The word hernia is a general term that is used to describe a bulge or abnormal protrusion of the abdominal wall that increases in size on standing or coughing and may go away on lying down.

The most common area that is prone to a visible hernia is the lower abdomen/groin (inguinal and femoral hernia). This may give rise to a painful visible lump.

The most common internal hernia (the hernia is not visible) is a hiatus hernia.

The most common location for hernias is the groin (or inguinal) area. Several different types of hernia may occur in this region. These include inguinal and femoral hernias, which are defined by the location of the opening of the hernia from the abdomen to the groin. Other types of hernia include epigastric, umbilical, incisional, lumbar, internal, and spigelian hernias, which occur at different sites over the abdomen.

With the exception of internal hernias (within the abdomen), these hernias are commonly recognized as a lump or swelling and are often associated with pain or discomfort at the site. Sometimes a hernia can form under the scar of an operation, in which case it is called an incisional hernia.

A lump or bulge is a common symptom of a hernia. However, not all lumps or swellings on the abdominal wall or in the groin are due to hernias. Your doctor or specialist should evaluate any such swelling.

Other possible causes of lumps and swellings include growths or enlarged lymph nodes. These problems require entirely different types of evaluation and treatment.

Inguinal hernias are somewhat more likely to develop on both sides. This is probably because the structural elements develop symmetrically and the stresses that occur over time are similar. When a patient becomes aware of a groin swelling on one side, examination by a doctor will often identify a small hernia on the opposite side.

Since genetics plays a role in passing on features and structure, there is a risk of inheriting the anatomical features that may predispose to a hernia.

There may also be inherited factors that result in tissue weakness, which ultimately speed up the deterioration of the supporting structures and leads to the formation of a hernia. However, this does mean that the sons or daughters of an individual with a hernia will automatically also develop a similar hernia. Other factors such as weight, fitness level and general health may also be factors and will be different for every individual.

Although some hernias may be present at birth (inguinal, umbilical hernia and hiatus hernia), the majority develop later in life. Some develop along pathways formed during foetal development, existing openings in the abdominal cavity, or areas of abdominal wall weakness.

Any condition that increases the pressure of the abdominal cavity may contribute to the formation or worsening of a hernia. This includes obesity, heavy lifting, chronic coughing and repeated straining during a bowel motion or when passing water. Other causes include fluid in the abdominal cavity (ascites) and previous surgery which may weaken an area. A family history of hernias can make you more likely to develop a hernia.

Trusses have previously been used to be used to keep the hernia in place. However, we now realise that for most patients, a repair is a much better long-term solution.

Most modern types of hernia repairs involve placement of a plastic mesh in the area of the hernia. The mesh strengthens the tissue surrounding the hernia and closes off the separation so that tissues can no longer push their way through. Most inguinal, femoral and umbilical hernia operations take less than one hour. Many can be repaired under local anaesthetic and many if not most, can be repaired using keyhole surgery techniques. Recovery is usually very swift for most patients.

Some types or hernia do not require surgery e.g. uncomplicated hiatus hernia. Hernias that are at risk for complications, cause pain, or limit activity, should be repaired. If they are not repaired, there is a risk that an emergency procedure may be required at a later date. This can be particularly difficult if timing is an issue around personal plans or during foreign travel.

In general terms, if you are fit enough fit surgery we generally recommend surgery, especially for femoral, inguinal and umbilical hernias. Most incisional hernias should also be fixed. However, for some patients, the risks of surgery are greater than the risk posed by the hernia. This is especially so for large hernia s in patients who have a number of medical problems. Such patients are possibly best advised to avoid surgery if possible.

In most cases a hernia is simply a painful nuisance. However, there is a danger that the bowel or fatty tissue that is present within the hernia becomes trapped. This can lead to strangulation of the tissues and would require emergency surgery for a strangulated hernia.

Unfortunately, for most patients, it is usually not possible to prevent a hernia developing. However, given that we feel that increasing weight may be a factor in the development of some hernias, it is best to avoid becoming overweight. If you have to lift heavy items, then make sure you do so correctly, by bending your knees and keeping your back straight.

Fortunately, a repair of a recurrent hernia is possible in most patients. With inguinal hernias, a laparoscopic or keyhole repair is very much the preferred method as the new repair is behind the muscle and old operation site. It allows the surgeon to avoid scarring and inflammation around the old operation sire.

It is interesting that many patients tell us that a laparoscopic repair for a recurrent hernia is often less sore and associated with a faster recovery compared to their original operation.

Yes, Scottish Hernia Centre surgeons perform many hernia operations each year and specialise in laparoscopic/keyhole surgery. They regularly perform laparoscopic repair in patients who have developed recurrent hernias, having had their first operation elsewhere.

Most hernias do not give rise to symptoms such as pain. The main problem is the swelling and concern regarding the risk of strangulation. In general terms, a hernia will not go away and will only get bigger in time. Our advice is to strongly consider repair if you are reasonably fit/healthy.