What is a hernia?

The abdominal wall is made up of 3 interwoven sheets of muscle. Although very strong, points of weakness do exist and, if stressed, these weak points may be torn open allowing a sac of the stomach lining (the peritoneum) to push through the defect. The “ hernial sac” may be empty or may contain part of the abdominal contents, commonly intestine.

The common sites for a hernia are;
  • The groin
    There are 2 types of groin hernia, the medical names are inguinal and femoral. The inguinal type are most common in males and tend to sit higher up in the groin. Femoral hernias are more commonly seen in women and tend to appear very low down in the groin. The latter can be more troublesome and should prompt early specialist advice.

  • The umbilicus
  • The midline of the abdomen above the umbilicus
  • In a previous surgical scar (“incisional hernias”)

Who develops a hernia?

Hernias are very common. In children and young adults, there is frequently a congenital (present from birth) weakness. The development of a hernia is promoted by stressing the abdominal wall, as in heavy lifting, straining in the toilet or a chronic cough.

What are the symptoms of a hernia?

Typically, an ache or discomfort is noticed when the hernia first appears, followed by the appearance of a swelling. The size of the swelling is dependent on the pressure in the abdomen and is usually more obvious on standing or after exertion. Commonly, the swelling is less apparent first thing in the morning but becomes more obvious during the day.

Are hernias dangerous?

Hernias in themselves do not threaten health but are associated with the risk of "strangulation". This is a rare but emergency situation in which part of an internal organ becomes trapped in the hernia, threatening its blood supply. The patient will feel great pain in the hernia and become rapidly unwell. Urgent medical advice should be sought.

Should my hernia be repaired?

Once a hernia has appeared, the abdominal pressure will always act to increase its size, a process which may occur over weeks or months. The only exception to this is that some umbilical hernias in small children may resolve spontaneously.

It is therefore generally recommended that hernias are repaired unless there is a serious medical condition directly preventing surgery. Increasing discomfort or inability to make the hernia go back inside may forewarn of strangulation and are indications for immediate repair.

Sportsman’s hernia (Sportsman’s groin, athletic pubalgia etc)

Groin pain afflicting sportsmen and women is a common and debilitating condition, particularly affecting runners and footballers. It covers a spectrum of conditions from “groin strain” to full-blown inguinal herniation. Diagnosis can be difficult and is usually based on clinical history and examination together with diagnostic ultrasound or MRI scanning. Treatment options include physiotherapy and steroid injection. Surgical intervention is a last resort.

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