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What to Know About a Ventral Hernia

Medically Reviewed by Poonam Sachdev on August 25, 2022

Your abdominal muscles keep your organs and intestines in place. The protrusion of abdominal organs through a weak spot in the abdominal wall is called a hernia. Ventral hernias involve the front part of the abdominal walls and include umbilical, paraumbilical, epigastric, and incisional hernias. 

Ventral hernia symptoms can be mild and can persist for years. But the contents of a hernia can get trapped, or the blood supply can get blocked, creating dangerous and even life-threatening situations. The decisive treatment of a ventral hernia is surgery, but much depends on its size, location, and your health status.

What Is a Ventral Hernia?

A ventral hernia is the bulging of abdominal contents through the front of the abdominal wall. A hole or weakness in the muscles of your abdomen at the front allows the organs inside to bulge through. This bulging is a hernia, and it is usually occupied by a loop of the intestine or the omentum. 

The omentum is a sheet of fatty tissue that lies in front of the intestines and other organs inside the abdominal cavity. It is often pushed through any defects in the front abdominal wall since it lies close to it.  

Ventral Hernia Causes

Ventral hernias result from weakness of the abdominal wall or increased pressure within. Some reasons for a ventral hernia:

  • Heavy lifting
  • Abdominal injury
  • Obesity
  • Diabetes
  • Pregnancy
  • Long-term coughing or vomiting
  • Lung diseases like emphysema and chronic obstructive pulmonary disease
  • Straining while passing urine or stools
  • Earlier surgery
  • Weakness in the abdominal wall present since birth
  • Old age

Ventral Hernia Types

Ventral hernias are named according to their location. 

Umbilical hernia. The abdominal contents bulge through the umbilicus. These hernias are especially common in children and are usually present from birth. Umbilical hernias contain fatty tissue and only rarely have intestines in them. Such hernias can be painful, but strangulation is rare. They often close on their own by age 3.

Umbilical hernias can happen in adults, too. Some reasons are a long-standing cough, obesity, lifting heavy objects, and having twins or multiple pregnancies. These hernias get worse with time and may develop obstruction or strangulation.

Paraumbilical hernia. These are beside the belly button. They're common in overweight women and may contain intestines or omentum.

Epigastric hernia. These are above the belly button and below the breast bone. They're almost always in the midline.

Incisional hernia. These hernias appear where the abdominal wall is weakened by a previous cut for an operation. About a third of people who have had surgery on the abdomen develop an incisional hernia. The hernia may appear after several months or even years.

Ventral Hernia Symptoms

The early stages of a ventral hernia are often free from pain. You may notice a bulge under the skin that flattens when you lie down. The bulge can also be reduced by pushing against it.

Ventral hernias become painful later. You may feel pain when touching it, or when you strain to pass motions or are urinating. Discomfort may also be experienced when you are lifting a heavy object or sitting and standing for a long time. Severe pain might be due to complications like incarceration or strangulation. These are emergency situations. 

Ventral Hernia Diagnosis

If you feel a lump on your abdomen, you should talk to your doctor about it. They'll ask about any pain and whether the lump can be pushed back (reducible hernia). If it cannot be pushed back, it is an irreducible hernia.

Your doctor may ask you to stand and cough. This increases the pressure inside your abdomen and makes any hernia prominent. Your doctor can diagnose a hernia by examining you but may ask for an ultrasound to know the extent and contents of the hernia.

If your doctor suspects the lump may be a tumor or other growth, they may ask for a computed tomography scan (CT scan) to confirm the diagnosis.

Ventral Hernia Danger Signs

The opening in the abdominal wall allows the contents of the hernia to move in and out. The hernia becomes larger when standing or straining and reduces or flattens when you lie down. You can also push the swelling back in by hand. If the hernia becomes firm and painful to touch, it could be:

Obstructed hernia. A part of the intestines is trapped inside the hernia and has become blocked. The contents of the intestines can't move ahead. You can't pass gas or motions, and you may have severe pain, vomiting, and abdominal swelling.

Strangulated hernia. The blood supply of the intestines or omentum inside the hernia has been cut off. This can happen because of swelling of the organs trapped in the hernia. It leads to tissue death and needs emergency surgery to release the trapped tissue and restore its blood flow.

Obstructed hernia and strangulated hernia are emergency conditions. You must go to the hospital immediately for treatment.

Ventral Hernia Treatment

Most ventral hernias need surgery for complete treatment. The aim is to push the bulged intestines or fatty tissue back into the abdomen and strengthen the abdominal wall. Hernia repair can be done by open surgery or by laparoscopy. Most often, hernia surgery is done as a planned procedure a few weeks after the hernia is detected. Sometimes, if the hernia is obstructed or strangulated, surgery is done as an emergency.

Umbilical hernias present from birth are not treated like other ventral hernias. They rarely have intestines in them and do not strangulate. These hernias should only be repaired if they persist beyond age three.

Open surgery. Your surgeon makes an incision near the hernia and works the bulged tissue back into the abdomen. The muscles that gave way are stitched together to prevent it from happening again. A common alternative is to place a mesh of synthetic material to strengthen the area.

Laparoscopic surgery. Your surgeon makes several tiny incisions around the hernia. A slim tube with a lens and light allows them to see inside the abdomen and repair the hernia using tools inserted through the other cuts. 

Ventral hernias do not go away on their own and cannot be treated with medicine. Hernia surgery is often done as a planned procedure a few weeks after the hernia is detected. You should plan early surgery to prevent complications.

Your doctor will probably discharge you the day after the surgery. You may have constipation, difficulty in passing urine, shoulder pain, bruising at the operation site, and some swelling of the testicles. Your doctor will prescribe medicine to reduce pain. These effects usually last only a few days.

Recovery takes a few weeks. You should take a few days off from work and avoid strenuous activities. You should be able to return to your usual activities in two weeks.

Show Sources

SOURCES:

Agarwal, A. et al. Oxford Handbook of Clinical Surgery, Oxford University Press, 2021.

Cleveland Clinic: "Ventral Hernia."

John Hopkins Medicine: "Ventral (Abdominal) Hernia."

National Health Service: "Discharge Instruction following Hernia Repair Surgery," "Hernia," "Umbilical hernia repair," "Ventral hernia repair."

World Journal of Gastroenterology: "The omentum."

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