Ask an expert about hernias 

A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall.

A hernia usually develops between your chest and hips. In many cases, it causes no or very few symptoms, although you may notice a swelling or lump in your tummy (abdomen) or groin.

The lump can often be pushed back in or disappears when you lie down. Coughing or straining may make the lump appear.

Our expert was consultant upper GI surgeon Mr Khaled Dawas. He is a senior member of the upper GI surgery team with much experience in both cancer and benign surgery (such as surgery for hernias). Mr Dawas was here to answer questions about hernias, from symptoms to diagnosis and treatment.

Below is a transcript of the webchat.


2:59
Hello. I am Khaled Dawas and I am Gastrointestinal (GI) Surgeon at UCLH with a specialist interest in hernia repair. I shall be very happy to answer as many of your questions as possible.
 
2:59 [Comment From Lauraine: ] 
I had an ileostomy 30 years ago and did not develop a hernia which was great! But 2 years ago I had a hysterecomy that resulted in a perforated bowel. I now have a parastomal hernia behind the original ileostomy. It doesn't bother me and was picked up on a scan. Should I just leave well alone? As an aside, do you intend doing any webchats on fistula at any point ? I have been left with enterocutaneous fistula when my bowel perforated two years ago. Devastated and very little support or information out there - thank you.
 
3:01
Hello Lauraine. You ve been very unlucky and Im sorry you've had such a rough time with this. If the parastomal hernia is not causing problems then leaving it alone is a sensible option.
Sadly, fistulae are not part of my expertise. Other colleagues in UCLH are the experts
 
3:02 [Comment From Kelley: ] 
I have a huge incisional hernia with 62 percent domain, I am 46 year old female and I have had this for six years after a bowel resection, I have a blood clot in my mesentric artery this slows my blood flow into my bowel, I am on warfarin My question is: I've been told I am very high risk to have surgery, but would you recommend me having surgery or should I just live with this?
 
3:03
Thanks Kelly. Your medical history is very complex indeed. The main factor will be your overall health. If the risks of surgery outweigh the benefit and your risk is too high then I would agree that you should avoid surgery. This is, however, a discussion to be had in person with your surgeon
 
3:03 [Comment From ALF: ] 
I am aged 85 and have had a hiatas hernia for the last 30 odd years. When it first occurred my (then) GP said that I should live with it as to have an operation would be too dangerous. Over the years my stomach has expanded considerably. I have also developed acid reflux which may or not be due to the hernia. Is there anything that can be done to stop my stomach from growing any bigger? I find it difficult if I try to exercise as the “lump” sticks out between the gap.
 
3:05
Hi ALF. Hiatus hernias can be very troublesome when large. It is also an area that needs a thorough assessment of fitness and the pros and cons of surgery. It can be repaired and there are different techniques. I suggest you meet a surgeon specialist to discuss this
 
3:05 [Comment From Ann: ] 
In 2013 I had an umbilical and ventral hernia repair. Unfortunately this wasn’t a success and I’ve been left in a worse state than I was before. I developed a dehiscence of my wound which required daily packing and internal abscess that required surgical drainage with hernia mesh removal. I’ve now been told that I require a component separation technique. Is this the right course of action? Do you have any advice?
 
3:07
Thanks Ann. Component separation describes a technique for repairing complex muscle weakness in the abdomen. It is a big operation and to come to that decision needs very careful surgical assessment. It may be the best option for you but you need to see a surgeon with experience in repairing complex hernias.
 
3:07 [Comment From Anonymous: ] 
I have recently been diagnosed with a 4cm sliding hiatus hernia after suffering for two years with horrendous chest, neck, shoulder and back pain. I have been to A&E a least 5 times this year thinking I was having heart problems. I had an endoscopy 4 weeks ago and was diagnosed, but I was sent home with no advice. I have been on all of the PPI's for the last 15 years as I suffer with GERD and IBS. If I eat the wrong thing it feels like I have got a tennis ball stuck behind my sternum. I am concerned about having an operation because I have read that the chances of success are not good. I have given up gluten and dairy and all spicy foods. I take a multi vitamin and magnesium supplements. Is there anything else I can do to help my symptoms? Omerprazole makes me feel worse so I am on Ranitidine.
 
3:09
Dear Anonymous,
Sometimes if these symptoms are severe enough then surgery is the best option but you need to be convinced and also your surgeon needs to exmaine you and ensure you have the correct diagnosis.
 
3:09 [Comment From Anonymous: ] 
18 months ago I had a spigelian hernia repair. Everything seemed to go well until the following April when I was in a lot of pain around the site of the operation. I subsequently found that I had 2 more hernias, a femoral hernia and an inguinal hernia. Both were repaired at the same time last August. It transpired that the mesh had come away from my 1st repair and wrapped itself round my inguinal hernia but this wasn't discovered until the actual repair was carried out. Now I have similar pain and another hernia. My GP says that it is an incisional hernia and it is at the end of the scar from the last repair! I'm scared that the pain will become as bad as it was last year and worried for my job as I always seem to be off recovering from surgery. Why am I getting so many hernias? My consultant implies that it is because I smoke but surely that can't be the only cause?
 
3:12
Hi Anonymous. Though smoking isn't the only cause it does play a big part. If you have been a long time smoker your healing will be impaired. On top of that we think hernias arise because of a weakness in the "scafold" that supports the elastic component in your tissues. So part is sadly genetic but there is the smoking and overall health aspect too eg obesity, poor diet, lack of exercise
 
3:12 [Comment From Michael: ] 
After an endoscopy I was diagnosed with a small sliding hiatus hernia which is treated with Omeprezole. Recently I have been encountering some breathing difficulties combined with a staggering amount of reflux and despite doubling to 40mg of Omeprezole - the reflux and breathing problems continue. I am fairly certain that the hiatus hernia/reflux is responsible for my breathing problems, but my doctors seem to disagree (although they cannot tell me what is causing it) Could the breathing problems be down to the hiatus hernia and if so how can the problem be resolved?
 
3:14
Thanks Michael. The problem is that small haitus hernias are very common so the question is then about deciding if a small hernia can give such symptoms. breathing problems from Hiatus Hernias usually only happen if the hernia is large.
If your reflux continues despite the high dose of medication you should discuss with your GP about seeing a gastroenterologist
 
3:15 [Comment From Jenny: ] 
I've recently been diagnosed with a 4cm sliding hiatus hernia, through an endoscopy. Over the past 3 months the quality of my life has drastically deteriorated. I am being sick almost every day (whether I eat or not), getting a burning sensation, burping a lot and being bloated constantly. The doctors have tried various medications before my diagnosis, however nothing has helped. I've read a lot online in regards to the condition, and frankly don't want to be on tablets for the rest of my life. Is there any way possible I can opt for surgery? My GP has not been helpful at all and at times I feel like I am hitting my head against a brick wall.
 
3:16
Sorry to read this Jenny. A 4cm hiatus hernia is not a large one but if you have very severe reflux that's not responidn to medication and you dont smoke and have cut out coffee and alcohol then surgery would be an option. This first needs further tests to confirm that surgery is likey to help you.
 
3:18 [Comment From David: ] 
I was diagnosed with a hiatus hernia over a year ago and in recent months the pain and discomfort is becoming unbearable. As a result I have massive anxiety and when I am having a bad time I feel like I am going to collapse. I have finally accepted that I have to make massive changes to my diet and lifestyle in order to manage the symptoms. What advice can you give me about my diet and other lifestyle choices?
 
3:19
Hi David. Its unusual to ahve so much pain from a hiatus hernia. Please ask your GP about this. Its difficult to advise you in this forum as your symptoms are so severe.
 
3:19 [Comment From Mary: ] 
I’m pregnant. Should I fix the hernia before the baby is born?
 
3:21
I hope the pregnancy is going well Mary. It's best you wait for at least a month after you've delivered before contemplating surgery. Your muscles will be stretched before then and that will affect the quality of a repair
 
3:22 [Comment From Anon: ] 
Hi I have an abdominal hernia look five months pregnant it was okay but now it is painful and I am finding it really hard opening bowls, what should I do?
 
3:23
Hello Anon.If your hernia is troubling youand you are fit for surgery please ask your GP to refer you to urgeon for an assesment
 
3:23 [Comment From Ben: ] 
Hi Khalad. I am due to have hernia surgery in February. I was wondering if there is a lot of pain post surgery? Also, I was told to take 2 weeks off work. Is the surgeon presneting the longest case scenario or will i be able to return to normal acitivies after a few days?
 
3:25
Thanks Ben. I assume you are having a groin hernia repair. If so then you should be well enough to go home the same day and you'll be needing regular painkillers for a week. You'll find sudden movements painful but manageable. 2 weeks is a realistic target.
 
3:25 [Comment From Jon: ] 
I had umbilical hernia surgery a year ago and I was lifting weights before surgery. My question is why am I still going through pain after a year when I'm trying to workout again?
 
3:26
Hi Jon. That's difficicult to answer without a face to face assessment. You should probably see your surgeon again
 
3:26 [Comment From Katie: ] 
I am confused by the amount of surgical techniques for hernia repair. There is so much information on the internet. Which is the best one?
 
3:27
What kind of hernia do you have Katie?
 
3:28 [Comment From Katie: ] 
hi mr dawaas - it is a umbilical hernia.
 
3:30
In that case there are 2 main techniques; open or laparoscopic (keyhole). The decision on the best technique is based on the hernia size and previous surgery. I usually advise open surgery for a small one as the cut is small and infact probably less painfull.
 
3:30 [Comment From Niraj: ] 
Is keyhole surgery better than open surgery for hernias?
 
3:32
Thanks Niraj. Sadly its not as straight forward as that. Every technique has its advantages. Groin hernias on both sides at the same time, recurrent hernias and where there is difficulty in diagnosis are good reasons to use laparoscopic repair. I personally advise young men with a single sided hernia to have open surgery as the recurrence rate is lower and the time for recovery between the 2 techniques is not very different
 
3:32 [Comment From Sam: ] 
I am about to have a paraumbilical hernia repair with open surgery – how quickly can I expect to go back to work? I work in a supermarket on the shelves and behind the till.
 
3:33
Hope it goes well Sam. If your work involves lifting then I advise taking 6 weeks off those kind of duties
 
3:33 [Comment From Rahul: ] 
Is gastric reflux a sympton of a hiatal hernia? If so, how best to manage it?
 
3:35
Rahul, yes one of the symptoms of a hiatus hernia is acid reflux. If its a small hernia try simple measures first, eg stop smoking, reduce alcohol and coffee inatke, improve your diet and then try medication. A lot of reflux is related to our lifestyle issues. Its very common in the over worked stressed person. Sadly our busy lives manifest as reflux amongst other things
 
3:35 [Comment From Debbie: ] 
Is there any way I can prevent myself from getting a hernia?
 
3:37
Hi Debbie. If you havent got one then live your life well and dont worry. Hernias are often a result of genetic weakness in our muscles / tissue but factors that increase the risks are obesity / poor diet ....
 
3:37 [Comment From Margaret: ] 
I am a lady in my eighties. My doctor tells me I am too old for hernia surgery but my hernia is so large, it makes me look pregnant and am too embarrassed to leave my home. Can anything be done?
 
3:39
Dear Margaret. Age on its own is not the sole reason to worry about surgery. If you are fit and active and feel very dibilitated by the hernia then most surgeons would ceratinly be very happy to see you and assess the problem. Large hernias are more complex to repair and I am sure that would be taken into account.
 
3:42 [Comment From Martin: ] 
Hi Mr Dawas, my surgeon does not inspire me with confidence and I would like a second opinion. Am I able to see you or a member of your team? If so how do I get in touch?
 
3:43
Thank you Martin. Of course you'd be very welcome. I would just need a referral letter as the hospital needs that from the GP please. You can ask your GP to address it to me or one of my colleagues personally.
 
3:43 [Comment From Rahul: ] 
Thanks Dr Dawaas, would a reduction of fatty foods help at all?
 
3:45
Hi Again Rahul. My advice always includes the following:
1. stop smoking
2. Cut alcohol and coffee
3. Reduce sugars and fatty foods
4. Lose weight if you're overweight
and finally......try to reduce the stress levels in your life, or at least manage them better.
I appreciate some of these wont apply to you but I find many patients have a combination of thse factors
 
3:58 [Comment From Alf: ] 
Thank you for your reply to my questions re my hiatus hernia. Is it possible to consult you, under the NHS ,regarding a possible repair or do I need to see you privately
 
3:59
Of course Alf. Both options are open to you. Please ask yor GP to send me a referral letter and I shall be delighted to meet you.
 
4:00
It’s been a pleasure answering your interesting and challenging questions and I hope it was useful for you all.
Hernias are varied and the problems are the same. The most common ones are in the groin and those can be treated either via open or laparoscopic surgery. Hiatus hernias and hernias called “incisional hernias” (ie those developing in previous surgery scars) are less common and more challenging to repair. Choose your surgeon well and have a discussion about the different options for treatment. Not all hernias need surgery.

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