Hernias: Consultant Q&A

A hernia happens when an internal organ or an area of fatty tissue pushes through a weakened muscle wall or connective tissue. There are various types of hernia. The most common is an inguinal hernia, which will affect around 27% of men and people assigned male at birth in their lifetimes. The figure is lower for those assigned female at birth, at just 3%.

So how do you know if you have a hernia? What are the signs and symptoms? Will you need treatment and if so, what is the most effective option? We spoke to three leading general surgeons, all with extensive experience of hernia surgery, to answer the most commonly asked questions about hernias.

The consultants

Mr Abhay Chopada is a consultant general surgeon practicing at Syon Clinic, The Clementine Churchill Hospital and The Bishops Wood Hospital.

Mr Nigel Suggett is a consultant general & colorectal surgeon practicing at The Priory Hospital.

Mr Adam Brooks is a consultant general surgeon practicing at The Park Hospital and The Lincoln Hospital.

What is a hernia?

Abhay Chopada: Hernia is simply a term that suggests an abnormal protrusion through a weak area. A hernia is most typically a lump in the groin or around the belly button, or around a surgical scar, which can usually be pushed back (reduced).

Nigel Suggett: A hernia is an abnormal protrusion of the contents of a body cavity through the wall of that body cavity. Put more simply it is a weakness or hole, usually of the abdomen or groin muscles, which allows the abdominal contents to bulge outwards.

Adam Brooks: A hernia is when part of the inside of the body, often the bowel, pushes through a defect in the muscle wall.

Are there different types of hernia?

Abhay Chopada: Hernias can be internal or external. External hernia include inguinal hernias, which are found in the groin, an umbilical hernia is around your belly button, and an incisional hernia is at or near the site of an incision, typically from a previous surgery. Internal hernias include a hiatus hernia (also known as a hiatal hernia), which involves your stomach moving through a gap (hiatus) in your diaphragm.

Nigel Suggett: There are many different types of hernia depending on location and cause. The most common hernias are in the groin (inguinal or femoral) and around the belly button (umbilical) but they also often occur through an old scar (incisional) or around a colostomy (parastomal). A hiatus hernia is a bit different and is internal involving the stomach.

Adam Brooks: There are many different types of abdominal hernia, but the commonest are groin (inguinal) hernias. Hernias around the umbilicus (umbilical hernias) are also very common.

What are the symptoms of a hernia?

Abhay Chopada: The main symptom of a hernia is usually a swelling which comes on during standing, straining or exercise. Usually, this swelling can be pushed back, but typically it will reappear later on during exertion or coughing. Some people may notice a discomfort or pain at the hernia site. On rare occasions the bowel may get stuck in a hernia and the patient may present with severe abdominal pain and vomiting (this is usually a surgical emergency).

Nigel Suggett: A hernia usually presents as a bulge, which increases on coughing or straining. Some are painful but not always and most can be pushed back in again. With a small hernia there may be pain but not an obvious bulge. Occasionally a hernia may 'strangulate'. This means that the contents swell and the hernia cannot be pushed back in. This is very painful and often requires urgent surgery.

Adam Brooks: Sometimes hernias cause no symptoms, but frequently you will see a bulge or swelling in the groin or around the tummy button which is worse towards the end of the day. Many people will complain of discomfort or a dragging sensation but acute pain, although an important symptom, is rare.

Who do hernias affect and how can I reduce the risk of getting one?

Abhay Chopada: Hernias can occur at any age from a newborn to the elderly. Groin hernias, especially indirect hernias, are due to a weakness that we may be born with. Whereas direct hernias are usually due to tissue weakness. Avoid excessive straining or weightlifting, especially as age advances. But remember that you often can't prevent a hernia.

Nigel Suggett: Hernias can affect anyone, although groin hernias (inguinal hernias), which are the most common type, are much more common in men. They can occur at any age from childhood to old age. Straining a lot, for example to open your bowels or to lift heavy weights, can increase the chance of a hernia, but usually only when there is already some weakness.

Adam Brooks: Hernias can affect anyone but are more common in men and in those where there is a history of hernias in the family. They are also more common in smokers. There is little you can do to reduce the risk of getting a hernia.

What treatments are available for a hernia?

Abhay Chopada: Hernias that are at a risk of complications like bowel obstruction are best repaired surgically, either with open surgery or keyhole surgery. It is best to get a qualified medical opinion if you suspect you have a hernia. Even if you think it is not causing significant symptoms or problems, you should always speak to a specialist to confirm this.

Nigel Suggett: Surgery is the only way of truly fixing a hernia. This usually involves closing the hole and reinforcing with surgical mesh, and may be done as an open procedure or via laparoscopic (keyhole) surgery. Which type of surgery you have will depend on your personal circumstances, on what type of hernia you have, and on the preferences of your surgeon.

Adam Brooks: Abdominal wall hernias can be repaired either by traditional open surgery or using keyhole surgery, during which three or so tiny holes are made into the abdominal wall. Through these we insert tiny surgical instruments as well as a camera, and the hernia is repaired using a synthetic mesh.

What are the benefits of having surgery for a hernia?

Abhay Chopada: Hernia surgery effectively repairs the hernia and strengthens the tissue surrounding it, usually with a mesh. This will prevent any future complications related to the hernia.

Nigel Suggett: Surgery will get rid of the bulge and associated pain and removes the risk of strangulation. For large abdominal hernias, bringing the muscles back together may also help with movement and posture.

Adam Brooks: Hernia surgery relieves the symptoms of the hernia, prevents it increasing in size and avoids acute pain or strangulation of the hernia.

What are the risks of having surgery for a hernia?

Abhay Chopada: Hernia repair surgery is very routine and usually risk free. The common problem following hernia surgery is usually some bruising and numbness in the area. Rarely there may be more pain or blood collection, though this is usually self-resolving. The surgery does not interfere with your sexual function.

Your surgeon will discuss your individual risk profile before surgery, so you'll be fully informed of the benefits and potential complications and whether it's the right choice for you.

Nigel Suggett: It all depends on the size of the hernia! Repair of small hernias is usually straightforward with few complications and a low recurrence rate, although some patients have some pain and numbness afterwards (typically this is temporary). Large incisional hernias can be much more complex, involving your bowel, and surgery to repair these may have more risks and a higher recurrence rate.

Adam Brooks: The risks of hernia surgery are very small. Like any operation on the abdomen there is a risk of bleeding or injury to the bowel and wound infection. About 1 hernia in 100 will recur after a repair.

Are there any alternatives to surgery?

Abhay Chopada: Small hernias, especially of the direct type, can be observed over time. Patients who cannot have surgery due to their poor health can sometimes benefit from a temporary truss whist they prepare for surgery.

Nigel Suggett: Although surgery is the only 'cure', where surgery is not advisable or wanted, a belt or truss may provide symptomatic relief. There may be a role for physiotherapy where there is not a true hernia but only a muscle weakness.