Is that bulge on your abdomen a hernia?

A hernia is an unusual bulge in the abdominal wall. Usually, it tends to ‘come and go.’

Most of the time, it is in the groin, umbilicus or at prior surgical sites. It is as a result of the contents of the abdomen sliding in and out through a hole (defect) in the abdominal wall. It can occur at any age and affects both genders.

Umbilical (belly button) hernia

These hernias are most common in children and pregnant women. In these cases, the belly button is large and appears to ‘pop out’ of the abdomen.

In pregnant women, it is due to the enlarging uterus which increases the pressures inside the abdomen. In most cases, umbilical hernias that develop in pregnancy return to normal after the birth of the baby. Children who have an umbilical hernia usually do not require surgical repair.

Most close on their own by the time the child is two years. Cases that persist longer than this (with no signs of getting smaller) need to be reviewed by a paediatric surgeon as they may require surgery.

Groin hernia

This is the most common adult hernia. It occurs as a swelling in the groin area. In males, the swelling can descend all the way into the scrotum. It thus presents with a swelling which seems to pop out when you strain (e.g. when coughing, bearing down in the toilet, lifting objects etc).

Most of the time, it goes back on its own. As it becomes larger, it can no longer go back into the abdomen. In such cases, it can be a great source of discomfort and embarrassment. Groin hernias can also occur in children.

Post-surgical hernia

When you undergo surgery, the doctor needs to cut through skin, muscle tissue and surrounding supportive (connective) tissue in order to get into your abdomen. In most cases, the wound heals well without further complications later in life. In some cases, however, the surgical site becomes an area of weakness which allows for the contents of the abdomen to come out through.

Internal hernia

These are inside the abdomen and are not visible. They, however, can cause heartburn, abdominal pain, excessive belching and a bitter taste in the mouth. This is particularly so if the hernia is around the stomach. Internal hernias around the stomach are medically known as ‘hiatus hernias’.

Who is at risk of getting a hernia?

Persistent cough: People with a constant cough e.g. smokers, untreated TB etc are at an increased risk of getting a hernia.

Obese people: Being overweight increases the pressure inside the belly which puts you at risk of getting hernias (especially at areas through which previous surgery has been done).

Pregnant women: This is true for umbilical hernias. Hernias can also develop a few months or years after a Caesarean section at the site of the surgery.

Fluid in the belly: Fluid can accumulate in the belly of people with liver, kidney or heart disease (medically known as ascites). This increases the risk of getting a hernia if you have a weakness in the abdominal wall.

Occupational hazards: Jobs in which you persistently lift heavy loads may put you at risk of getting a hernia.

Can I ignore it and hope it goes away on its own?

The answer is no. The only hernia that sometimes disappears with time is the belly button hernia. The rest only get bigger with time.

Can hernias get complications?

Yes, they can. Intestines can slide into a hernia and get trapped inside. In these cases, you get severe pain at the hernia site, you vomit, and get severe constipation (even gas is not passed). The blood supply to the intestines can get cut off causing them to rot. This is an emergency which needs urgent surgery.

How about a special belt to ‘push things in’?

Corsets or other special belts used to hold in the belly are no longer used in the treatment of hernias.

What are my treatment options?

Unfortunately, there is no medication or supplement which can cause your hernia to go back into your belly. The only treatment is surgery. The operation involves closing the hole in your abdomen through which the hernia is coming out and repairing the layers of the abdomen. The only exception is umbilical hernias which can resolve on their own as earlier described.

How about internal (hiatus) hernias?

Internal hernias are usually suspected from the symptoms you tell the doctor. If he/she feels you may be having an internal hernia, he/she will put a special camera known as a scope down your throat into your stomach.

Once inside, the hernia can be visualised. In most cases, medication is given to improve your symptoms. If you do not improve, the next option is surgery.