External abdominal hernia refers to protrusion of peritoneum and abdominal contents through a congenital or acquired defect in the abdominal wall. Its manifestations vary with type and stage but usually share several core features.
- Visible or palpable lump
A soft bulge appears at the hernia site—most commonly the groin, umbilicus, or a previous surgical scar—and enlarges on standing, coughing, or straining; it may reduce or disappear when the patient lies down . - Local discomfort
Patients often report a dull ache, heaviness, or dragging sensation that worsens with prolonged standing or physical exertion and eases at rest . - Gastro-intestinal symptoms
When bowel is partially trapped, vague bloating, nausea, or altered bowel habits may develop. Progressive constipation or early satiety can signal chronic partial obstruction . - Incarceration signs
Sudden enlargement with constant pain, tenderness, and inability to push the mass back suggests incarceration. If accompanied by vomiting, abdominal distension, and absence of flatus, concomitant intestinal obstruction is likely . - Strangulation signs
Overlying skin becomes erythematous or dusky; pain intensifies and becomes constant; fever, tachycardia, and leukocytosis may appear. These features indicate compromised blood supply and demand emergency surgery . - Special situations
- Femoral hernias (more common in older women) are small, lie below the inguinal ligament, and carry the highest risk of incarceration .
- Umbilical hernias in adults tend to be difficult to reduce and may strangulate despite modest size .
- Incisional hernias enlarge gradually, giving a tugging sensation and, when large, secondary gastro-esophageal reflux or respiratory discomfort .
Early recognition is important: any hernia that becomes painful, irreducible, or associated with systemic features warrants immediate medical evaluation to prevent bowel necrosis and sepsis.
| Key Symptom / Sign | Description |
|---|---|
| Lump | Enlarges with effort, reduces when supine |
| Discomfort | Aching, heaviness, dragging sensation |
| GI upset | Bloating, nausea, constipation |
| Incarceration | Irreducible, tender, possible obstruction |
| Strangulation | Severe pain, red/purple skin, fever, vomiting, no flatus |
| Emergency indicators | Sudden pain, systemic signs, skin color change |