A hernia is a bulge or protrusion through a weakness or an opening. An inguinal hernia is one that occurs in the groin where the abdomen meets the hips and usually involves tissue, fat and sometimes intestines pushing through the opening.

Inguinal hernias are much more common in men, at a rate of eight to one. They can occur at any age, from infants to the elderly. They become more common as we age.

How to treat a hernia

Inguinal hernias are common and treatment is usually straightforward, particularly if it is done early.

Your GP can organise an ultrasound to diagnose your inguinal hernia. It is best to have your inguinal hernia repair done before it becomes an emergency. This is usually a day procedure and sometimes you return home on the same day.

Further resources & patient information about inguinal hernias

Inguinal hernias: Causes, Symptoms and Treatment – Patient.info

Inguinal hernia – Health Direct

Laparoscopic Inguinal Hernia Repair – Medscape

When people come to see the doctor with abdominal pain, often they are worried it could be Appendicitis. So how do you know if you have Appendicitis? Here are a few tell-tale signs that doctors look out for. But first, what exactly is Appendicitis?

What is the Appendix and what does it do?

• The appendix is a small worm-like tubular structure that extends from the start of the large intestine (the caecum), which in most people is situated in the lower right side of the abdomen (tummy).
• The appendix does not appear to have any important functions in modern-day humans. However, in other mammals, the appendix still has a role in the digestion of food- so it may have had a similar purpose for our human ancestors.

What will a doctor pick up on examination?

Certain findings on examination may suggest Appendicitis.

• Fever
• The tummy may feel hard or rigid
• “guarding”- this means that when the doctor presses on your tummy the abdominal muscles involuntarily tense up. It’s a sign of inflammation.
• Rebound tenderness- this means that when the doctor presses on the tummy the pain gets suddenly worse just as they take their hand away.
• Rovsing’s sign- this means when the doctor presses on the left side of the tummy, the pain is still felt on the right (the side of the appendix)

However, symptoms and examination findings can vary a lot from one person to another.

If your doctor suspects Acute Appendicitis, they’ll usually recommend you go immediately to hospital, as it needs to be treated as an emergency.

 What are the complications of Appendicitis?

• Perforation- if the appendix gets very inflamed it can burst or rupture, allowing bugs to enter the abdominal cavity, leading to serious infection known as “peritonitis”.
• Sepsis- if bacteria enter the bloodstream , it can cause serious infection throughout the body, with fevers, chills and low blood pressure, shock and even death.
• Abscess formation- some people may develop an abscess (a collection of pus) around the appendix

What is the treatment for Appendicitis?

• In most cases, an operation is urgently required- this is called an Appendicectomy or Appendectomy- it involves the appendix being removed.
• It may be done by keyhole surgery, but sometimes “open” surgery through a larger incision is needed.
• If there has been perforation, a drain may be placed, to allow the infection to pass out of the abdomen after the surgery.
• Intravenous antibiotics can also be used as treatment, particularly if someone is to weak or frail to have an operation- but in most cases surgery is required.

If you have concerns about Appendicitis or think you have symptoms of Appendicitis, you should see a doctor urgently.

Further Patient Resources:

Appendicitis. betterhealth.vic.gov.au

Appendicitis. mayoclinic.org

Article Resources:

Shogilev D et al. 2014. Diagnosing Appendicitis: Evidence Based Review of the Diagnostic Approach in 2014

We all get abdominal aches and pains now and then- most of the time it’s nothing much to worry about and gets better by itself.  However, certain causes of tummy pain can indicate a serious underlying problem and shouldn’t be ignored:

Ectopic Pregnancy

• An ectopic pregnancy is when a fertilised egg implants outside the uterus- in a fallopian tube, ovary or elsewhere in the abdomen.
• As the pregnancy grows, it can cause serious complications including internal bleeding- which, if not diagnosed quickly, can lead to death.
• The pain tends to be sharp and located low in the tummy, often to the left or the right side.
• There may be abnormal vaginal bleeding, but usually not.
• A woman may be a few days late for a period, but not necessarily.
• Any woman who is sexually active and develops lower abdominal pain that is not settling should see a doctor as soon as possible- particularly if her period is late, the pain is sharp or getting worse, or if she is feeling weak and unwell.
• Quick diagnosis of ectopic pregnancy is extremely important. Treatment can involve medication or surgery.

Ovarian Cysts

• Sometimes women can develop a cyst on their ovary.
• There are several different types of ovarian cysts, and some women can be quite  prone them ( e.g if they have PCOS or endometriosis).
• Whilst ovarian cysts may be have no symptoms, pain can occur  if they twist, rupture or get big enough to place pressure on other organs.
• The pain tends to be low down in the pelvis on the affected side.  
• Symptoms can be quite similar to appendicitis or an ectopic pregnancy, so immediate medical attention should be sought.

Of course, there are many many other causes of tummy pain- we’ve just gone through some important types that are particularly relevant to women. If you have concerns about abdominal pain, be sure to speak to a doctor as soon as possible.

Further resources

www.nhs.uk