Umbilical, abdominal wall and incisional hernia
A bulge around the navel, on the midline of the abdomen or over an old scar. Why it happens, when surgery is needed and what the repair options are.
Where do these hernias happen?
- Umbilical hernia: a bulge at or beside the navel. In adults it is more common with pregnancy, excess weight, a long-lasting cough or fluid in the abdomen.
- Epigastric hernia: a small bulge on the midline between the navel and the breastbone.
- Incisional hernia: a bulge over the scar of an earlier operation. The wall stays weaker at the cut and can give way months or years later.
An umbilical hernia in a baby is a different matter and often closes by itself. For a child, ask a paediatrician.
Signs
The bulge grows when you stand, cough or strain and shrinks when you lie down. It may be painless or may feel like a pull. The skin over a large hernia can become thin.
When is it urgent?
A hard, painful bulge that will not go back, a change in the colour of the skin over it, vomiting, severe bloating and no passing of wind or stool can mean the hernia is trapped. Go to the emergency department or call 115.
Is surgery needed?
These hernias do not heal by themselves. A hernia that hurts, grows or gets in the way of daily life is usually assessed for repair. A small hernia without symptoms is sometimes watched. The doctor weighs the size of the hernia, your other illnesses and the risk of surgery together.
What helps before surgery?
With abdominal wall hernias, smoking, excess weight and uncontrolled blood sugar raise the risk of wound infection and of the hernia coming back. If surgery is not urgent, the doctor may ask you to work on these first.
Ways to repair it
Small hernias are sometimes repaired with stitches, and the rest usually with mesh. The operation may be open or laparoscopic. An incisional hernia is more complex, because there is scar tissue and sometimes several weak spots side by side. The right method is decided after an examination and, if needed, a CT scan.
Risks and recovery
Risks include wound infection, fluid collecting under the skin, long-lasting pain and the hernia coming back. When you can return to activity depends on the size of the hernia and the method, and the doctor sets this for you.
The first step is a calm examination.
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