A hernia is a weakness or hole in the muscles and fibrous coverings of the abdominal wall. Because of this, things which belong inside your abdominal cavity such as fat and bowel can push out through this hole and cause trouble. Often they freely move in and out of this hole, but there is a risk the contents can become stuck out of the abdomen, and this usually requires emergency surgery. They occur at areas of weakness in your abdominal wall. Some of these weak areas are there from birth, though others come later in life with wear and tear. Anything which increases the pressure inside your tummy cavity is a risk for hernia formation some examples of which are chronic cough, heavy lifting, constipation, pregnancy and obesity.
Our genes probably also play a role with the makeup of our tissues (specifically our collagen) affecting our body’s ability to withstand wear and tear.
Hernias can cause no symptoms at all, or can present as a lump and or abdominal pain. Uncommonly they present as an emergency when the hernia becomes stuck with a hard lump which does not go away, bad pain or symptoms of bowel obstruction.
There are many different common locations for hernias, including inguinal, femoral, umbilical, epigastric and incisional. Dr Adams regularly performs surgery for all these different types of hernias, as well as more rare hernias.
Inguinal hernia is the most common of all the hernias. They are common in men and women, but more common in men. There is a natural area of weakness in the groin as a result of the way your testicles or ovaries developed before you were born, but you can also acquire a weakness here through wear and tear. Left untreated, at best your symptoms will stay the same, though it is likely over time the hernia will get larger. There is a risk that without treatment you could experience serious complications from your hernia that require emergency surgery though this is uncommon.
Dr Adams performs both open and laparoscopic inguinal hernia repairs. During your consultation she can discuss the benefits and risks of each with you, and together you can select the best option.
You can read more about these procedures here:
Open inguinal hernia repair is usually performed under general anaesthetic though alternatives can be used in patients at high risk for anaesthetic. Surgery can be done as a day case or with a single night stay in hospital. A horizontal cut is made in the groin over the top of the hernia. The layers of the abdominal wall are opened to identify the hernia, and then any bowel or fat is put back into the abdominal cavity. The weakness is repaired using stitches and then a piece of mesh is secured to fortify the repair. Local anaesthetic is used to help with early post operative pain relief. Pain is normal after inguinal hernia repair but the severity varies from person to person. Painkillers will be provided to you on discharge. It takes some time for the mesh to become incorporated into your tissue and therefore for the repair to have any strength. You will need to avoid lifting anything heavy or performing other activities which strain your core abdominal muscles for four weeks following surgery.
This surgery requires general anaesthetic, and patients can be discharged the same day or stay for a single night in hospital. Three small 5-10mm cuts are made, one at the belly button and two below. A potential space is entered between the sac that covers your bowel (peritoneum) and the under surface of your abdominal wall. From here the hernia is identified, any fat or bowel within it put back where it belongs, and a piece of mesh used to cover the hole. Pain after laparoscopic hernia surgery is normal, but the severity varies from person to person. It is less painful than open surgery. Painkillers will be provided to you on discharge. Bruising of the scrotum is normal after surgery and gets better within 2 weeks. You will need to avoid lifting anything heavy for two weeks after surgery.
Femoral hernias are not common. They occur in the groin below the inguinal area, beside the major blood vessels to the leg. Hernias here are at higher risk of bowel becoming stuck in them requiring emergency surgery. For this reason, repair is usually recommended in a planned setting once the hernia presents. Similar to inguinal hernias they can be repaired open or keyhole.
Umbilical hernias are those occurring at the belly button or navel. There is a natural weakness here because as babies this was where our umbilical cord connected to our insides. This hole should close after birth however the muscles do not always seal completely leaving a weakness which can develop into a hernia with wear and tear. Umbilical hernias cause a lump with or without pain and can be embarrassing and unsightly. Usually by the time they start causing symptoms they will continue to do so, so repair is recommended.
Umbilical hernia repair is a relatively straightforward procedure during which the weak area is repaired using stiches and mesh. Mesh is a synthetic material used to fortify the repair and is required for all but tiny hernias. It decreases the risk of the hernia recurring. The surgery is performed open through a small incision around the bottom of your belly button under general anaesthetic. Surgery can usually be done as a day case though sometimes an overnight stay is needed. Some pain is expected but you will be given painkillers before going home. It takes some time for the mesh to become incorporated into your tissue and therefore for the repair to have any strength. For this reason Dr Adams will recommend you refrain from heavy lifting or other activities which strain your core abdominal muscles for four weeks following surgery.
Between the two vertical long muscles of the abdomen (the rectus or six pack muscles) is a fibrous area joining them called the linea alba. This can weaken and stretch with time (called divarication) or can develop a hole or hernia. Repair of an epigastric hernia is similar to an umbilical hernia
Incisional hernias occur through weak areas of scars from previous surgery. They can occur in anyone but are more common in patients who had serious wound infections after surgery or have poor healing due to medication or other health problems such as diabetes. Other risks are shared with non-incisional hernia types include chronic cough, heavy lifting, constipation and obesity. Repair can be performed open or keyhole, and always involves mesh. Depending on the size of the hernia, this can sometimes be major surgery. Recurrence of the hernia is a considerable risk. For this reason, usually only hernias causing significant symptoms are repaired.