What is a hernia?
Hernias are protrusions of abdominal contents (fat or intestines) through a weakness in the abdominal wall (muscles and fascia) and present as a bulge or swelling. There are many types of hernias but the most common is the inguinal hernia at the groin area.
What causes it?
Most hernias are caused by a combination of intra-abdominal pressure and an opening or weakness in the abdominal wall. The pressure pushes an organ or tissue through the opening or weak spot over time. Sometimes the muscle weakness is present at birth; more often, it occurs later in life.
Anything that causes an increase in pressure in the abdomen especially sudden or frequent increases in intra-abdominal pressure can cause a hernia, these include -
- Lifting heavy objects without stabilizing the abdominal muscles
- Chronic constipation
- Persistent coughing or sneezing
- Weakness in the abdominal muscles/ fascia after surgery and/or contributed by poor healing
- Weakening of our muscles and fascia with age
- Obesity, poor nutrition and smoking can all weaken muscles and make hernias more likely
Hernias may become more apparent or bigger when the patient is standing or straining and it may disappear when lying down. It may also be associated with discomfort, a pulling or a heavy sensation and pain.
If left untreated, hernias may become irreducible and obstructed or strangulated. This happens when the blood supply to the contents of the hernia e.g. intestines, is cut off by the narrow opening of the hernia sac (neck). If left untreated, the patient will become very ill and the condition is potentially fatal as the intestines within can die.
If you suspect you have a hernia, or you have an abnormal swelling/bulge, pain or discomfort in the groin, it is advisable to consult a surgeon. You may be advised to undergo surgery to prevent potential complications.
Once a hernia form, it will not heal by itself. Surgery can be performed to repair a hernia, and to prevent complications such as strangulation or obstruction from occurring.
Surgery involves returning the abdominal contents to the abdominal cavity, and reinforcing the weakened area of the abdominal wall. This is usually done with the insertion of a mesh over the weakened area. The mesh provides the scaffolding for the body to form strong scar tissue in the region in where it is placed and strengthens the abdominal wall in that region. There are different types and sizes of mesh and your surgeon will choose the most suitable one depending on the size and type of hernia you have.
- Laparoscopic Approaches
- Traditional (Open)
Laparoscopic techniques can result in less pain and smaller scars and may be beneficial in certain situations e.g. bilateral inguinal hernia; but not all hernias are suitable for laparoscopic approaches.
Open approaches may still be recommended and may be better in certain situations where laparoscopic approaches are not ideal e.g. large, chronic hernias.
The hernia repair can be done under general anaesthesia, or under regional anaesthesia.
How long will I take to recover?
In fit, young patients with no significant medical problems, the surgery can be performed as day surgery. Elderly patients or patients with more serious medical problems may require admission and may need to stay a day or two after surgery to recover.
After surgery, you may feel some numbness over the inner thigh (if surgery is performed for an inguinal hernia) and some tightness over the region of the surgery. This is due to the fibrosis and scarring that is taking place. This will mostly resolve over a few weeks.
You will be advised to refrain from carrying heavy loads and strenuous activities during the immediate post-operative period to allow healing to occur and to minimise recurrences; but you may gradually return to carrying loads and normal activities after a few weeks.
Other Common Hernias
Paraumbilical hernias are hernias that develop next to the belly-button(umbilicus). They usually present as enlarging lumps or bulges that are more prominent when standing or straining. They can also become incarcerated and cause pain.
lncisional hernias occur when the muscle and fascia layer underneath surgery scars become weak over time and/or contributed by poor healing e.g. wound infection. They can occur at various parts of the abdomen that have undergone abdominal surgery.
Femoral hernias occur when the intestine or fat enters the canal carrying the femoral vessels into the upper thigh, near the lower groin-inner thigh area. Femoral hernias are more common in women, especially in older, thin women.
If you suspect you have a hernia, consult your surgeon, or make an appointment with our hernia specialists at Surgical Associates.
Senior Consultant Hepatopancreatobiliary Surgeon
MBBS, MMed (Surgery), MSc, FAMS, FRCSEd
Prior to private practice, Dr Lee Ser Yee was a founding member and Senior Consultant at the
Hepatopancreatobiliary (HPB) and Transplant Surgery at Singapore General Hospital (SGH). He
served as the
Director of the Laparoscopic programme and the Director of the Surgical Skills Training Program
SingHealth Surgical Skills Centre.
He started his medical training at the National University of Singapore in 1996 and completed his training in General Surgery, HPB surgery and Liver Transplantation at SGH and National Cancer Centre, Singapore.
He also completed dual USA-fellowships in Advanced Laparoscopic HPB surgery and Liver Transplantation under Professor Daniel Cherqui at the New York Presbyterian Hospital-Weill Cornell Medical Center and a Complex Surgical Oncology clinical fellowship at Memorial Sloan Kettering Cancer Center in New York.
Senior Consultant Colorectal Surgeon
MBBS, MMed (Surgery), FAMS, FRCSEd
Dr Tan Wah Siew was senior consultant surgeon at the Department of Colorectal Surgery, Singapore
Hospital (SGH) prior to her move to private practice. She was the first female
consultant colorectal surgeon in
the history of SGH, and was one of the earliest female surgeons in Singapore to be trained in
She graduated from the Faculty of Medicine, National University of Singapore in 2003 and completed her Advanced Surgical Training in General and Colorectal Surgery at SGH in 2011. In 2013, she completed a one year Ministry of Health sponsored Healthcare Manpower Development Plan Fellowship (HMDP) at St. James University Hospital in Leeds, United Kingdom. While there, she trained in minimally invasive and robotic colorectal surgery for colorectal cancer, surgery for inflammatory bowel disease as well as treatment of locally advanced rectal cancers and recurrent pelvic cancers requiring removal of multiple organs and/or pelvic exenterations.