Spigelian Hernias: Causes, Symptoms, and Treatment

A Spigelian hernia is a rare type of hernia that occurs along the abdominal wall, often going unnoticed due to its hidden location beneath layers of muscle. Understanding its causes, symptoms, and treatment options is crucial for early detection and preventing complications. In this article, we'll explore what leads to Spigelian hernias, how they present, and the best ways to treat them.

What is a Spigelian Hernia?

A Spigelian hernia is a rare type of hernia that occurs along the Spigelian fascia, which is part of the abdominal wall. If you know a bit about hernias, you’ll know that common hernias protrude through well-defined openings in the abdominal muscles. A Spigelian hernia, instead of that, pushes through the thin layers of tissue between the muscles. This makes it harder to detect and diagnose, as the bulge may not always be visible on the surface.

This type of hernia typically develops along the edge of the rectus abdominis muscle, which runs vertically on either side of the midline of your abdomen. Due to its location, it often causes discomfort or pain that can be mistaken for other abdominal issues. Spigelian hernias are more likely to occur in people over the age of 50 and are more common in women than men, though they can affect anyone.

Because these hernias are rare, research on them is limited compared to other types. However, studies estimate that Spigelian hernias account for about 1-2% of all abdominal wall hernias.

What Causes Spigelian Hernia?

A Spigelian hernia occurs when there is a weakness in the Spigelian fascia (the layer of tissue in the abdominal wall). This weakness allows internal organs or fatty tissue to push through, creating the hernia. Several factors contribute to the development of this condition, many of which are related to increased pressure within the abdomen or damage to the abdominal wall.

One of the most common causes is chronic strain on the abdomen. This can happen through frequent heavy lifting, persistent coughing (as seen in conditions like chronic obstructive pulmonary disease), or regular constipation, which forces the abdominal muscles to work harder. 

Research has shown that people who are obese or overweight are also at a higher risk, as the added pressure on the abdominal wall over time weakens the tissue. 

Previous abdominal surgeries may also contribute. When the abdominal muscles are weakened from surgery, it can create vulnerable spots in the tissue. Pregnancy is another factor, particularly in women who have multiple pregnancies, as it stretches and weakens the abdominal muscles.

Aging also plays a significant role in the development of Spigelian hernias. As you age, muscle and tissue strength naturally decrease, making it easier for weak points to form. Studies estimate that most people who develop Spigelian hernias are over the age of 50, reflecting this gradual weakening over time.

Symptoms of Spigelian Hernias

Symptoms of a Spigelian hernia can often be subtle, which makes the diagnosis challenging. In typical hernias, a bulge appears on the abdomen, but since Spigelian hernias develop beneath layers of muscle, you may not see an obvious lump. This, however, does not mean you won’t face any discomfort.

One of the most common signs is pain or tenderness on one side of your lower abdomen. This pain may come and go or worsen with activities that increase pressure on your abdomen, such as lifting, coughing, or straining during bowel movements. You might also feel a sense of fullness or pressure in the affected area. Some people report that the pain becomes sharper after standing for long periods or engaging in physical activity, though it may improve when lying down.

In more severe cases, especially when the hernia traps part of the intestine (a condition known as incarceration), symptoms can become more pronounced. You may experience nausea, vomiting, and difficulty passing gas or having bowel movements. Studies have shown that incarcerated Spigelian hernias carry a higher risk of complications, such as strangulation, where blood flow to the trapped tissue is cut off, leading to tissue death. This is considered a medical emergency and requires immediate attention.

Diagnosis of Spigelian Hernias

As we mentioned above, diagnosing a Spigelian hernia can be difficult because it often doesn't present with a visible bulge, unlike other types of hernias. The hernia lies beneath layers of muscle, which means your doctor will need to rely on other methods to identify it. 

If you’ve been experiencing persistent abdominal pain or tenderness, particularly on the side of your abdomen, your healthcare provider will begin with a physical examination. However, due to the hidden nature of Spigelian hernias, a physical exam alone is often not enough to confirm the diagnosis.

Imaging tests play a crucial role in diagnosing this condition. Ultrasound is often the first choice, as it’s non-invasive and effective at revealing the presence of soft tissue abnormalities. Studies have also shown that ultrasound can accurately detect hernias that may otherwise go unnoticed during a manual exam. 

In some cases, your doctor may order a CT scan or MRI to get a clearer view, especially if the hernia is small or if other abdominal conditions need to be ruled out. 

Treatment Options for Spigelian Hernias

Treating a Spigelian hernia almost always requires surgery, as non-surgical options are rarely recommended due to the risk of complications like incarceration or strangulation. 

The first and most traditional method is open repair surgery. In this procedure, the surgeon makes an incision directly over the hernia site, allowing them to manually push the herniated tissue back into place. Once the tissue is repositioned, the opening in the abdominal wall is closed, often with the help of a synthetic mesh. 

Mesh reinforcement has become the standard in most hernia surgeries because it strengthens the area and significantly reduces the risk of recurrence. Research has shown that without mesh, the recurrence rates can be as high as 15%, but with mesh, those rates drop to around 1-3%. 

Laparoscopic surgery is the more modern and less invasive option. This procedure uses several small incisions rather than one large one, allowing the surgeon to insert a camera (laparoscope) and specialized instruments to repair the hernia. 

This type of surgery is minimally invasive, so it generally results in less postoperative pain, a shorter hospital stay, and faster recovery. However, not all patients are candidates for laparoscopic surgery, particularly if the hernia is large or if there have been previous abdominal surgeries that may complicate the procedure.

Your doctor will help determine the best surgical approach based on your specific case. In most instances, surgery offers a long-term solution, allowing you to return to your normal activities with minimal risk of recurrence. 

Complications and Risks

Spigelian hernias, while relatively rare, carry certain risks if not treated promptly. One of the most concerning complications is the potential for the hernia to become incarcerated. 

Incarceration happens when a portion of the intestine or fatty tissue becomes trapped within the hernia and cannot be pushed back into the abdomen. This can lead to severe pain, swelling, and in more serious cases, digestive issues such as constipation or the inability to pass gas. If you notice these symptoms, it’s important to seek immediate medical attention, as the situation can worsen quickly.

Another serious complication is strangulation. When a hernia becomes strangulated, the blood supply to the trapped tissue is cut off. Without proper blood flow, the tissue begins to die, which can lead to severe infections and even sepsis. Studies estimate that between 17% and 30% of Spigelian hernias present with incarceration or strangulation, which highlights the urgency of getting diagnosed and treated early. The longer a hernia goes untreated, the higher the risk of these complications.

Even after surgery, some risks remain. All surgeries carry potential complications, and hernia repair is no different. Infection at the surgical site is one possibility, particularly in open repair surgeries where the incision is larger. 

This risk is typically managed with proper postoperative care and, in some cases, antibiotics. Another postoperative risk is hernia recurrence, though the use of mesh during surgery has been shown to significantly lower this risk. 

Other complications can include chronic pain or discomfort in the area where the hernia was repaired. This can be due to nerve damage or inflammation from the surgery. Fortunately, this is relatively rare, and most people experience significant improvement once they’ve recovered from the procedure.

Prognosis and Long-term Management

The prognosis for Spigelian hernias is generally positive, especially when they are treated early. Once surgically repaired, the likelihood of recurrence is low, particularly if mesh reinforcement is used during the procedure. 

Recovery times can vary depending on whether you undergo open or laparoscopic surgery. Typically, laparoscopic surgery offers a faster recovery, with most patients resuming daily activities within a few weeks, while open repair may require a longer period of rest. Regardless of the type of surgery, it’s important to follow your surgeon’s instructions closely during the recovery phase. 

In terms of long-term management, maintaining a healthy lifestyle plays a significant role in preventing future hernias. Obesity, for example, is a known risk factor not just for developing hernias but for recurrence after surgery. A study in the American Journal of Surgery highlighted the importance of weight management and regular physical activity in reducing hernia recurrence rates. Strengthening the abdominal muscles through appropriate exercises can also provide additional support to the repaired area, though it’s essential to avoid exercises that may cause excessive strain too soon after surgery.

For those who have undergone surgery, routine follow-ups with your healthcare provider are recommended to monitor the success of the repair. Your doctor may also advise regular imaging tests, particularly if any new symptoms arise, to ensure there are no signs of recurrence.

Overall, most patients with Spigelian hernias lead normal, active lives following surgery, with minimal risk of complications. 

Prevention Tips

While it’s not always possible to prevent a Spigelian hernia, certain lifestyle changes can reduce your risk and help maintain the strength of your abdominal wall. One of the most effective ways to lower your risk is by managing your weight. 

Obesity puts extra strain on the muscles of the abdomen, weakening the tissue over time. Studies have shown that maintaining a healthy weight through balanced nutrition and regular physical activity can significantly reduce the likelihood of hernia development. If you’re already overweight, gradual weight loss can alleviate some of the pressure on your abdominal wall.

Exercise plays a key role in prevention, but it’s important to choose the right types of exercise. Strengthening your core muscles can help provide better support for your abdomen, but be cautious not to engage in activities that involve heavy lifting or excessive strain, as these can do more harm than good. 

Low-impact activities like walking, swimming, and yoga are great options to keep your body strong without putting too much pressure on the abdominal wall. 

Another factor to consider is how you manage chronic conditions that increase abdominal pressure. If you suffer from a persistent cough due to respiratory issues like chronic bronchitis, or if you have difficulty with regular bowel movements, these conditions can contribute to the development of a hernia. Treating the underlying causes of chronic coughing or constipation is essential. For instance, using proper medications to manage coughs and staying hydrated to promote healthy digestion can prevent unnecessary strain on the abdominal muscles.

If you engage in any heavy lifting—whether at the gym or in your daily life—practice safe lifting techniques. Always lift with your legs, not your back or abdominal muscles, and avoid lifting objects that are too heavy for you. The repetitive strain from improper lifting can lead to the development of hernias over time. Following these precautions can help protect your abdominal wall from excessive stress.

Ultimately, while some factors like age and genetics are beyond your control, these lifestyle adjustments can make a significant difference in reducing your risk.

If you're experiencing symptoms of a Spigelian hernia or suspect you may have one, don't wait for complications to arise. At Hernia Innovations, we specialize in providing the best hernia treatment services, using advanced techniques to ensure successful outcomes and faster recovery. Contact us today to discuss your options and take the first step toward a healthier, hernia-free life.