A spigelian hernia usually has minimal symptoms, with dull and intermittent pain in the lower abdomen being the most common. Diagnosing the condition may take time, as the symptoms can be vague and it may be challenging to figure out what is causing them. Treatment is usually surgery to repair the herniation and prevent strangulation, where part of the bowel becomes trapped in the hernia and dies as a result of not getting enough blood. This surgery can be performed by a general surgeon or a hernia repair specialist and is usually not an emergency procedure.
In a spigelian hernia, part of the muscle wall of the abdomen separates. Some patients have a small empty sac in the separated space, while in others, a loop of bowel may slip through. Sporting activities, strain, pregnancy, existing weak spots, and severe coughing or vomiting can all be potential causes of a spigelian hernia. Initially, the patient may notice a lingering dull ache in the area, sometimes interrupted with more sharp pain during bends, twists, and heavy lifting.
Patients may also develop bowel irregularities in some cases, experiencing diarrhea, constipation, or changes in stool color. People with well developed musculature and minimal abdominal fat sometimes see a small bump where the hernial sac is located, and it is also possible to palpate a soft mass in the abdominal wall. This mass will often move with pressure and can appear intermittent in nature. All of these signs of a spigelian hernia can be helpful diagnostic clues, and a medical imaging study will be requested to look at the abdominal wall and see if a hernia can be identified.
In some cases, bowel strangulation occurs, leading to significant abdominal pain, changes to the stool, and issues like nausea and vomiting. If a strangulation develops, surgery to correct it is required immediately to remove the diseased section of bowel before infection and other complications set in. During the surgery, the hernia will also be repaired to prevent future strangulation.
This type of hernia is relatively rare and can occur in people of all ages. In spigelian hernia repair surgery, a doctor will place mesh across the tear, preventing the contents of the abdomen from protruding through the herniation. This also gives the tissue a chance to knit back together, sealing the tear, and the mesh will prevent future herniation in that location. Patients can experience high postoperative pain, and they will need to refrain from heavy physical activity for several weeks after the surgery to give the site time to heal.