What Is a Ventral Hernia?

What does "ventral hernia" mean?

The word ventral simply means "front." A ventral hernia is any hernia that pushes through the front wall of the abdomen — as distinct from groin (inguinal or femoral) hernias, which push through the lower wall near the hip.

Inside the abdominal cavity, your organs and fatty tissue are contained by layers of muscle and a tough fibrous material called fascia. When a weakness or gap develops in these layers, tissue can push through — producing a lump you can see or feel, often with aching or discomfort.

There are several types of ventral hernia, each occurring at a different location on the abdominal wall. The most common in adults are umbilical hernias (at the belly button), epigastric hernias (upper midline), and incisional hernias (through old surgical scars). Less common types include Spigelian hernias and parastomal hernias.

Types of ventral hernia

Umbilical hernia

Your belly button is a natural weak point in the abdominal wall — it is where the umbilical cord once passed through. Over time, this area can weaken or reopen due to pressure from within the abdomen, multiple pregnancies, or simply ageing. Umbilical hernias are the most common type of ventral hernia in adults.

Epigastric hernia

The linea alba is a band of fibrous tissue running down the centre of the abdomen between the two sets of abdominal muscles. Small gaps can develop in this tissue between the belly button and the breastbone, allowing small pieces of fatty tissue to push through. Despite being small, these hernias are often quite painful — the tight opening grips the fatty tissue and causes localised discomfort that people sometimes mistake for a muscle or bone problem. They do not usually push back in as easily as umbilical hernias.

Incisional hernia

Incisional hernias develop at the site of a previous abdominal cut — after bowel surgery, a hysterectomy, a caesarean section, or any operation that opened the abdominal wall. They are more common than many people realise: roughly 10–20% of abdominal incisions will eventually develop a hernia at the scar. Factors that increase the risk include infection after the original operation, excess weight, diabetes, smoking, a chronic cough, and poor wound healing.

Incisional hernias range from a small, straightforward defect to very large, complex hernias where so much tissue has pushed through that the abdomen can no longer contain everything comfortably. Large incisional hernias are among the most challenging operations in general surgery to repair well.

Parastomal hernia

When a stoma (colostomy or ileostomy) is created, the bowel is brought out through the abdominal wall — and this creates a permanent weak spot at that site. Over time, the surrounding muscle and fascia can stretch, and abdominal contents can bulge around the stoma. Parastomal hernias are very common — affecting up to half of all stoma patients — and they can cause real practical problems with stoma bag fitting, leakage, and discomfort.

Spigelian hernia

A Spigelian hernia passes through a specific fibrous line at the side of the abdominal muscle. Because it often burrows under a layer of muscle rather than pushing straight outward, it may not produce a visible lump on the surface — which can make it harder to diagnose. An ultrasound or CT scan is often needed. Spigelian hernias carry a higher risk of becoming trapped than umbilical hernias and are generally repaired when found.

Why do ventral hernias form?

All ventral hernias share the same basic mechanism: a gap or weakness in the abdominal wall allows the pressure inside the abdomen to push tissue through. The things that make this more likely include:

• Previous surgery — the most important single risk factor for an incisional hernia. Scar tissue from a healed surgical incision is never as strong as the original intact fascia.
• Wound complications after surgery — infection, a blood collection (haematoma), or the wound opening up after your original operation significantly increases the chance of an incisional hernia forming later
• Being significantly overweight — this keeps the pressure inside your abdomen chronically elevated, and also makes wound healing more difficult
• Multiple pregnancies — pregnancy stretches and weakens the midline fascia and the belly button ring with each pregnancy
• A chronic cough — each cough produces a pressure spike, and if you cough repeatedly day after day, these add up over time
• Constipation and regular straining — similarly generates repeated internal pressure spikes
• Connective tissue conditions — conditions like Ehlers-Danlos syndrome affect the quality of your body's fibrous tissue throughout, including your abdominal wall
• Smoking — reduces your body's ability to make and maintain collagen (the protein that keeps tissue strong), and significantly increases the chance of incisional hernias forming after surgery

What symptoms does a ventral hernia cause?

The most recognisable symptom of any ventral hernia is a visible or felt bulge in the abdominal wall — most obvious when you stand, cough, or strain, and reduced or absent when you lie flat. Other symptoms include:

• An ache, dragging sensation, or feeling of pressure at the hernia site — often worse after standing for a long time or being active
• Sharp pain with coughing, sneezing, or lifting
• The bulge visibly enlarging when you bear down or strain
• Occasional nausea if a piece of bowel is temporarily getting caught in the hernia sac

Some hernias — particularly small epigastric or Spigelian ones — cause significant pain despite being small. Others, including some very large incisional hernias, can be surprisingly well tolerated for a long time before they start causing real problems. Every hernia is different, and how much yours bothers you does not always reflect how large or serious it is.

How is a ventral hernia diagnosed?

Most ventral hernias can be diagnosed by your surgeon examining you — feeling the lump while you stand and bearing down, which makes the hernia protrude and easier to assess.

Imaging is used when:

• The hernia is small or not clearly felt (Spigelian hernias, or early incisional hernias in people with excess weight around the abdomen)
• A CT scan is needed to understand the size and anatomy of the defect before planning a complex repair
• There is uncertainty about what the lump actually is
• The hernia is very large and the surgeon needs to assess how much of the abdominal contents have moved into the hernia

An ultrasound is a simple, non-invasive first investigation. A CT scan provides the most detailed picture of the anatomy and is usually requested before large or complex hernia repairs to plan the operation carefully.

How is a ventral hernia repaired?

Ventral hernia repair aims to gently return the hernia contents to the abdomen and close the gap in the wall, typically reinforced with a mesh. The approach depends on which type of hernia you have, how large it is, where it sits, and your overall health.

Keyhole (laparoscopic) repair is used for many umbilical, epigastric, and small-to-moderate incisional hernias. It involves two to four small cuts, a camera, and placement of mesh inside or just behind the abdominal wall. The benefits are a shorter hospital stay, less pain after surgery, and a faster return to normal life.

Open repair remains the standard for large incisional hernias, parastomal hernias, and hernias that are not suited to a keyhole approach. A single cut directly over the hernia gives the surgeon clear access to close the defect and place the mesh. Very complex cases may require additional techniques that release the abdominal wall muscles to close large gaps without putting the repair under excessive tension.

Mesh is used in the vast majority of ventral hernia repairs because it dramatically reduces the chance of the hernia coming back. You may have heard concerns about mesh — but these relate mainly to vaginal mesh in a different surgical context. Mesh used for abdominal hernia repair has an excellent long-term safety record.

When to seek urgent advice

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