Is there a lump in the front of your stomach? Is this a 'ventral hernia'?

Have you ever felt a lump in the front of your stomach that bulges out and then slides back in? You may notice it when you laugh, cough, lift something heavy, or go to the bathroom. Many people think this is normal and ignore it. But it could be a sign of a condition called a ventral hernia . Don't worry, we'll keep everything simple.

What is a ventral hernia?

Simply put, this is when an organ (such as the intestine) or tissue inside the abdomen pushes out through the abdominal muscles. The word 'ventral' means 'front' or 'area around the stomach'.

Think of our abdominal muscles as a strong wall. Inside this wall, organs like our intestines are safely housed. If for some reason, this wall becomes weak somewhere, a hole forms. Then, due to the pressure inside the abdomen, those organs are pushed out through that hole. That's what we call a hernia.

What are the main types of ventral hernias?

These hernias can be divided into several main types depending on where they occur. These are the ones we see most often.

What are the symptoms of this?

The first and most obvious sign of a ventral hernia is a bulge or lump that protrudes from somewhere in the front of the abdomen. This may not always be visible. It may only become visible when the abdominal muscles are strained during certain activities. For example:

• While laughing
• When crying
• When coughing
• When the crocodile goes
• When trying to go to the toilet
• When leaning forward
• When lifting a weight
• When exercising

Some people can feel the hernia. It may feel like a slight pulling, aching, or a sharp pain as it comes out, pulling , or pushing. A hernia that hurts is a sign that it is getting bigger and is at risk of becoming incarcerated when it comes out.

Sometimes, when a hernia causes complications, symptoms such as these may also occur:

• Nausea and vomiting
• Redness or a rash at the hernia site
• Severe pain

What are the causes of ventral hernia?

A hernia is caused by a weakness in the muscles or tissues. This weakness can occur for a variety of reasons. Sometimes it is something that is present at birth. Other times it can be caused by something like an accident or surgery. Sometimes it can be caused by a gradual weakening over time.

Here are some common reasons:

• Congenital weaknesses: Some babies may be born with weak spots in the abdominal wall (e.g., umbilical hernia).
• Chronic obesity: As body weight increases, the abdominal muscles are constantly under pressure, which can weaken them.
• Injuries to the stomach: Damage to the stomach muscles due to an accident.
• Abdominal surgery: If the incision does not heal properly after surgery or if the muscles in that area become weak.
• Pregnancy and childbirth: During pregnancy, the abdominal muscles can become weak due to stretching.
• Persistent cough: Continuous coughing due to medical conditions like asthma and COPD can put a lot of pressure on the stomach.
• Chronic constipation: Frequent urges to go to the bathroom also increase pressure in the abdomen.
• Weight lifting: People who work in jobs that require frequent lifting or pushing are also at risk.
• Aging: Muscles naturally weaken as we age.

Can this be dangerous? What are the complications?

Yes, some hernias can be dangerous if left untreated. Many hernias will come out and go back in. But as they do, the tissue around the hole weakens. Over time, the hole gets bigger, and the hernia gets bigger. That's when complications start to occur.

There are two main complications:

1. Incarceration: Imagine, the part of the intestine that came out cannot go back in and gets stuck in that hole. This is called 'incarceration'. When this happens, the intestine can become blocked. It can cause severe pain and vomiting.

2. Loss of blood supply (Strangulation): This is the most dangerous and urgent situation . The blood supply to the strangulated part of the intestine can be completely cut off. Then the tissue starts to die. This can be a life-threatening situation. If you experience symptoms such as severe pain, fever, and discoloration of the hernia, you should immediately go to the emergency room (ETU) of a hospital.

How does a doctor find this?

When you go to the doctor, he will first ask you about your symptoms. Then he will make you lie down on a bed and examine your stomach.

• They will ask you to cough and pretend to lift a weight to see if the tumor will come out.
• They also check to see if it can be pushed back in by hand. This is called a 'reducible' hernia. If it cannot be pushed back in, it is an 'irreducible' hernia.
• Sometimes, an ultrasound scan , CT scan , or MRI may be ordered to confirm the diagnosis.

Does every hernia require surgery?

Most ventral hernias will eventually require surgery. But it may not be an emergency. A small hernia that is asymptomatic and can be easily retracted is not a major risk.

But remember, hernias get worse over time, and they don't heal on their own. So it's best to have them repaired before they get bigger and cause complications. An elective surgery is always safer than an emergency surgery.

A doctor may recommend surgery for you in the following cases:

• If the hernia cannot be pushed in by hand.
• If you have symptoms like constant pain .
• If it's big enough to get stuck .
• If your overall health condition allows for surgery.

What are the surgical methods?

The main goal of surgery is to close the hole in the abdominal wall and strengthen the area so that a hernia cannot occur again. There are three main methods for this.

What is a 'mesh' used during an operation?

When repairing a hernia, a special mesh is used to strengthen the weakened muscles. This is similar to closing a hole in a wall and applying a plaster to strengthen the area. This greatly reduces the risk of a hernia occurring again in the same area.

Not all hernias require mesh. Small hernias may not require mesh. However, for incisional hernias, which are common after surgery, mesh is often used. This is because the tissue is never 100% as strong as it was before surgery.

If surgery is not possible, are there other options?

The only way to completely repair a hernia is through surgery. However, some people may not be able to have surgery due to other health problems (such as heart disease). For these people, your doctor may recommend using a special brace (corset, binder, or truss) to help keep the hernia in place. However, this only temporarily controls the hernia and does not cure it.