A hernia arises when an internal body part, such as an organ or fatty tissue, pushes through a weakness in the surrounding muscle or connective tissue wall. While hernias commonly occur in areas like the groin or navel, lateral hernias represent a specific category that develops on the side of the abdominal wall.
Defining Lateral Hernias
A lateral hernia involves the protrusion of internal tissues through a defect in the abdominal wall, specifically located away from the central midline. This occurs when the supportive layers of muscle and fascia develop a weak spot, allowing abdominal contents to push through and create a bulge.
Among the types of lateral hernias, Spigelian hernias are notable, occurring through the Spigelian fascia. This fascia is a layer of connective tissue situated between certain abdominal muscles, typically found along the outer edge of the rectus abdominis muscle, often below the belly button. Spigelian hernias are relatively rare and can sometimes be challenging to diagnose because they may not produce an obvious external bulge, remaining hidden beneath layers of muscle.
Another type is the lumbar hernia, which develops in the lower back region. These hernias manifest when tissue protrudes through weak points in the muscles of the lower back, often presenting as a lump on the side or back. Like Spigelian hernias, lumbar hernias are uncommon.
Signs and Risk Factors
A common indicator of a lateral hernia is a noticeable bulge or lump on the side of the abdomen or in the lower back. This protrusion may become more apparent when standing, straining, or coughing, and might recede or disappear when lying down.
Individuals may also experience localized pain or discomfort at the hernia site. This pain can intensify with physical activity, such as lifting or exercising, or during actions that increase abdominal pressure like coughing or straining during bowel movements. Some people might also describe a feeling of pressure or heaviness in the affected area. However, some smaller lateral hernias may not cause any noticeable symptoms.
Several factors can increase the likelihood of developing a lateral hernia, primarily conditions that lead to increased pressure within the abdomen. These include chronic coughing, such as from COPD or bronchitis, and persistent straining due to constipation. Heavy lifting and activities that involve significant physical exertion also raise intra-abdominal pressure, potentially leading to hernia formation.
Other contributing factors include pregnancy, which puts considerable strain on the abdominal wall, and obesity, where increased abdominal weight can weaken supportive tissues. The natural aging process can also weaken abdominal muscles and connective tissues over time. Individuals with a history of abdominal surgery or trauma may have compromised areas in their abdominal wall, making them more susceptible to developing hernias. Certain inherited connective tissue disorders can also predispose individuals to weaker tissues, increasing hernia risk.
Confirming and Addressing Lateral Hernias
Confirming a lateral hernia typically begins with a physical examination. During this exam, the doctor will feel the affected area for bulges or tender spots, sometimes asking the patient to stand or perform actions like coughing or straining (Valsalva maneuver) to make a subtle hernia more evident. Because lateral hernias can be difficult to detect solely through physical examination, especially if small or deep, imaging tests are frequently used.
Ultrasound or computed tomography (CT) scans are common diagnostic tools that provide detailed images of the abdominal wall. These imaging techniques help confirm the diagnosis, determine the size and location of the hernia, and rule out other conditions with similar symptoms. Imaging is particularly helpful for lateral hernias, which may not always present with a clear, visible lump.
Once a lateral hernia is confirmed, the approach to addressing it depends on its size and whether it is causing symptoms. For very small hernias that do not cause any discomfort, a period of watchful waiting may be considered. However, hernias generally do not resolve on their own and tend to enlarge over time.
Surgical repair is the definitive treatment for lateral hernias. Two primary surgical techniques are commonly employed: herniorrhaphy and hernioplasty. Herniorrhaphy involves directly stitching together the weakened tissues to close the defect. In contrast, hernioplasty utilizes a synthetic mesh patch to reinforce the weak area, providing additional support to the abdominal wall. Hernioplasty is often favored for its association with lower recurrence rates and reduced postoperative pain.
The primary goal of surgical intervention is to return the protruding tissue to its correct anatomical position and strengthen the compromised abdominal wall. For lateral hernias, the surgical approach may involve anchoring the mesh to fixed bony structures to ensure a more robust repair. It is important to seek medical advice for any suspected hernia, as untreated hernias can lead to complications such as incarceration (where tissue becomes trapped) or strangulation (where the blood supply to the trapped tissue is cut off), which can be a serious medical emergency.