernia to repair it.

●Minimally invasive surgery – "Minimally invasive" surgery lets the doctor make smaller cuts in the skin. They insert long, thin tools through the cuts. One of the tools has a camera (called a "laparoscope") on the end, which sends pictures to a TV screen. The doctor can look at the screen to see inside the body. Then, they use the long tools to do the surgery. They can control the tools directly, or with the help of a robot (this is called "robot-assisted" surgery).

If your hernia has reduced the blood supply to a loop of intestine, your doctor might need to remove that piece of intestine. Usually, they will then sew the intestine back together.

The recovery and aftercare for each type of hernia repair is different. Your doctor or nurse can tell you what to expect after your surgery.

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