Hernias

Most hernias occur when part of the bowel or peritoneum pushes through a gap in the abdominal wall. The peritoneum is the membrane that lines the abdominal cavity and completely or partly encloses most of the organs in the abdomen. The protruding pouch is called the hernia or hernial sac and may contain parts of organs such as the bowel or stomach. A bulge can usually be seen from the outside. Whether or not a hernia causes problems will depend on where it is and how big it is. 

These are the most common types of hernia:

Inguinal hernias

Inguinal hernias occur at a weak spot above the inguinal ligament. This is the most common kind of hernia and usually affects men.

For more detailed information on inguinal hernias in men, for example, visit gesundheitsinformation.de.

Femoral hernias

Femoral hernias mainly affect women. They occur in the upper part of the thigh, below the inguinal ligament.

Incisional hernias

Incisional hernias occur in scar tissue from surgery. The abdominal wall is weaker there, so hernias are more likely.

Umbilical hernias

Umbilical hernias arise at a weak point in the abdominal wall near the belly button (navel). They are most common in babies and overweight adults.

Epigastric hernias

Epigastric hernias are where tissue pokes through a gap in the abdominal wall between the breastbone and the belly button.

Hiatal hernias are a special kind of hernia. They occur when one of the gaps in the diaphragm becomes bigger and the peritoneum or part of the stomach moves up into the chest area from the abdomen. As these hernias are not visible from the outside they are referred to as “internal hernias”.

Most hernias don’t go away if left untreated. One exception is umbilical hernias in babies. These usually go away on their own within the first two years of the baby’s life.

Most hernias can be felt or even seen as bulges. Not all people with hernias have symptoms. But hernias might lead to pain, burning, a feeling of pressure or a pulling sensation, especially during physical strain. Some people only have symptoms when they tense their abdominal (tummy) muscles a lot. 

If the bowel is pinched by the hernia, people may have problems with their digestion. In men who have an inguinal hernia, tissue may poke into the scrotum, making it swell a lot (scrotal hernia). 

Severe or sudden new pain in the area of the hernia, or nausea and vomiting in addition to the pain, could be signs that the hernia sac has become constricted. This can lead to serious complications such as peritonitis (inflammation of the peritoneum). 

Large, clearly visible hernias are very unpleasant and can be very distressing for those affected. 

The symptoms caused by hiatal hernias are different to those caused by hernias that poke through gaps in the abdominal wall. These internal hernias can lead to heartburn, swallowing and breathing difficulties. These symptoms can be treated with medication. And the hernia can be fixed through surgery.

People with weak abdominal muscles or weak connective tissue are more likely to get hernias. Some people are born with weak connective tissue, whereas in others it becomes weaker in older age. Illnesses or surgery can also weaken tissue and muscles.

People who are very overweight have increased pressure in their abdomen. But this only increases the risk of incisional and umbilical hernias. It doesn’t affect the risk of inguinal hernias. Tumors or a build-up of fluid in the abdomen can increase the pressure on the abdominal wall too. 

Abdominal wall hernias are also more common in pregnant women. Smoking and illnesses like diabetes can make it more difficult for wounds to heal properly, which makes incisional hernias more likely.

Coughing, straining or lifting heavy objects and can make existing hernias grow in size. Whether they can also cause hernias in the first place probably depends on the type of hernia. Scientific studies have not yet made clear whether this is the case with inguinal hernias, for example.

Inguinal hernias are the most common type of hernia. About 25 out of 100 men and 2 out of 100 women have at least one inguinal hernia at some point in their lives. The second most common types of hernia are umbilical and incisional hernias. Depending on the kind of surgery done, up to 15 out of 100 people develop incisional hernias following surgery involving the abdominal wall. Epigastric hernias, femoral hernias and hiatal hernias are less common.

If left untreated, hernias can get bigger over time, become more visible and cause more problems. These problems are rarely serious though. 

Sometimes the hernia sac becomes constricted and may, for instance, trap the bowel. This can cause the bowel to become blocked (bowel obstruction), which leads to severe pain, nausea and vomiting. The likelihood of this happening is greater with femoral hernias than with inguinal hernias, for instance. 

If the blood vessels are pinched too, the herniated tissue might die which could result in peritonitis (inflammation of the peritoneum). In rare cases, the skin covering the hernia may thin out and die. If that happens, the area may become inflamed or the hernia might break through the skin. 

Any measures for prevention depend on the type of hernia. It is a good idea, for example, to avoid strain like carrying heavy objects for a while following surgery on the open abdomen. This helps to prevent incisional hernias. If the risk of recurrence is very high, a synthetic mesh can be used as a preventive measure.

People who are overweight can lower the risks of incisional and umbilical hernias by losing weight. But weight loss won’t lower the risk of inguinal hernias. It’s not clear whether carrying heavy objects makes inguinal hernias more likely.

Stopping smoking can help surgical wounds heal better, which probably lowers the risk of incisional hernias. Making sure that medical conditions like diabetes and anemia are treated properly reduces the risk of an incisional hernia, because they too can affect how well wounds heal.

Hernias are often clearly recognizable as such. The doctor first takes a look while the patient is standing, after asking them to tense their stomach muscles and cough. Then the patient is asked to lie down. This makes it easier for the doctor to feel how big the hernia sac is and see whether it can be pushed back into the abdomen. The doctor can use a stethoscope to listen for bowel sounds in the hernial sac.

Sometimes an ultrasound scan is done too. X-rays, CT (computed tomography) scans or MRI (magnetic resonance imaging) scans are very rarely needed.

Surgery is the only treatment option for hernias. It involves the doctor pushing the hernia sac back into the abdomen or removing it, and closing the gap in the abdominal wall with stitches. A fine synthetic mesh is usually also used to strengthen the abdominal wall and prevent the hernia from coming back.

In open surgery, the operation is carried out through a larger cut where the hernia is. In minimally invasive surgery (also called laparoscopic or keyhole surgery), the doctor makes a few small cuts. Surgical instruments and a fine tube with a camera attached to it (laparoscope) are then inserted into the abdomen or abdominal wall. The surgery options used by the doctor will depend on things like the type and size of the hernia. 

This is also true in people who are very old, weak or seriously ill and have a hernia that doesn’t pose an acute risk. People who have an inguinal hernia, on the other hand, are usually advised by their doctor to have surgery.

Hernia supports or hernia belts were often used in the past. These tight, belt-like bandages used to try to stop hernias from bulging out of the abdomen are not recommended by medical practitioners nowadays, because they don’t make the hernia go away and can have side effects such as pressure ulcers (bedsores).