Bulge on your abdomen could be hernia

By Dr. Jana Macleod

A hernia is an abnormal bulging of part of the intestines through an actual defect in the abdominal wall. Normally, the front of the abdomen has several layers made of skin, fat, and ligaments or fascia. In most parts the fascia is a tough layer of tissue that surrounds the muscle and keeps muscles in place as they contract and work.

Underneath all these lie the intestines (guts). If there is a weak point in the fascia, especially in areas where there is no muscle or weak muscle, part of the intestines can push through that defect. You can then feel a soft lump under the skin.

Hernias can occur because of surgery where the fascia was divided and even though it was sewn back properly by the surgeon, it is weaker and can develop a hole or defect. Even without surgery you can get a hernia. Hernias can cluster in some families and if someone in your family has it your risk is slightly higher of developing one but often there is no specific reason for the hernia. Obesity can also be a cause of a hernia.

Most often hernias occur in the groin area as this is where there lies a canal that passes through the abdominal wall and thereby allows passage of other contents as well. However, they can also be found at other sites such as next to the navel (belly button) or under an old operation scar (incisional hernia).

Synthetic patch

Hernias are not usually painful, but many people feel an ache over a hernia. Often they are noticed after a strain, for example, lifting a heavy object. The hernia can be pushed back, but may pop out after straining, such as coughing.

In time the hernia might become bigger as the gap in the fascia becomes larger. In groin hernias in men they can grow so large that they track down into the scrotum.

Hernias can be a serious ailment and therefore, treatment is usually advised for two reasons: They may gradually become bigger and more uncomfortable.

Secondly, there is a chance a hernia might strangulate. This happens when too much intestine has come through the gap or defect in the fascia and then it’s blood supply becomes squeezed and cut-off. This can be very serious because the intestine can in fact, die and you can become very sick.

This lack of blood supply to this portion of intestine in the hernia is detected by the person because of severe pain as a result of the damage to the intestines. These strangulated hernias are uncommon and require emergency surgery. It is better to have the hernia repaired routinely at your own convenience.

It is important that any conditions that cause abdominal strain, like a chronic cough due to smoking, or difficulties passing urine be dealt with before having hernia surgery if the hernia is repaired when it is not strangulated. This is because they may cause the hernia to recur after repair.

Hernias can be repaired by a small operation. The intestines organs are returned to the abdominal cavity. The surgeon then sews the fascia back together over the defect. The best repair is to use a synthetic patch that is placed over the defect and sewn in place. This patch reduces the chance the hernia will recur much better than sewing alone.

Newer techniques mean that people tend to be off work for much shorter periods than in the past. The first few days at home after surgery should be used to rest.

—The writer is the Chair, Department of Surgery, Aga Khan University Hospital, Nairobi.