What causes bumps on the lower abdomen
Hernia(Hernia): Sack-like or bulge-like protuberance of the peritoneum (hernial sac) through a gap in the abdominal wall (hernial opening, hernial ring). The hernial sac contains viscera, parts of organs or fatty tissue. At 75%, an inguinal hernia is the most common type of intestinal hernia; Male babies and older men are particularly affected. The femoral hernia is the second most common form at 10% and particularly often affects women aged 50 and over.
Visceral hernias can only be repaired surgically. Whether and when a hernia has to be operated on depends on its location and the symptoms it is causing. An operation is always urgent if parts of organs (especially intestinal loops) become trapped in the hernial opening (Break entrapment, Hernia incarceration) and an intestinal obstruction and thus a death of intestinal loops threatens.
- Outwardly visible bulging of the abdominal wall, constantly or only when coughing or when pressing during bowel movements
- No pain at all or slight pain; if there is pain, it is often only when there is pressure or pressure
- Severe pain over the protrusion when parts of the intestinal wall are pinched.
When to the doctor
Over the next two weeks, though
- a painless or painful bulge is noticed in the groin or navel area.
In the next few hours if
- there is a bulge in the abdomen and sudden severe pain in the bulging area of the abdominal wall or if there are sudden digestive problems. Both indicate an entrapment of intestinal loops.
Disease emergence and causes
Normally, the abdominal wall is completely closed by overlapping muscle layers, so that the intestines are always held in their position even when there is increased pressure in the abdominal cavity, for example when coughing. In some cases, however, the abdominal wall can no longer withstand the pressure from the inside, so that it deviates at its natural weak points - these are the penetration points for blood vessels, nerves or muscles. This creates hernial ports through which the intestines emerge when sneezing, coughing, lifting heavy loads or pressing hard during bowel movements and are then visible and palpable as a protrusion (hernial sac). Causes for the weakening of the abdominal wall are z. B.
- weak abdominal muscles
- congenital weakness of the connective tissue
- Damage after operations
- chronic cough
Fractures or hernias can be divided into different forms:
Acquired hernias are fractures that are favored by external circumstances, especially by frequent lifting of heavy loads or frequent abdominal cramps, e.g. B. in chronic constipation. In contrast, the rarer ones arise congenital hernias due to an incomplete abdominal wall closure in prenatal development.
If the protrusion can be remedied by hand or if it slides back by itself, there is one repairable hernia in front. Adhesions between the contents of the hernia and the hernial sac can mean that the hernia cannot be pushed back (irreversible hernias). If the hernia is trapped in the hernial orifice, it is called one incarcerated hernia.
In addition to visible and tactile external hernias there is also internal herniasthat are not visible from the outside. The most common internal hernia is the diaphragmatic hernia (hiatal hernia). They are less common z. B. in the perineal area (perineal hernias) or in the small pelvis (obturator hernia, ischiadic hernia).
In principle, an intestinal hernia is possible anywhere in the abdominal cavity; here is an overview:
Inguinal hernia. The Inguinal hernia (Inguinal hernia, inguinal hernia) usually appears in the crotch above the inguinal ligament. Newborns and children are predominantly affected by a congenital inguinal hernia, in which the contents of the hernia emerge along the spermatic cord (the canal that contains the spermatic duct) or the maternal ligament (the analogous structure in girls). The acquired inguinal hernia, on the other hand, usually occurs in adults, especially in older men. In this case, the contents of the hernia exit directly through the weakened abdominal muscles of the inguinal canal from the abdomen towards the scrotum. In men, doctors operate on the inguinal hernia if it gets bigger or causes symptoms, such as: B. Pain or difficulty urinating. Inguinal hernias in women should always be operated on.
Femoral hernia. In the Femoral hernia (Femoral hernia, hernia femoralis) is the hernial port below the inguinal ligament; the protrusion can usually be seen on the inside of the thigh; but it can also be absent. It almost exclusively affects middle-aged and older women. Because the hernial hernia is very narrow, the femoral hernia carries a particularly high risk of entrapment and - provided there are no other diseases to the contrary - it is operated on quickly.
Umbilical hernia. In the Umbilical hernia (Umbilical hernia) shows the bulge at the umbilical opening; if infants are affected, the umbilical hernia often recedes by itself within the first year of life (spontaneous closure). In adults, surgery is performed if possible because of the relatively high risk of entrapment.
Incisional hernia. In the Incisional hernia the break occurs in the area of a surgical scar; it occurs as a complication in up to 10% of all major abdominal operations and is the result of impaired wound healing or a generalized weakness of the connective tissue.
Repeated intestinal hernias. Every fourth hernia is a recurrent hernia. H. the success of a previous hernia operation was not permanent. Here the doctors operate the hernia a second time. If the first operation was an open procedure, they usually proceed in a minimally invasive manner for the recurrence operation (see below).
The dreaded complication of every intestinal hernia is the jamming of the contents of the hernia in the hernial orifice (incarceration). An operation must always be carried out immediately, as the stuck intestinal parts are threatened with death.
Most of the time, the patient describes exactly how and when the fracture shows up. The doctor then examines the hernial orifice and its opposite side while standing and lying down. If the hernia does not bulge on its own, he makes the patient cough or squeeze in order to provoke the bulge. The doctor confirms the diagnosis with an ultrasound examination and displays the contents of the hernia; sometimes he also listens to the hernial sac for intestinal noises. If the doctor has doubts about the location and extent of the hernia, he will arrange for an MRI or CT scan to clarify.
Differential diagnoses. Bulges in the groin area are also caused by lipomas (fatty tissue growths), lymph node swellings and vasodilatation such as B. an aneurysm of the femoral artery (thigh artery). Bulges in the umbilical area also occur in diastasis recti.
Because of the risk of entrapment, every hernia is an indication for surgery (Fracture gap closure, Hernioplasty), whereby the doctor operates at a time when the patient has (almost) no symptoms. The aim is to move the contents of the hernia back into the abdominal cavity, to close the hernia port and to strengthen the abdominal wall so that it can withstand internal pressure in the future. The exception is the inconspicuous inguinal hernia in men: here you can wait and see under regular controls. The operation is due if the fracture causes discomfort or becomes larger.
Either classic open surgery or - more and more often - the minimally invasive laparoscopic technique come into question.
- After open surgery Shouldice Doctors expose the hernial sac through an incision, open the hernial sac and push the contents back into the abdominal cavity. Then they close the hernial orifice or narrow it down severely. To stabilize the abdominal wall, the edges of the abdominal wall layers are usually sutured with an overlap (doubling of the fascia).
- In the case of larger fractures, doctors use plastic nets to reinforce the suture to prevent a repeated intestinal hernia (recurrent hernia) (surgery after Lichtenstein).
Doctors use minimally invasive procedures primarily for recurrent hernias, bilateral hernias and all hernias in women. Because patients can exercise again physically just 3–4 weeks after the operation, these procedures are also suitable for patients who need to be fit again quickly.
- Transabdominal preperitoneal hernioplasty (TAPP): With the laparoscopic approach, the closure is from the inside through the abdominal cavity. The doctors insert the endoscope and the necessary instruments through small incisions and push the contents back into place. Then they push a plastic net up to the hernia and sew or staple it from the inside.
- Total extraperitoneal hernioplasty (TEP): A variant of the minimally invasive treatment of the inguinal hernia is the TEP technique using an abdominal mirror. Here, the doctors do not push the endoscope and instruments through the abdominal cavity, but between the skin and the peritoneum and advance until they break. The contents of the hernia are pushed back and a plastic net is placed between the abdominal muscles and the peritoneum, which then closes the hernia from the inside. Due to the position between the abdominal muscles and the peritoneum, the mesh does not have to be sewn or clamped, it holds by itself, so to speak.
- Transinguinal preperitoneal plastic (TIP): Minimally invasive procedure for the treatment of femoral hernias, in which the doctors also insert a plastic mesh via an access from the groin.
In the event of a fracture with trapped intestinal tissue, doctors operate immediately so that the trapped intestine does not die. This emergency operation carries a high risk, every fifth patient dies from it.
A hernial ligament, which is intended to prevent the hernial sac from protruding through external mechanical pressure, is only prescribed today if an operation is not possible or is refused. It cannot eliminate the cause and can also damage the skin and the underlying tissue due to external pressure. In addition, a truss ligament means that the muscles in the abdominal wall become weaker and weaker due to the constant support.
Inguinal hernias reappear in up to 10% of cases after an operation and then have to be treated again (so-called recurrent hernias). In the case of a pinched inguinal hernia, the mortality rate is around 20% despite surgery.
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What you can do yourself
Protect the abdominal wall. After the hernia operation, avoid excessive stress on the abdominal wall until the surgical suture has completely healed and has scarred. Also, hold back laughing for the first few days and suppress hiccups as much as possible. Always put one hand on your stomach when coughing and sneezing - this will provide counter pressure.
Avoid constipation. It is important that you ensure that your stool is soft. Drink as much as possible and add flaxseed or flea seeds to your diet (self-help with constipation).
Restrict movement. Refrain from physical activity for 3–4 weeks after the operation. After that, light activities such as swimming and the occasional lifting of loads (less than 10 kg) are permitted. Moderately difficult activities such as jogging and cycling are allowed again after 6 weeks, heavy activities such as weightlifting and competitive sports after 12 weeks.
Keep the closed season. After inserting the mesh material and wound healing without complications, the load-bearing capacity is possible again after about 6–8 weeks. If you have had a laparoscopic operation, you can already fully exercise again after about 3–4 weeks.
AuthorsDr. med. Arne Schäffler, Dr. Bernadette Andre-Wallis in: Health Today, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 22:10
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