That Bulge Isn’t Normal: Understanding Hernias and When to Act

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Dr Maré du Plessis, a specialist surgeon based at Mediclinic Milnerton, shares what you need to know about hernias

As well as potential treatment. A hernia occurs when an organ or fatty tissue pushes through a weak area or tear in the surrounding muscle or connective tissue of the abdominal wall.

While some hernias can be monitored, surgery is the only effective treatment. Watchful waiting is only recommended in specific, low-risk cases. If you suspect you have a hernia or if a known hernia suddenly becomes painful, seek immediate medical attention,” says Dr du Plessis.

There are different types of hernias

The most common type is an inguinal hernia. This typically presents as a bulge in the groin or scrotum and develops when a weakness in the abdominal wall allows tissue from inside the abdomen to protrude into the inguinal canal.

A femoral hernia also occurs in the groin region but it develops in the femoral canal, to the side of the femoral vein and artery, and is less common than an inguinal hernia. Other hernias include umbilical and hiatal hernias, incisional hernias and ventral hernias.

What does having a hernia feel like?

• Discomfort. Many people experience a bulge in the abdomen or groin that can cause a feeling of pressure, a dull ache, or a pinching sensation, especially when straining, lifting, or coughing. This can become painful.
• Progressive worsening: Without treatment, hernias tend to enlarge over time. The opening continues to stretch and weaken, making complications more likely.
• Impact on daily life: Depending on the size and location, a hernia can interfere with normal activities, causing pain during exercise, walking, or even bowel movements.

How do you know it has reached emergency levels?

• A hernia becomes a serious medical emergency when it becomes incarcerated or strangulated.
• Incarcerated hernia: This is when the herniated tissue, often a piece of the bowel, becomes trapped in the abdominal wall and cannot be pushed back into place.
• Strangulated hernia: If an incarcerated hernia's blood supply is cut off, the tissue can die. This requires immediate surgery. 

Symptoms of a strangulated hernia include:

• Sudden, severe, and worsening pain at the hernia site.
• A hernia bulge that becomes red, purple, or dark.
• Nausea and vomiting.
• Fever and a racing heart rate.
• An inability to have a bowel movement or pass gas.

Dr Du Plessis reiterates: “A patient may say ‘It doesn’t really bother me and I don’t have any discomfort,’ but we would still recommend repair. Evidence shows that hernias which are initially asymptomatic are likely, over time, to become symptomatic and begin to cause problems for the patient.”

Dr Du Plessis performs a wide range of routine and emergency surgeries, including for conditions of the gastrointestinal tract, and hernia repairs. At his rooms he has a private endoscopy suite for colonoscopy and gastroscopy procedures.