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Consultant Laparoscopic Colorectal and General Surgeon

Pre-surgery investigations

Types of hernia – how are they recognised?

Do you have a hernia?

“If your hernia is small, it pushes back into the abdomen easily and it causes you no discomfort, it is tempting to ignore it. This would be unwise; it is important that a hernia is assessed and treated promptly if necessary. Any hernia can become strangulated and this usually means a trip to casualty and emergency surgery. Strangulation occurs when the contents of the hernia become trapped and the blood supply is cut off, resulting in severe pain. If this situation is not fixed rapidly, the hernial contents can die, resulting in more major surgery, potential postoperative complications and prolonged recovery. On the other hand, planned surgery is often simple and is performed as a day-case procedure.”

Mr Jonathan Wilson specialises in laparoscopic hernia repair for all types of hernia, including groin and abdominal wall hernias.

Types of hernia: adult paraumbilical hernia

Types of hernia: adult paraumbilical hernia

Main types of hernia

  • A congenital hernia is present at birth.
  • Inguinal hernias are the most common type, which occur in the groin region. It is more common in men than in women. One in four men develop an inguinal hernia sometime during their life, while only three in 100 women are affected.
  • Incisional hernias can occur along the line of previous surgical scars due to poor knitting together of the tissues.
  • Femoral hernias are also in the groin region, but the bulge occurs lower than in inguinal hernias, in the crease where the upper leg meets the groin.
  • Umbilical hernias commonly occur in babies and young children around the navel. They rarely need treatment as the majority are resolved spontaneously early in childhood.
  • Paraumbilical hernias (see photograph) are the adult equivalent of an umbilical hernia where a crescent-shaped bulge develops in the navel.

Hernia symptoms

Abdominal hernias are more common in people who are overweight or obese, or who do a lot of heavy lifting. Some people will feel a hernia “pop” out or they may just notice one day that they have a small lump. When the lump is pressed or when lying flat, the hernia contents will often reduce and the lump will disappear, only to return again on standing or straining.

Some people have no other symptoms but others find they have a dull ache around the lump. This can worsen through the day, or after standing for a long time, and is often described as a “dragging” sensation in the lower abdomen and groin area.

Hernia complications

When a hernia has been present for many years, it may no longer disappear on pressing/lying. This is known as an incarcerated hernia.

If this happens acutely and is associated with severe pain, the blood supply to the intestine inside the hernia may have been cut off or strangulated.

If a strangulated bowel is ignored, the bowel will perish and perforate leading to peritonitis and this can have fatal consequences in some cases.

This is a medical emergency and often requires an assessment in the Emergency Department, followed by admission to hospital and immediate surgery to prevent the death of the section of bowel.

Are hernias common?

Some types are. Inguinal hernias, for example, account for 75% of all adult hernias and general surgeons carry out 70,000 hernia repair operations each year in the UK alone. Femoral hernias are also relatively common with between 3,000 and 4,000 repairs done each year in Britain.

Rare types of hernia include a spigelian hernia, an epigastric hernia (both on the abdominal wall) and an obturator hernia. This last one is very rare, affecting mainly women and occurring deep in the pelvis, where it can cause bowel obstruction.

Diagnosing a hernia

An inguinal, femoral, paraumbilical or incisional hernia is usually straightforward and is based on the history you provide to the doctor and on physical examination of the area. If the hernia is very small, or the patient is very overweight, the hernia may be difficult to feel and some further radiological tests may be necessary (eg. ultrasound).

What are my treatment options if I have a hernia?

Once your hernia diagnosis has been confirmed by your GP, you are usually referred to a specialist, who will discuss three possible options:

  • No treatment for the moment: this is usually only recommended when the hernia is very small and is causing no symptoms. It will be monitored carefully, and you will be advised of warning signs to look out for.
  • Open hernia repair surgery:?this is the traditional method, using an incision over the hernia. The intestine is put back into position and the gap in the muscles is stitched together, and may also be supported by a synthetic mesh for added strength.
  • Laparoscopic hernia repair surgery: this is the more favoured method today as recovery is quicker, patients experience less discomfort and little scarring. The results are just as good as for open surgery.

Please get in touch today to arrange an appointment here.