I have some pain in my lower abdomen and yesterday I noticed a swelling. The pain has been there for two days now. My housemate says it could be hernia. It gets more painful. What is hernia and how do I treat it? Peter

Dear Peter,

How old are you? Have you been operated on in the lower abdomen? Does the swelling reduce when you touch it and is it aggravated while coughing or lifting a heavy object?

Hernia is protrusion of an organ or tissue through an opening. Mostly, it occurs in the abdomen.

Weakening of the abdominal wall due to old trauma or surgery, commonly leads to incisional hernia, that is, herniation of the bowels through the scar in the abdomen. Lifting heavy weights, strain on the abdominal muscles like in chronic cough or constipation, are other factors that precipitate and augment hernia. Pregnancy, obesity, and collagen vascular disease, are other risk factors. Genetics also plays a small part.

Inguinal hernia occurs in the groin, is more common in infants and elderly men. Femoral hernia also occurs in the groin, more in women.

Typically, there is a soft swelling at the site of hernia, which is augmented while coughing or straining and is usually painful. It is reduced in size, when the abdominal muscles are relaxed, as in lying down, unless only if it is severe or is obstructed. Apart from the discomfort, there is risk of strangulation of the bowel in hernia, which is a surgical emergency to prevent death. Hernia is easily detected by physical examination, Treatment is by surgery.

However, there can be other causes for swelling in the lower abdomen. Enlargement of lymph nodes in that region can cause a soft to firm swelling. It resolves after treatment of infection/malignancy, causing enlarged lymph nodes. Lipoma (fatty swellings), enlargement of veins in that part, undescended testes, hydrocele, are other conditions that can present as swelling in the lower abdomen. An abscess will manifest as painful swelling with or without fever. These can be diagnosed by clinical examination and scans and are all treatable.

Tumours can be a serious condition causing a swelling in the lower abdomen. A biopsy can help determine, whether it is benign or malignant and treatment will depend on results of scans and biopsy.