Gastrointestinal · Topic 7 of 20
Abdominal Hernias (Inguinal, Umbilical, Incisional)
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Abdominal Hernias (Inguinal, Umbilical, Incisional)
Bowel or other tissue protrudes through a weak spot in the abdominal wall. The danger is strangulation: the hernia has lost its blood supply, and that is a surgical emergency.
What causes it
Raised intra-abdominal pressure pushes tissue through a weak spot
Obesity and ascites apply mainly to umbilical and incisional hernias. Adult umbilical hernia is linked to obesity, ascites, pregnancy and chronic peritoneal dialysis.
Reducible, incarcerated or strangulated
A strangulated hernia has lost its blood supply
An incarcerated hernia can cause bowel obstruction.
The types
Inguinal is the most common; femoral has a higher strangulation risk
About 75% of abdominal wall hernias are inguinal. Femoral hernias have the highest strangulation rate, about 15% to 20%, so they are usually repaired promptly.
What you'll see
A reducible bulge shows with coughing or standing and recedes lying down
Red flags
Severe pain with a tense, tender, red or dusky bulge means strangulation
Treatment
Avoid heavy lifting and straining as directed
Raised abdominal pressure stresses the repairSplint the incision with a pillow for deep breathing and any needed cough
Avoid forceful coughingFluids, fiber and a stool softener as ordered
Opioids add to constipationScrotal support and ice wrapped in a towel
Check voiding; report trouble urinating
Report redness, warmth, drainage, fever or worsening pain
Repair and discharge details
Nursing priorities
Infant umbilical or inguinal hernia?
An infant inguinal hernia does not close by itself
| Umbilical | Inguinal | |
|---|---|---|
| Closure | Usually closes by age 4 to 5 | Does not close by itself |
| Care | Watchful waiting; no tape or coins | Prompt surgical repair, because it can incarcerate |
| Who | Common, especially in preterm and Black infants | More than 90% are boys; much higher rate in premature infants |
In preterm infants, inguinal repair can often be safely considered after NICU discharge. A communicating hydrocele holds fluid, not bowel; it can mimic an inguinal hernia and is often watched until 12 to 18 months of age.
Teach your patient
Teach parents that crying and straining can make the bulge bigger but do not cause a hernia.
Reducible returns, incarcerated is trapped, strangulated has lost its blood supply. A tense, tender, dusky bulge with severe pain is a surgical emergency: keep NPO, notify the provider, and do not force it back.
Sources · Hernias of the Abdominal Wall (Merck Manual) · Inguinal Hernia (NIDDK) · Femoral Hernia (StatPearls) · Strangulated Hernia (StatPearls) · Assessment and Management of Inguinal Hernias in Children, 2023 (AAP) · Inguinal Hernia in Infants & Children (AAP HealthyChildren) · Umbilical hernia (MedlinePlus) · Management of asymptomatic pediatric umbilical hernias (J Pediatr Surg) · Inguinal Hernia Repair, Discharge (UF Health) · Deep breathing after surgery (MedlinePlus) · Follow your facility's protocol for postoperative activity limits.
Abdominal Hernias (Inguinal, Umbilical, Incisional)
An abdominal hernia is a protrusion of bowel or other tissue through a weak spot in the abdominal wall, driven by raised intra-abdominal pressure from heavy lifting, chronic cough, straining, pregnancy, obesity or ascites. Inguinal hernia is the most common type, femoral hernia carries a higher strangulation risk, and incisional hernia develops at a prior surgical incision. A reducible hernia returns to the abdomen, an incarcerated hernia is trapped, and a strangulated hernia has lost its blood supply. Sudden or worsening severe pain with a tense, tender, red or dusky bulge, vomiting, distention, fever and tachycardia is a surgical emergency: the nurse keeps the client NPO, notifies the provider immediately and does not force the bulge back. After repair, the client avoids heavy lifting and straining, splints the incision, and prevents constipation. In infants, an umbilical hernia usually closes by age 4 to 5 and needs no tape or coins, while an inguinal hernia needs prompt surgical repair.
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