Inguinal, Umbilical and Abdominal Wall Hernias: Symptoms and Treatment

What Is a Hernia?

The abdominal wall is a strong structure made up of muscle and connective tissue that surrounds the organs inside the abdomen. However, weaknesses — either congenital or acquired — can develop in certain areas of the abdominal wall.

When fatty tissue or organs from inside the abdomen protrude through such a weak area, this is called a hernia.

One of the most common sites for hernias is the groin. Hernias can also develop around the navel, at the incision sites of previous operations, or at other points of the abdominal wall.

The most common abdominal wall hernias include:

Inguinal (groin) hernia

Umbilical (navel) hernia

Epigastric hernia

Incisional hernia

In the treatment of hernias, many factors — including the patient’s age, complaints, and the size and location of the hernia — are evaluated together.

What Is an Inguinal Hernia?

An inguinal hernia occurs when tissue from inside the abdomen protrudes through a weak point in the groin area. It is more common in men than in women.

The swelling that appears in the groin may become more prominent when standing, coughing, straining or lifting heavy objects. When the patient lies down, the swelling may shrink or disappear completely.

Inguinal hernias can be classified into different groups according to their anatomical features, such as direct and indirect inguinal hernias. From the patient’s perspective, however, what matters more are the complaints the hernia causes, its size and the risk of complications.

What Are the Symptoms of an Inguinal Hernia?

Inguinal hernia symptoms can vary from person to person. The most common finding is swelling in the groin area.

In addition, there may be pain or discomfort in the groin, a feeling of pressure that increases after standing for long periods, pain that becomes more noticeable with coughing or straining, and a pulling sensation during physical activity.

Some small inguinal hernias may cause only pain or discomfort without any noticeable swelling.

Since groin pain has many different causes, not every groin pain should be assumed to be a hernia.

What Is an Umbilical Hernia?

An umbilical hernia occurs when tissue from inside the abdomen protrudes through a weak point in the abdominal wall around the navel.

Umbilical hernias in childhood and those that develop in adults are evaluated differently. In adults, umbilical hernias may be related to weight gain, pregnancy, increased intra-abdominal pressure and structural weaknesses of the abdominal wall.

Swelling around the navel is the most common symptom. While the hernia is small, it may be noticeable only when standing or straining. Over time it can grow and become permanently visible.

What Is an Incisional Hernia?

A hernia can develop over time at the incision site of a previous abdominal operation. This is called an incisional hernia.

Problems that occur while the abdominal wall heals after surgery can lead to weakness at the incision site. Wound infection, obesity, smoking, diabetes and conditions that increase intra-abdominal pressure can all influence the development of an incisional hernia.

Incisional hernias can be very small, or they can appear as complex hernias affecting a wide portion of the abdominal wall. For this reason, not every incisional hernia is treated with the same method.

Why Do Hernias Form?

In the development of a hernia, weakness of the abdominal wall and factors that increase intra-abdominal pressure usually play a role together. Genetic and connective tissue characteristics can predispose some people to hernias.

In addition, chronic cough, constipation and persistent straining, heavy physical activity, obesity, pregnancy and previous abdominal operations can contribute to hernia formation.

However, the idea that “heavy lifting is the sole cause of hernias” is not correct. Heavy lifting or sudden strain can contribute to making a pre-existing weakness apparent.

Do Hernias Go Away on Their Own?

An inguinal or abdominal wall hernia that develops in an adult does not close on its own. The size of the hernia and the complaints it causes may change over time, but the anatomical defect in the abdominal wall persists.

This does not mean that every hernia requires urgent surgery the moment it is diagnosed. In particular, for some inguinal hernias that cause no symptoms or only minimal complaints, watchful waiting may be considered depending on the patient’s characteristics.

That said, surgical treatment comes onto the agenda for hernias that cause pain, affect daily life, grow larger or carry a risk of complications.

When Does a Hernia Become Dangerous?

The bowel or fatty tissue inside the hernia sac can sometimes become trapped in the hernia opening. When the contents of the hernia cannot return into the abdomen, this is called an incarcerated hernia. If the blood supply of the trapped tissue is compromised, strangulation can develop. This situation may require urgent surgical evaluation.

If a hernia that previously moved in and out suddenly becomes hard, or if severe and constant pain, nausea and vomiting, abdominal bloating or cessation of bowel movements occur, medical attention should be sought without delay.

How Is a Hernia Diagnosed?

A significant proportion of inguinal and umbilical hernias can be diagnosed by physical examination. Evaluating the patient in both standing and lying positions, and examining the hernia area while the patient coughs or strains, helps establish the diagnosis.

However, not every hernia is easily seen on examination. Ultrasound can be used particularly for small or occult inguinal hernias. For incisional hernias or more complex abdominal wall hernias, computed tomography can be useful for surgical planning.

What Is the Treatment for a Hernia?

In adults, the treatment that permanently corrects the hernia defect in the abdominal wall is surgery. The main aim of hernia surgery is to return the herniated tissues to their proper anatomical position and to repair the weak area of the abdominal wall.

The operation can be performed as open hernia surgery or as closed/laparoscopic hernia surgery.

Which method is more suitable can vary depending on the location and size of the hernia, whether it is unilateral or bilateral, previous operations and the patient’s general characteristics.

How Is Inguinal Hernia Surgery Performed?

Inguinal hernia surgery can be performed using open or minimally invasive methods.

In open surgery, the hernia site is reached through an incision in the groin and the weak area of the abdominal wall is repaired. Today, synthetic mesh may be used to reinforce the repair in a large proportion of adult inguinal hernias.

In closed (laparoscopic) inguinal hernia operations, the hernia site in the abdominal wall is reached through small incisions with the aid of a camera. The most commonly used techniques in laparoscopic inguinal hernia repair are TEP and TAPP.

What Are TEP and TAPP?

TEP (Totally Extraperitoneal Repair) and TAPP (Transabdominal Preperitoneal Repair) are two different surgical approaches used in closed inguinal hernia operations.

In both methods, the aim is to reinforce the hernia opening in the groin with a wide mesh placed from the back side of the abdominal wall.

In the TAPP method, the abdominal cavity is entered and the area behind the peritoneum is accessed. In the TEP method, the work is done in the space between the peritoneum and the abdominal wall, without entering the abdominal cavity.

Each method has its own technical characteristics. Which method is used can be determined by the surgeon’s experience, the patient’s previous operations and the characteristics of the hernia.

Open or Laparoscopic Hernia Surgery?

One of the questions patients ask most often is: “Which is better — open or laparoscopic hernia surgery?” There is no single correct method for everyone.

Laparoscopic methods can offer advantages particularly for patients with bilateral inguinal hernias, or for some inguinal hernias that recur after previous open surgery. Smaller incisions, less pain in the early post-operative period and a quicker return to daily activities are among the potential advantages of minimally invasive surgery.

Conversely, open surgery may be more suitable for some patients. The patient’s age, anesthesia risk, previous operations and the anatomical features of the hernia are important in choosing the method.

Therefore, the best method is the one best suited to the individual patient and the characteristics of the hernia.

Is Mesh Necessary in Hernia Surgery?

Hernia mesh is a surgical material used to reinforce the weak area of the abdominal wall. Mesh repair is widely used today, particularly in the treatment of adult inguinal hernias.

Rather than closing the defect in the abdominal wall under tension with sutures alone, mesh allows a wider area to be supported.

However, the same mesh or the same surgical technique is not used for every hernia. The location and size of the hernia, the risk of infection and the patient’s characteristics all influence the choice of mesh and the method of placement.

How Is Umbilical Hernia Surgery Performed?

Umbilical hernia surgery can be performed with different techniques depending on the size of the hernia and the patient’s characteristics.

Some small umbilical hernias can be repaired with sutures, while in larger hernias the use of mesh may be considered to reduce the risk of recurrence.

As the size of the hernia increases, detailed assessment of the abdominal wall defect and the surrounding tissues becomes more important. In patients with obesity, weight status can also affect surgical planning and the risk of hernia recurrence.

How Are Large Abdominal Wall Hernias Treated?

Large incisional hernias and complex abdominal wall hernias may require a different approach from small inguinal or umbilical hernias.

In these patients the aim is not merely to close the hernia defect. The goal may be to reconstruct the functional anatomy of the abdominal wall as far as possible.

In some large hernias, advanced surgical techniques such as abdominal wall reconstruction and component separation can be used. For this reason, the surgical planning of complex abdominal wall hernias must be individualized.

Recovery After Hernia Surgery

Recovery time after hernia surgery varies according to the type of operation performed and the size of the hernia. The recovery process after a small inguinal hernia repair cannot be expected to be the same as after the repair of a large incisional hernia.

After inguinal hernia operations, most patients can walk and carry out basic daily activities in the early period. The time to return to a desk job and the time to return to heavy physical work can also differ.

Completely restricting movement after surgery is usually not necessary. However, for heavy exercise and activities that create high loads, the patient should follow the surgeon’s recommendations according to the type of operation performed.

Can a Hernia Come Back After Surgery?

The re-formation of a hernia in the same area after hernia surgery is called a recurrent hernia. Although modern surgical techniques have significantly reduced recurrence rates, no hernia operation can be said to carry zero risk of recurrence.

The size of the hernia, the surgical technique used, wound infection, obesity, smoking and the patient’s connective tissue characteristics can all affect the risk of recurrence.

For hernias that have been operated on before and have recurred, the method used in the first operation is particularly important when determining the new surgical approach.

Obesity and Abdominal Wall Hernias

Obesity is an important factor in the development and treatment of hernias, particularly umbilical and incisional hernias. Increased intra-abdominal pressure can contribute to hernia formation and to the risk of recurrence after surgery. Obesity must also be considered in terms of wound healing and surgical complications.

In patients with obesity and a large abdominal wall hernia, the timing of treatment and weight management should be planned individually. In some patients, losing weight before hernia surgery can help improve surgical outcomes.

What Should You Do If You Have an Inguinal or Umbilical Hernia?

Hernias are a very common general surgical problem, but they do not follow the same course in every patient. The treatment of a small, asymptomatic inguinal hernia is not the same as that of a large, painful incisional hernia.

For this reason, hernia treatment is not just a matter of asking “Is there a hernia?” The following questions must be evaluated together:

Where is the hernia?

How large is it?

What complaints is it causing the patient?

Has it been operated on before?

Is the open or the laparoscopic method more suitable?

Today there are various surgical options, including open hernia surgery, laparoscopic hernia surgery, TEP, TAPP and mesh repair. Choosing the right method should be done on an individual basis, evaluating the type of hernia and the patient’s characteristics.

Information Note

This content has been prepared for general information purposes. It is not a substitute for diagnosis or individual treatment advice. In hernia treatment, the surgical method should be determined based on the patient’s examination, the type of hernia and the patient’s individual health characteristics.

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