Is there a strange lump under your belly button? This could be a 'Spigelian Hernia'!

Do you feel a lump under your belly button, just to the side of your belly button, when you stand up? But when you lie down, it goes away. It may not even hurt when you touch it. Have you ever had something like this happen to you? This is not something to just ignore. Because even though it may seem like a small thing, sometimes it can turn into a serious condition. Today we are talking about a condition called 'Spigelian Hernia', which many people have not heard of, but is very important to know about.

What is Spigelian Hernia?

Simply put, this is a type of hernia. Think of it like the organs inside our abdomen, like the intestines, are protected by a strong wall made of muscle. We call this the abdominal wall. Sometimes, if there is a weakness in this wall, the pressure inside the abdomen causes a part of the intestines, or a piece of fatty tissue, to push through that weak spot. That's what we call a hernia.

A 'spigelian hernia' is a protrusion of the intestine through a specific weak spot in the muscles at the front of the abdomen. It usually occurs below the belly button, on the right or left side. Unlike other hernias, this one can sometimes be a little harder to spot because it's not visible from the outside.

What are the symptoms of this?

The main symptom in most cases is the lump or swelling that appears in the abdomen, as we mentioned earlier. However, this is not always visible. Some people may have this hernia without any symptoms.

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Why does a hernia like this form?

The main reason for this is the weakening of the muscles in the stomach. There are several reasons why these muscles can become weak.

• Aging: As we age, the muscles in our body naturally weaken.
• Pregnancy: During pregnancy, the muscles of the abdominal wall can become weak due to stretching.
• Injuries to the abdomen: If you suffer a hard blow to the abdomen or have an accident, the muscles can be damaged and a hernia can form.

Additionally, certain conditions that continuously increase pressure inside the abdomen also increase the risk of developing this hernia. Imagine what happens if you keep blowing air into a balloon. It's like that.

Things that increase intra-abdominal pressure:

• Persistent cough: A persistent cough, especially in people with conditions like COPD , often puts pressure on the abdominal muscles.
• Chronic constipation: Frequent, straining urination while going to the bathroom also increases abdominal pressure.
• Liver disease: Some liver diseases cause the abdomen to fill with fluid. We call this ascites . This is also a lot of pressure.
• Obesity: As body weight increases, the pressure on the abdominal wall increases.
• Heavy lifting: People who engage in jobs that require frequent heavy lifting are also at risk.

What are the potential complications?

Although it usually starts as a small, painless lump, there are three situations in which this hernia can become dangerous. It is very important to be aware of these.

1. Bowel Obstruction: The part of the intestine that came out of the hernia becomes blocked, preventing food and waste from passing through it.

2. Incarceration: A part of the intestine that has come out becomes stuck and cannot go back in. This can cause severe pain.

3. Strangulation: This is the most dangerous and urgent condition . If the blood vessels supplying blood to the blocked part of the intestine become constricted and the blood supply stops, that part of the intestine begins to die. We call this in medicine (mesenteric ischemia) . This is a life-threatening condition that requires emergency surgery.

If you suddenly have severe pain where your hernia is, if you can't get the knot back in, if it turns red or purple, or if you start vomiting, it could be an emergency.

How do you find this, Doctor?

When you go to see a doctor, he will first ask you a detailed question about your symptoms. Then he will examine your stomach.

• Physical examination: The doctor will ask you to stand, cough, or strain to see if the lump appears.
• Valsalva maneuver: This involves you holding your breath, closing your mouth and nose, and squeezing your stomach. Like you would when you go to the toilet. This increases the pressure in your stomach, which can make a hernia appear if you have one.
• Imaging Tests: Sometimes, if the hernia is not clearly visible, a CT scan (Computed Tomography scan) or an ultrasound scan may be recommended to confirm it.
• Laparoscopy: In some rare cases, a small incision in the abdomen may be made to confirm the diagnosis and a camera may be inserted to examine the inside of the abdomen.

What are you doing as treatment?

The best and most commonly used treatment for a Spigelian hernia is surgery , as this type of hernia does not heal on its own and carries the risk of the dangerous complications we discussed earlier.

During surgery, the part of the intestine that came out is put back into the abdomen and the weak spot or hole in the muscle is closed. Sometimes, something like mesh is used to strengthen the area.

This surgery can be done in several ways. Your surgeon will explain to you which method is best for you.