Abdominal Wall Hernias

What it is

A hernia is the passage of part of the abdominal contents — usually fat or a loop of intestine — through a weak point in the abdominal wall, forming a bulge under the skin. The most common types are inguinal (groin), femoral (more frequent in women), umbilical, epigastric (between the navel and the chest) and incisional (at a surgical scar). Pregnancy, physical strain, chronic cough, constipation, obesity and previous surgeries favor their development. The bulge usually increases when standing or straining and decreases when lying down; it can be painful or just bothersome. The risk is incarceration, when the contents become trapped, with intense pain and the need for emergency surgery. Diagnosis is clinical, with ultrasound when there is doubt, and treatment is surgical, with mesh, planned electively.

Most common symptoms

• A bulge in the groin, navel or a surgical scar
• Bulge that grows when standing, coughing or straining, and eases lying down
• Pain or a feeling of heaviness and burning at the site
• Discomfort that worsens through the day or after exertion
• Severe pain and an irreducible bulge, in hernia incarceration
• Nausea, vomiting and no passing of gas when the bowel is trapped

Causes and risk factors

• Natural or acquired weakness of the abdominal wall
• Pregnancy and childbirth
• Repeated physical strain and heavy lifting
• Chronic cough and constipation
• Obesity and rapid weight gain
• Scars from previous abdominal surgeries

How it is diagnosed

In most cases, the diagnosis is made during the consultation: the patient reports the bulge, and the surgeon identifies it on physical exam, standing and lying down, asking her to cough or strain to bring out the hernia and check whether its contents go back into the cavity. Abdominal wall ultrasound is ordered when there is doubt, in small hernias or in overweight patients. CT scans can be useful in large or complex incisional hernias, to plan the surgery.

How we treat it at Femi Saúde

A hernia does not resolve on its own, and treatment is surgical, planned electively to avoid incarceration. Small hernias without symptoms may be monitored, depending on the case. The general surgery team at Femi Saúde repairs the defect in the wall and reinforces it with mesh, by laparoscopy or open technique, depending on the type and size of the hernia, previous surgeries and the patient's condition. When diastasis recti is also present, both conditions can be treated in the same procedure. The plan is individualized, with guidance on managing weight, coughing and constipation, on the postoperative period and on gradually returning to activities.

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