When there is a weakness in the muscle wall or connective tissue (fascia), and an organ or fatty tissue protrudes through it, this is known as a hernia. The most common types of hernias are inguinal (inner groin), incisional (caused by an incision), femoral (outer groin), umbilical (belly button) and hiatal (upper stomach).
Congenital hernias develop before birth and are present upon birth, but may not be detected for weeks, months, or even years. A hernia that occurs much later in life may be the result of a weakness that you have had since you were a newborn.
Acquired hernias occur when the muscles or connective tissue in the abdomen become injured or get weaker over time, disrupting the body's natural cycle of tissue breakdown and repair.
A soft swelling or bulge under the skin is a classic sign of a hernia. The location of the bulge will be determined by the type of hernia present. Some hernias are only visible when one is standing and may disappear when lying down. Others may be noticeable only when your muscles are strained by coughing, sneezing, laughing, bending or lifting.
There is a small risk that an organ such as the intestine (bowel) will become trapped when it pushes through the abdominal wall. This is referred to as an "incarcerated hernia”. If part of your intestine becomes trapped outside the abdominal wall and you are unable to push it back into your abdomen, you may experience pain or feel a hard mass on your abdomen. In such a situation, emergency medical intervention is required.
The most common type of hernia, it occurs when the intestine protrudes through a weak spot in the abdominal muscle or into the inguinal canal in the groin. This results in a bulge on either side of the pubic bone that can be painful. Inguinal hernias tend to affect men more. In Singapore, hernia treatment may take the form of a hernia operation, or as recommended by one’s doctor.
A femoral hernia occurs when tissue pushes through the inner thigh or a weak spot in the groin. This form of hernia is more common in women. Common causes include straining during bowel movements, lifting heavy weights, and excessive coughing. A hernia surgeon may recommend hernia repair in Singapore to fix a femoral hernia.
An umbilical hernia occurs when a piece of the bowel or fatty tissue bulges through the abdomen near the navel (belly button). It is especially common in babies under 6 months old, but can also happen to adults. In some cases (if the hernia is causing pain or at risk of strangulation), a hernia operation may then be required to treat the patient properly.
Epigastric hernias are identified by the presence of lumps or bulges forming in the upper abdominal region, specifically between the belly button and the lower part of the breastbone (sternum). An epigastric hernia can be present from birth, is typically small in size, and may not exhibit any symptoms. However, if the hernia grows larger or causes discomfort, hernia repair surgery may be required.
An incisional hernia develops when an organ or tissue protrudes through a former surgical site in the abdominal wall, which may have been weakened. Hernia surgery can help to repair the weakened abdominal wall by reinforcing it with mesh for enhanced strength and support.
A perineal hernia is a type of hernia that occurs in the perineum, a skin area located between the anus and the genitals. While it can be a rare complication of pelvic surgery, it may also arise from an injury, during pregnancy, or be present at birth (congenital). The symptoms may include pelvic or groin pain, difficulty with bowel movements, urinary problems, and discomfort when sitting and moving. A hernia operation is necessary to reposition the herniated tissue back to its proper place.
When the diaphragm develops a hole or defect, a diaphragmatic hernia may form. The opening allows abdominal organs, such as the stomach, liver, and intestines, to move into the chest cavity. Diaphragmatic hernias can be either congenital or acquired due to trauma or previous surgery. To treat this condition, a hernia surgeon may need to restore the normal positions of the affected organs, and repair the hole in the diaphragm.
Diagnosing a hernia involves conducting a thorough physical examination and reviewing the patient’s medical history. During the exam, the hernia specialist in Singapore may ask the patient to cough, stand, or bear down in order to assess the presence of any visible signs, such as a bulge or swelling, or if the hernia becomes more prominent. They may also apply gentle pressure to the affected area to see if the hernia can be felt or pushed back in.
In certain cases, an imaging test may be necessary to confirm the diagnosis of the condition. This test can be an abdominal ultrasound, CT scan, or MRI, which helps determine the size and location of the hernia and identify any potential complications.
Hernia repair surgery is one of the world’s most common surgical procedures. Hernia surgery can help to relieve pain, return the hernia abdominal organs to their correct place and, strengthen the weak muscle area. A hernia operation usually takes around an hour as a day case procedure. It can be performed by:
Under general anaesthesia, an incision usually around 2.5 to 3 inches is made to your skin near your hernia and your surgeon will push your hernia back into your abdomen. Commonly, a mesh is placed over the defect and fixed using fine stitches. The mesh acts like a scaffold and your own tissue will grow through the mesh to reinforce the weakened area without putting tension on the surrounding tissues.
Under general anaesthesia, three smaller incisions are made to allow your surgeon to use a less invasive technique using various special instruments including a tiny telescopic camera to repair your hernia. A mesh is then be used to strengthen your abdominal wall.
Proper preparation for hernia surgery begins with following the preoperative
instructions provided by your doctor, including guidelines on fasting before
surgery, as well as any medications or supplements to avoid.
Patients must arrange transportation to and from the hospital as the effects of
anaesthesia and pain medicine might impair their ability to drive home after a
hernia operation.
Generally, hernia repair surgery is performed under general anaesthesia, which
means the patient is asleep and pain-free during the procedure. The surgical
technique varies based on the type and location of the hernia.
Oncean incision is made by the Singapore hernia specialist, the herniated tissue
is pushed back into its rightful position, and the weakened or torn muscle walls
are repaired using stitches, staples, or adhesive glue. In some cases, surgical
mesh or other synthetic material is placed to help reinforce the area of the
muscle wall and prevent the hernia from recurring.
Following hernia surgery, patients are usually discharged on the same day. You
should be able to return to most normal activities within 1 to 2 weeks. Pain,
bruising, and swelling around the incision site are common but temporary and
will subside with time; and some may also feel sensations of pulling in the
area. In Singapore, hernia surgeons usually prescribe pain relief medications to
make the recovery process more comfortable.
Instructions on diet and proper wound care will also be provided. In the days
following the operation, it is important to rest and avoid engaging in
physically strenuous activities.
Your doctor will schedule follow-up appointments to monitor your recovery and
ensure that the incision is healing properly.
As with all surgeries, there are risks associated with hernia repair, which
includes infection, excessive bleeding, damage to surrounding organs and blood
vessels, reaction to anaesthesia, and fluid accumulation (seroma) near the
hernia site.
While these risks exist, hernia repair surgery is usually a very safe procedure
with a high success rate. Your hernia surgeon in Singapore will discuss these
risks with you and take all the necessary precautions to minimise them.
Several factors can increase an individual’s risk for hernia formation. These include:
When a hernia is left untreated, it has the potential to cause serious complications. These may include a bowel obstruction, in which the herniated tissues could become trapped and cause a blockage of the intestines; or strangulation of the hernia, which can cause the tissue to die due to a lack of blood flow.
Hernias typically do not resolve on their own. If an individual has a small, asymptomatic hernia, the doctor may recommend watchful waiting or wearing a corset, binder, or truss to support the herniated area. However, hernia treatment commonly involves surgical repair that aims to restore the herniated organ or tissue to its proper position. The doctor can provide a personalised treatment plan after evaluating the specific characteristics of the hernia and the patient's overall health.
Consultant Vascular & General Surgeon
MBBS (Singapore), MMed (Singapore), FRCS (Edinburgh)
An experienced vascular and general surgeon in Singapore, Dr Sujit Singh Gill’s main interests include the minimally invasive treatment of venous, arterial and diabetes-related vascular disorders. His expertise in general surgery also allows him to treat various colorectal, gastrointestinal and hepatobiliary conditions with good patient outcomes. Having trained in Singapore, Australia and the United Kingdom, Dr Sujit Singh Gill’s diverse background also helps put his patients at ease.
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The Vascular & General Surgery Centre
Unit 18-05, Paragon Medical Suites, 290 Orchard Road, Singapore 238859
Tel: +65 6736 2302
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