"What Happens When the Abdominal Wall Ages and Becomes Lax?"... A Bulge Beside the Navel Can Lead to a Hernia [Health Talk]

[Financial News] If a bulge has appeared in the groin or around the navel after lifting something heavy or coughing repeatedly, a hernia should be suspected.
Organs in the body remain in place with support from surrounding muscles and tissues. However, if the muscles or tissues surrounding an organ weaken or separate, the intestines or fatty tissue can protrude through the gap and move out of position. This condition is called a hernia.
According to HIRA's National Disease Statistics on Diseases of Public Interest, the number of hernia patients rose from 88,790 in 2020 to 104,797 in 2024, an increase of approximately 18% in five years. As the number of patients continues to rise, it is important to know the main symptoms and warning signs of a hernia.
Bong Jun-woo, a professor of colorectal surgery at Korea University Guro Hospital, said, "In the early stages, a hernia may cause only a bulge in a specific area or a heavy, uncomfortable sensation, making it easy to dismiss as insignificant." He explained, "However, if the condition worsens, it can lead to serious complications such as bowel obstruction or bowel necrosis. Suspected symptoms should not be taken lightly, and patients should receive treatment at the appropriate time."
Hernias can occur in various parts of the body, but most develop in the abdominal wall, which consists of the muscles and tissues surrounding the abdomen. When a weakened area or gap forms in the abdominal wall, the peritoneum, the thin membrane surrounding the abdominal cavity, can protrude in the shape of a sac. The intestines or fatty tissue may then slip out along with it.

Hernias have various causes. Part of the abdominal wall may fail to close properly before birth, leaving a gap. As people age, their muscles and tissues may weaken, or tissue around a surgical site may separate. In addition, the risk of developing a hernia can increase when intra-abdominal pressure remains elevated due to factors such as repeatedly straining because of chronic coughing or constipation, lifting heavy objects, pregnancy, or ascites.
Hernias are classified into several types according to where they occur. The most common type is an inguinal hernia, which develops in the groin. Other types include a femoral hernia, which occurs where the thigh meets the lower abdomen; an incisional hernia, which develops when tissue at a surgical scar weakens; and an umbilical hernia, in which the intestines or other tissue protrude through a weak area around the navel. In particular, a femoral hernia carries a higher risk than an inguinal hernia that the protruding intestine will become trapped in a narrow opening and fail to return to its original position. If this condition persists, the blood supply to the intestine can be cut off, causing tissue damage or necrosis and requiring prompt treatment.
The most typical symptom of a hernia is a lump that protrudes beneath the skin. In the early stages, the bulge is small and causes little or no pain. It often becomes more noticeable when pressure is exerted on the abdomen, such as when standing or coughing. Conversely, the bulge may disappear when the person lies down as it returns to its original position. As the hernia progresses, however, the protruding area may no longer go back in easily. If the intestine becomes trapped at the hernia site and cannot return to its original position, severe pain may occur along with nausea, vomiting, and fever.
If these symptoms recur or the bulge gradually grows larger, patients should not leave it untreated but should seek medical attention for an accurate diagnosis. Hernias are usually diagnosed through a physical examination in which the protruding area is visually inspected and palpated. Doctors also check whether the bulge becomes more pronounced when the patient coughs or strains the abdominal muscles. If a physical examination alone is insufficient or another disease must be ruled out, ultrasound or computed tomography (CT) scans may be performed.

After a hernia is diagnosed, the treatment method is determined by considering the location and size of the hernia, the condition of the abdominal wall, and the patient's overall health. The fundamental treatment for a hernia is surgery, which involves returning the protruding intestine or tissue to its original position and reinforcing the weakened abdominal wall. Surgical options include open surgery, laparoscopic surgery, and robotic surgery.
Both laparoscopic and robotic surgery involve inserting a camera and surgical instruments through small incisions, which can reduce postoperative pain and facilitate faster recovery. Robotic surgery, in particular, allows surgeons to view the operative area three-dimensionally through a high-resolution camera and precisely manipulate articulated instruments. As a result, its use in hernia surgery has recently been increasing. According to a domestic study published in the Journal of the Korean Surgical Society, the number of robotic inguinal hernia surgeries rose from 19 in 2019 to 226 in 2022.
Bong said, "A treatment plan for a hernia should be established after carefully assessing the patient's history of previous surgery and the current condition of the abdominal wall." He added, "It is important to receive treatment at a medical institution that can not only select a surgical method suited to the patient's condition but also provide systematic care, from postoperative pain management, early ambulation, and returning to daily activities to lifestyle management aimed at preventing recurrence."
Hernia recurrence after surgery also requires attention. Incisional hernias, in particular, have a relatively high risk of recurrence. According to guidelines from the European Hernia Society (EHS), the recurrence rate after incisional hernia surgery has been reported at 23–50%. Recurrent hernias can be more difficult to treat because the anatomical structure of the abdominal wall may have changed as a result of previous surgery or adhesions may have formed.
When previous surgery has made the structure of the abdominal wall more complex, robotic surgery can be useful. Its magnified view allows surgeons to distinguish normal tissue from areas with adhesions in detail, while its precise instruments can be operated even in narrow spaces. This makes it possible to dissect the necessary areas while minimizing damage to surrounding tissue. Robotic surgery can also help reconstruct the weakened abdominal wall in a stable manner by suturing the abdominal wall defect and placing surgical mesh in an appropriate position.
Bong said, "In complex hernia surgery, it is important to reconstruct the weakened abdominal wall as securely as possible while minimizing damage to surrounding tissue." He added, "Precise dissection and abdominal wall reconstruction can reduce unnecessary tissue damage during surgery, ease postoperative pain and the burden of recovery, and help patients return to their daily lives more quickly."
To prevent hernias and reduce the risk of recurrence, it is important to prevent excessive pressure from being repeatedly applied to the abdomen. People should maintain an appropriate weight and, if they strain during bowel movements because of constipation or have a persistent chronic cough, use lifestyle changes and appropriate treatment to prevent repeated increases in intra-abdominal pressure. When lifting heavy objects, it is better to bend the knees and use the strength of the legs as well, rather than relying only on the lower back and abdomen.
Bong emphasized, "A hernia is not a condition caused simply by lifting heavy objects or exerting too much force. It develops through a combination of factors that raise intra-abdominal pressure when the abdominal wall is already weakened." He added, "It is important to consistently manage the condition by reducing factors that place excessive strain on the abdomen and returning to daily activities after surgery according to the state of recovery."
 

[email protected] Jung Myung-jin, medical writer Reporter