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An abdominal wall hernia is a protrusion of the intestine through an opening or area of weakness in the abdominal wall.
Abdominal hernias are very common, particularly among men. There are about 700,000 hernia operations each year in the United States. Hernias are usually named for the area in which they occur.
The abdominal wall is thick and tough in most places, so hernias usually occur in an area of weakness where a previous opening has closed. Heavy lifting or straining may make a hernia more obvious but does not cause a hernia to form.
Inguinal Hernia:
Inguinal hernias appear in the crease of the groin or in the scrotum. They are more common among men. There are two types, direct and indirect, depending on exactly where the hernia occurs.
Umbilical Hernia:
Umbilical hernias occur around the bellybutton (umbilicus). Many babies have a small umbilical hernia because the opening for the umbilical cord blood vessels did not close completely. Some adults have an umbilical hernia because of obesity, pregnancy, or excess fluid in the abdomen (ascites).
Femoral Hernia:
A hernia may develop just below the crease of the groin in the middle of the thigh where the femoral artery and vein leave the abdomen to go into the leg. This type of hernia is more common among women.
Incisional Hernia:
Sometimes hernias form through a surgical incision in the abdominal wall. This type of hernia may develop many years after surgery.
Incarceration and Strangulation:
Sometimes, a loop of intestine becomes stuck in the hernia, a condition called incarceration. Rarely, the hernia traps the intestine so tightly that it cuts off the blood supply, a condition called strangulation. With strangulation, the trapped piece of intestine can develop gangrene in as few as 6 hours. With gangrene, the intestinal wall dies, usually causing rupture, which leads to peritonitis (inflammation and usually infection of the abdominal cavity), shock, and, if untreated, death.
Symptoms
Most people usually notice only a bulge at the site of the hernia. Sometimes the hernia appears only with lifting, coughing, or straining. There is usually little or no discomfort, and the bulge can be pushed back in (reduced) by the person or a doctor. An incarcerated hernia has no additional symptoms, but the bulge cannot be reduced. A strangulated hernia causes steady, gradually increasing pain, typically with nausea and vomiting, cannot be reduced, and is tender when touched.
Diagnosis
Doctors base the diagnosis on an examination. Lumps in the groin that resemble hernias may be swollen lymph nodes or undescended testes. A swelling in the scrotum may be a varicocele (a condition in which the blood supply of the testis develops varicose veins) or a spermatocele (a collection of sperm in a sac that develops next to the epididymis). Sometimes the doctor performs an ultrasound to help make the diagnosis.
Treatment
Umbilical hernias in infants rarely strangulate and are not treated. Most go away without treatment within several years. Very large umbilical hernias may be repaired after the infant is 2 years old.
Because other types of hernias are more likely to strangulate, doctors usually repair them surgically when they are diagnosed. If the hernia is incarcerated or strangulated, surgery is performed immediately. Otherwise, repair is done at a time convenient for the person (elective surgery).
Holding the hernia in by tape, bandages, or other means sometimes makes the person more comfortable but does not lower the risk of strangulation or allow the opening to close; therefore, these are not recommended treatments. Only umbilical hernias go away without treatment.
Last full review/revision September 2007 by Parswa Ansari, MD
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