Abdominal wall muscles

Hernias: A Pain in the Groin

What Exactly Is A Hernia?

Your abdominal cavity is surrounded by muscles which keep all the internal organs from falling out. In the back, the muscles of the spine are thick and strong but on the front the muscles are thinner. At the upper part of your abdomen, the diaphragm separates your abdomen from your chest.

You’d experience a hernia if there is a weakness or rupture of part of this muscular wall. Basically, a hole forms in the muscular wall of your abdomen.

Some of the contents of your abdomen may protrude through this hole. It can be some fat but it can also include your bowel.

Abdominal wall muscles
Abdominal wall muscles
Your Lump Is A Hole!

From the outside, you may see a lump but that lump is in fact a hole!

In the early stages, the lump may come and go. When you lie down, the contents return to your main abdominal cavity so the lump “disappears” only to return when you stand up or cough.

At a later stage, your lump may become stuck and remain visible even when you are lying down.

Hernias are more common in men and occur in the groin (called an “inguinal hernia”). An inguinal hernia starts as a lump in the groin but if large, it can fill the whole scrotum. It can also occur in a previous abdominal wound due to poor healing (incisional hernia). Other areas for hernias to appear include the umbilicus (umbilical hernia), lower groin (femoral hernia) or diaphragm (diaphragmatic hernia).

Inguinal (groin) hernia
Inguinal (groin) hernia
Are Hernias Dangerous?

Generally, no although they can cause discomfort and pain. If your bowel protrudes and gets trapped in the hernia, it may become obstructed. Your bowel will then swell and may go gangrenous if the blood supply is cut off. If that happens, it becomes a surgical emergency and needs an immediate operation to avoid rupture or perforation of the bowel.

Can Hernias Be Prevented?
Bowel protruding through a hernia in the abdominal muscles
Bowel protruding through a hernia in the abdominal muscles

Hernias are caused by excessive muscular straining which is associated with heavy lifting or persistent coughing.

Footballers often get a hernia. If you are overweight with weak abdominal muscles. you may be at risk of getting a hernia. If you have had previous abdominal surgery and the wound has not healed well, you may also get a hernia. Possible causes include previous wound infection, obesity and thin weak abdominal muscles (such as in the elderly).

  • Lose weight!
  • Avoid heavy lifting or strenuous activity
  • Keep your bowels regular, avoid constipation and straining too hard
  • Stop smoking! All smokers cough!
Treatment for Hernias

If you have a hernia, you need surgery to repair your hernia.

In the past, if you had a defect in your muscle, the surgeon would repair this defect with sutures or stitching. But this can lead to re-occurrence of your hernia if the sutures or stitches tear out of the muscle, especially if your muscles are weak to begin with.

You have a better option today.

As surgeons, we now use a special plastic mesh to cover up the hole and the mesh stays permanently.

Mesh repairs have a much higher success rate compared with the older method of using sutures. Scar tissue grows into the mesh (made from polypropylene, a sturdy and strong type of plastic) adhering the mesh firmly to your surrounding muscle. A skilful surgeon will have no problems inserting the mesh into the right place.

What’s even better is that the mesh can be inserted using laparoscopic surgery or keyhole surgery. We simply roll up the mesh and stick it in! This method results in faster healing, smaller scars and less pain.

If you come for a hernia surgery, I suggest you consider using laparoscopic surgery for your hernia repair.

Will My Hernia Come Back Again?

It is possible but not common for hernias to recur if a proper mesh repair has been done.

My own personal results was 1 case of recurrence out of a series of over 300 repairs – that is 99.7% success and only 0.3% recurrence.

Of course, if you get an inguinal hernia, you could still get a hernia on the other side if you continue to do heavy lifting or straining!