Why does it appear
The basis of the problem is a combination of congenital weakness of connective tissue and increased pressure inside the abdomen. The tendon fibers of the white line diverge, and first the fatty tissue protrudes into the resulting defect, and then the organs. This is provoked by heavy lifting, straining work, severe cough with chronic bronchitis, constipation, difficulty urinating with prostate adenoma, obesity and pregnancy. Separately, postoperative hernias that occur in the scar area are distinguished. An extended linea alba is often combined with diastasis recti, and then the surgical plan changes.
- Hereditary weakness of connective tissue
- Lifting weights and straining
- Obesity
- Pregnancy and childbirth
- Chronic cough and constipation
- Postoperative scars
- Concomitant diastasis of the rectus muscles
How it manifests itself
Often the first sign is a firm, round formation in the midline of the abdomen, usually above the navel, ranging in size from a pea to several centimeters. It is more noticeable in a standing position and with abdominal tension, and may disappear while lying down. Many people are bothered by a pulling or stabbing pain in the upper abdomen, which intensifies with exercise, coughing and after eating. Sometimes the pain appears before the protrusion becomes noticeable, and it is mistaken for stomach problems. Small hernias with strangulated fat are more painful than large ones.
- Lump in the midline of the abdomen
- Increased with straining and standing
- Nagging pain in the upper abdomen
- Discomfort after eating and during exercise
- Sometimes pain without visible protrusion
- Possible combination of several defects
Why is it dangerous?
The main risk is strangulation, when the contents of the hernial sac are compressed in the narrow hernial orifice and its blood supply is disrupted. Fatty tissue, omentum, or a loop of intestine can be pinched. In the latter case, intestinal obstruction develops and, if surgery is not performed, intestinal necrosis and peritonitis. Infringement is manifested by sudden sharp pain, irreducible protrusion, nausea and vomiting. This condition requires immediate surgery, so it is impossible to forcefully reduce the hernia at home. Over time, the hernia enlarges, and elective surgery becomes more difficult than at an early stage.
- Strangulation of the contents of the hernia
- Intestinal obstruction
- Necrosis of the strangulated organ and peritonitis
- Gradual increase in defect
- A more complex operation for advanced hernia
Diagnostics
Usually, an examination by a surgeon is sufficient: the doctor palpates the midline of the abdomen while standing and lying down, asks to tense the abs and cough, assesses the size of the hernial orifice and reducibility. Ultrasound of the soft tissues of the abdominal wall clarifies the size of the defect, its contents and helps to find additional hernias that are not visible to the eye. For large and incisional hernias, a CT scan is performed to plan the operation. Before the intervention, a standard preoperative set of tests, an ECG and examination by a therapist are prescribed, and in case of stomach complaints, a gastroscopy is prescribed.
- Examination and palpation by a surgeon
- Ultrasound of soft tissues of the abdominal wall
- Computed tomography for large hernias
- Preoperative tests and ECG
- Gastroscopy for epigastric pain
Surgery and recovery
The only radical treatment method is surgery. Small defects in young people are sometimes repaired with their own tissue, but more often a mesh implant is installed, which strengthens the abdominal wall and significantly reduces the risk of a recurrent hernia. The intervention can be performed using open access or laparoscopically. If there is diastasis of the rectus muscles, the surgeon discusses simultaneous plastic surgery, otherwise relapse is more likely. After the operation, lifting weights is limited for about a month and a half, it is recommended to normalize weight, treat cough and constipation. The bandage does not treat a hernia and is used only temporarily as prescribed by a doctor.
- Hernioplasty with mesh implant
- Plastic surgery with your own tissues for small defects
- Open or laparoscopic approach
- Simultaneous correction of diastasis if necessary
- Limiting exercise for 4–6 weeks
- Weight loss, treatment of cough and constipation
- Bandage is a temporary measure, not a cure.
