A Spigelian hernia occurs when tissues or organs push through a space in the lower abdominal muscles, creating a bulge. This area is called the Spigelian fascia.
Spigelian hernias are very rare and mostly develop in women. They're often difficult to diagnose and can cause serious complications.
Surgery can repair Spigelian hernias. At UPMC, we provide expert diagnosis and treatment for this rare condition.
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What Is a Spigelian Hernia?
A Spigelian hernia occurs when tissues or organs push through a space in the abdominal muscles, called the Spigelian fascia. When this occurs, it creates a lump below and to the side of the belly button.
Spigelian hernias are sometimes called lateral ventral hernias.
Spigelian hernias are more common in women. They often occur in older women whose abdominal muscles have weakened with age, creating space where tissues and organs can bulge.
This type of hernia is extremely rare, accounting for less than 2% of all hernias. They are also more likely than other types of hernias to become incarcerated, or stuck. Doctors estimate that up to 27% of Spigelian hernias end up incarcerated.
An incarcerated hernia can become strangulated, which cuts off the blood supply and can lead to dead tissue or a blocked intestine. It’s a life-threatening condition that requires emergency surgery. For this reason, doctors often recommend surgery for Spigelian hernias, even when they are small and causing little discomfort.
What are the types of Spigelian hernias?
Spigelian hernias can be classified into two types:
- Interstitial — This type of Spigelian hernia pushes beyond the internal oblique muscles but stays below the external oblique muscles. Oblique muscles run alongside the belly. Interstitial Spigelian hernias are often harder to diagnose because the hernia can’t always be seen or felt through the muscle.
- Subcutaneous — This type of Spigelian hernia pushes beyond both the internal and external oblique muscles. It creates a visible bump.
How common are Spigelian hernias?
Spigelian hernias are very rare. They make up less than 2% of all hernias.
What causes a Spigelian hernia?
A Spigelian hernia happens when tissues or organs push through a space in the lower abdominal muscles, slightly below and to the side of the belly button. Often, this is due to weak abdominal muscles.
Spigelian hernias are more likely to happen as you age and your muscles weaken.
Spigelian hernia risk factors
Anyone can develop a Spigelian hernia, but they are much more likely if:
- You are a smoker with a chronic cough.
- You are a woman.
- You are an older adult.
- You are obese.
- You have ascites, a buildup of fluid in the abdomen caused by liver cirrhosis or kidney failure.
- You’ve had multiple pregnancies.
Spigelian hernia complications
Spigelian hernias are usually small and cause little discomfort. In fact, you may not realize you have a Spigelian hernia until it starts causing you pain.
Your provider is likely to recommend surgery to repair the hernia right away. That way, you can avoid complications.
Doctors estimate that about a quarter of Spigelian hernias will become stuck and strangulated. Strangulation cuts off the blood supply and can result in dead tissue or a blocked intestine. This condition is an emergency.
You should see a doctor immediately if you experience the following symptoms:
- Nausea or vomiting.
- Redness around the hernia.
- Severe constipation.
- Sharp pain in your abdomen.
- Swelling in the abdomen.
How can I prevent a Spigelian hernia?
You can’t prevent a Spigelian hernia. But you can reduce your risk of developing one by strengthening your abdominal muscles and avoiding activities that put pressure on your belly.
Some measures your provider may recommend include:
- Lifting heavy objects with proper form to prevent twisting or straining.
- Maintaining a healthy weight.
- Strengthening your abdominal muscles, especially the oblique and rectus abdominus muscles.
- Stopping smoking to reduce your chances of chronic cough.
What Are the Signs and Symptoms of Spigelian Hernia?
- Discomfort or tenderness in the belly, usually located slightly below and to the side of the belly button.
- Severe pain in the abdomen, especially when you’re doing an activity that puts pressure or strain on your abdominal muscles.
When should I see a doctor about my Spigelian hernia symptoms?
If you notice a lump or tenderness in the belly, you should make an appointment with your provider. Spigelian hernias are rare, but they're more likely than other hernias to have complications.
Sometimes, a hernia can get stuck or strangulated, which cuts off blood supply. It requires emergency surgery. This issue is more common with Spigelian hernias.
See a doctor right away if you have any of the following symptoms:
- Nausea or vomiting.
- Redness around the hernia.
- Severe constipation.
- Sharp pain in your abdomen.
- Swelling in the abdomen.
How Do You Diagnose Spigelian Hernia?
Spigelian hernias are rare and often complicated to diagnose. That’s because the hernia can “hide” behind the outer oblique muscles, making it difficult to see or feel.
The pain can also be mistaken for other conditions. Your doctor is likely to order tests to make a correct diagnosis.
Tests to diagnose Spigelian hernia
- CT scan — A CT scan uses a series of x-rays to create a three-dimensional image of the tissues and organs in your abdomen. It is painless and noninvasive.
- MRI — An MRI uses a powerful magnetic field to create a detailed image of your tissues and organs. It is painless and noninvasive.
- Ultrasound — An ultrasound uses sound waves to create an image of your tissues and organs. It is painless and noninvasive.
How Do You Treat a Spigelian Hernia?
Surgery for Spigelian hernia
Surgery is the only way to repair a Spigelian hernia.
Typically, your doctor will use one of two surgical methods to repair your hernia:
- Laparoscopic surgery — In this type of minimally invasive surgery, your doctor will make several small incisions in your abdomen and use tiny instruments and a camera to repair your hernia. Laparoscopic surgery usually means less pain and faster healing time.
- Open surgery — Large or more complicated hernias may need open surgery. In this type of surgery, doctors make one long incision in your abdomen to repair the hernia. They close the incision with stitches or surgical mesh.
What happens during surgery for Spigelian hernia?
Most hernia surgeries take place in a hospital under general anesthesia. You many need to stop eating, drinking, and taking certain medications in the hours before your surgery.
Smoking increases your risk of infection after hernia surgery. Your doctor may recommend quitting in the weeks before surgery.
During surgery, your doctor will:
- Push the bulging tissue or organ back into place.
- Repair the weak spot in your muscle wall.
- Use surgical mesh to strengthen the muscle wall and prevent another hernia. Mesh is not used in all cases but is common for Spigelian hernias to reinforce the weakened muscle.
Depending on the type of surgery you undergo, you may need to stay in the hospital for a night or two.
Pain at the incision site is common. You can typically manage the pain with over-the-counter pain medications like acetaminophen or ibuprofen. Pain usually goes away in about 72 hours.
You should call your doctor right away if you experience any of these symptoms after your hernia surgery:
- Abdominal pain and swelling.
- Continuous vomiting.
- Fever.
- Foul-smelling or pus-like drainage from your incision.
- No bowel movements after two to three days.
- Pain that gets worse and cannot be controlled with medication.
- Swelling, redness, or bleeding near the incision site.
Is hernia surgery the right treatment for my Spigelian hernia?
Surgery is the only way to fix a Spigelian hernia. Doctors almost always recommend speedy surgery. That's because Spigelian hernias are more likely to cause complications than other types of hernias.
People who smoke, have diabetes, or are overweight have an increased risk of complications after hernia surgery. If you have these health concerns, you should speak with your doctor about whether hernia surgery is right for you.
How long does it take to recover after surgery for a Spigelian hernia?
You may be able to resume light activity after a few days, but full recovery takes several weeks. Your doctor will give you specific postoperative instructions.
Why Choose UPMC for Hernia Surgery?
UPMC provides expert care for all hernia types.
At UPMC, you can expect:
- Access to new and innovative treatment — Nearly all our surgeons participate in clinical or laboratory research. Their discoveries ensure that patients receive the latest treatments using the most advanced techniques.
- Care close to home — At UPMC, we provide care to patients at hospitals and outpatient care sites across Pennsylvania, New York, and Maryland. That means you never have to travel far to receive the world-class care you need.
- Top doctors — Our multidisciplinary team of surgeons and specialists is available around the clock to diagnose and treat patients with the most advanced care available. All our surgeons are certified by the American Board of Surgery. Many are nationally renowned for the comprehensive care they provide patients.
