Hernia is a general term used to describe various types of protrusions of tissues and organs through the walls of the body cavities, which they are normally located inside. Predominantly, hernias occur in the abdominal area. These hernias are known as abdominal or visceral hernias and exist as several different types.

Abdominal hernia types are named after the part of the abdomen in which they occur. Therefore, we can differentiate groin hernias (inguinal and femoral type), hiatus (diaphragmatic hernia), umbilical, obturator and incisional hernias.

Other types of a hernia exist too. These include non-abdominal hernias such as a brain hernia, lumbar hernia, etc. Since these are far less common, this article will focus mainly on the highly prevalent abdominal hernia types.

In most cases, the appearance of an abdominal hernia is not considered to be an extremely serious or life-threatening condition. However, when complications occur, imminent surgical treatment is often required. 

Overview

In general, hernias affect men more often compared to women. Age groups in which hernias are most common are during the first year after birth and after the age of fifty. Even so, the risk of developing an abdominal hernia exists at any age and it depends on the factors such as obesity, chronic cough or constipation, exposure to heavy lifting, surgical interventions in the abdominal area, peritoneal dialysis, pregnancy, smoking, chronic obstructive pulmonary disease, and others.

Some types of a hernia are equally present in both men and women. This is the case with an umbilical hernia. Other types, like a groin hernia, are up to five times more common in men. This is due to the larger size of the men’s inguinal canal.

Abdominal hernias are often, but not always, easily visible as the unusual lump appears in the area where the protrusion of the abdominal wall has occurred. Usually, it is the fatty tissue that protrudes first and is later followed by an organ (colon, bowel, stomach, etc.). Pain and the feeling of discomfort are sometimes present as well.

Those hernias that do not present any symptoms (usually groin hernias) may not require surgical repair. However, this is truer in men than women because femoral hernias which are prone to serious complications are more common in women.

Sometimes, hernias can be treated with medications and certain lifestyle alterations (e.g. weight loss), but most require a surgical intervention. Any hernia-related complications, such as strangulation, have to be taken extremely seriously and treated promptly.

Types of an Abdominal Hernia

There are several common types of an abdominal hernia, named after the location in the abdominal wall at which the organ protrusion occurs. These are the groin, umbilical, incisional, obturator hernia, and hiatus (a diaphragmatic hernia).

Groin Hernia

This name refers to two types of a hernia which occur in the groin area. These are an inguinal and femoral hernia.

Inguinal Hernia

When tissue and organs protrude from the abdominal cavity through the inguinal canal, the inguinal hernia develops. Inguinal hernias account for three-quarters of all abdominal hernias. This type of a hernia is usually accompanied by symptoms which include a creation of the lump in the groin area, discomfort, and pain. An inguinal hernia is more common on the right than on the left side and can lead to intestine strangulation. Statistically, men are more likely to develop this type of a hernia. When needed, the treatment is surgical.

Femoral Hernia

This is not a very common type of a hernia and almost all cases develop in women. The reason is the larger width of the female pelvic area and therefore the femoral canal. When tissue or organs protrude through the femoral canal, a lump usually becomes visible in the groin area. Pain and discomfort can be, but are not necessarily present. Due to it being prone to complications, such as obstruction and strangulation of the intestines, the femoral hernia is often a subject of an urgent surgical operation.

Umbilical Hernia

A type of an abdominal hernia that develops in the umbilicus (belly button or navel) area is referred to as an umbilical hernia. Newborn babies are particularly prone to developing the umbilical hernia but obesity and multiple pregnancies are major risk factors too. The damage to the abdominal wall behind the naval can sometimes be significant but the risk of strangulation is usually low. Surgical repair is not always necessary as the condition, especially with young children, can resolve itself during the time.

Incisional Hernia

As its name suggests, the main cause for the development of this type of a hernia is the incomplete healing of a surgical incision. Main causes for slower than usual and incomplete healing of surgical wounds are infections, hematoma, persistent coughing, constipation, etc. Incisional hernias are fairly common and their appearance does not correlate with the size of the incision. Major trauma can also be the cause for an incisional hernia. The use of synthetic mesh during surgical repair of an incisional hernia is often needed to avoid recurrence. 

Obturator Hernia

This is a rare type of a hernia that usually occurs in women and it is characterized by the protrusion of the tissue or organs from the abdominal cavity to the leg through the obturator canal. Risk factors for its development are multiple pregnancies and a recent, significant loss of weight. Older women are more likely to develop an obturator hernia. The occurrence of pain in the medial thigh is common when a hernia is pressuring the obturator nerve.

Hiatus (Diaphragmatic Hernia)

The hiatus develops at the top of the abdomen when abdominal organs protrude into the chest area. With this type of a hernia the stomach slips under the diaphragm as a result of increased abdominal pressure caused by bending, heavy lifting, hard coughing, vomiting, etc. Other risk factors include major trauma, old age, and obesity. Multiple symptoms are usually present, the most common being the heartburn, acidic taste in the mouth (due to the Gastroesophageal Reflux Disease or GERD), chest pains, and trouble swallowing. Complications related to hiatus are bowel obstruction, anemia, strangulation, and others. Surgical treatment is rarely necessary as lifestyle alterations can significantly resolve most of the effects of a hiatal hernia.

Symptoms

Abdominal hernias are usually accompanied by symptoms that indicate the existence of damage to the abdominal wall. Different types of abdominal hernia will manifest differently.  However, there are some symptoms that most of the abdominal hernia types have in common.

The first and the most obvious of these is the lump or bulge appearing at the location on the abdominal wall where the protrusion of tissue or organs has occurred. Whether it is in the groin area (an inguinal and femoral hernia), belly button (an umbilical hernia), post-operative scar (an incisional hernia), or some other place in the abdomen, this unusual lump is most commonly the first tell-tale sign of an abdominal hernia.

These lumps differ in appearance depending on the size and nature of the protrusion. As the body position changes, some lumps may retreat back into the abdomen (e.g. when laying down) or become more prominent and uncomfortable (e.g. when bending over, lifting, etc.). Regardless of this, most lumps require the surgical repair of the abdominal wall to disappear completely. Certain hernias cannot be pushed back into the abdomen. These are called irreducible hernias and they are treated as a chronic condition.

Other symptoms of abdominal hernias are discomfort and pain. These are not always present, but rather depend on hernia-related complications. Discomfort is often associated with certain actions and positions which cause the abdominal hernia to be felt more or less. Pain can be a sign of problems with the organ that is compressed or trapped inside a hernia. The most common complication is strangulation.

Strangulation occurs when the bowel twists around itself and cuts off the blood supply or blocks the intestine. This is a very serious condition and needs to be managed urgently. When strangulation occurs, the general condition of the affected person deteriorates rapidly. Common symptoms of strangulation are vomiting, abdominal pain followed by bloating, constipation, bloody stool, and even fever. In all cases, emergency surgical intervention is needed to prevent a serious injury to the intestine.

Causes

Abdominal hernias can be congenital. This is often the case with umbilical hernias due to the fact that the intestine is developed outside of the abdominal cavity during the fetal stage. The incomplete formation of the abdominal wall can be a cause for other types of a congenital hernia, too.

When hernias are acquired, they develop as a combination of a weakness in the abdominal wall and the pressure inside the abdominal cavity. The pressure can be caused by several factors such as obesity, pregnancy, straining due to constipation, difficulties urinating (enlarged prostate), lifting heavy loads, chronic cough, violent vomiting, peritoneal dialysis, abdominal tumors, the excess of liquid inside the abdomen, trauma, and others. All of these causes can also worsen the condition of an existing hernia.

Smoking, poor nutrition, chronic pulmonary disease, cystic fibrosis, sudden weight gain, and abdominal surgery are also associated with the development of an abdominal hernia.

Diagnosis

The methods of diagnosing abdominal hernias differ depending on the type of a hernia. Physical examination might be enough to detect inguinal, incisional and umbilical hernias. This is because these types of a hernia tend to create clearly visible bulges or lumps.

Other diagnostic methods are used when there are no clearly visible signs of a hernia. Ultrasound and CT scan are used when a detailed look inside the abdominal cavity is necessary. Often this is the case with femoral and obturator hernias.

Diaphragmatic hernias or hiatus hernias are usually diagnosed with the use of barium x-ray or endoscopy. Endoscopy is usually performed by gastroenterologist when complications related to this type of a hernia, such as bleeding, ulcers, and esophagitis appear.

Treatment

The treatment for most types of abdominal hernias is surgical. Usually when there are no complications the treatment is not urgent. However, surgical repair of hernias is strongly recommended in order to avoid any possibility of serious complications such as strangulation and bowel obstruction.

The surgical repair of hernias can be laparoscopic or through open surgery. Laparoscopic repair of hernias significantly reduces the recovery period. When no complications are present, hernias are repaired by being pushed back into the abdominal cavity and suturing the opening in the abdominal wall. Sometimes the abdominal wall needs some strengthening and in those cases, the surgeons use a synthetic mesh to cover the defect in the tissue.

When complications such as strangulation occur, surgeons might need to evaluate the damage to the affected organ and remove a part of it. When the abdominal muscle is sutured without tension the chances of a hernia recurring are lower.

It is not uncommon that certain hernias, such as an umbilical hernia, are treated by providing a kind of external support (e.g. belts, trunks, etc.). However, these methods are not proven to work and their connection with certain complications (strangulation, infections, etc.) remains unclear.

Hiatus or a diaphragmatic hernia is a type of a hernia that is most often treated with medications when no complications are present. The therapy consists of closely following the condition and managing the symptoms of Gastroesophageal Reflux Disease (GERD).

Precautions

An abdominal hernia develops as a consequence of a weakness in the abdominal muscle. Although there is no certain way to prevent a hernia from occurring, there are certain precautionary measures that can be taken: 

• sustaining a normal body weight
• exercising
• not smoking
• avoiding the lifting of heavy loads and using proper techniques for lifting (knees not back)
• treating persistent cough
• eating balanced diet with adequate fiber to prevent constipation

When a hernia does appear it is important to understand that it will not heal on its own and that seeking help from a professional is strongly recommended in order to avoid possible life-threatening complications.

Final Word

Abdominal hernias affect men, women, and children. The condition can be acquired and/or congenital. Treatment is usually simple and outcomes are very positive. Life-threatening complications can easily be avoided if hernias are dealt with in a timely manner. After