Spigelian Hernia: The “Hidden” Side-Belly Hernia
Published on: 8/Oct/2025
Posted By: Arka Health
Introduction: That Vague, Nagging Pain on the Side of Your Belly
You feel a sharp, localized pain on the side of your abdomen, especially when you cough, lift something, or stand for a long time. You look for a bulge, but there’s nothing there. The pain comes and goes, leaving you confused and concerned. For many in Bengaluru, this mysterious discomfort is often mistaken for a muscle strain or another internal issue. However, it could be a rare and tricky type of hernia known as a Spigelian hernia.
Unlike more common hernias that create an obvious lump, a Spigelian hernia is often called the “hidden” hernia because of its unique location deep within the abdominal wall. It is a rare condition, accounting for only 0.12% to 2% of all abdominal wall hernias, but its stealthy nature makes it important to understand.1 Because it won’t heal on its own and carries a high risk of complications, getting an accurate diagnosis and timely treatment is crucial.
This guide will explain why a Spigelian hernia is so hard to spot, the role of imaging in diagnosis, and the basic treatment path. For those in Bengaluru seeking definitive answers and expert care, ARKA Anugraha Hospital stands as a premier institution, formally recognized as a ‘Centre of Excellence in Hernia Surgery’ by both the Asia Pacific Hernia Society and the Hernia Society of India. We are dedicated to providing not just advanced surgical solutions, but a holistic and integrative path to a full recovery.
Why It’s Hard to Spot: The Anatomy of a “Hidden” Hernia
The main reason a Spigelian hernia is so difficult to identify is its location. It doesn’t pop out just under the skin like other hernias.
What Makes a Spigelian Hernia Different?
A Spigelian hernia is a type of lateral ventral hernia, meaning it occurs on the side of the abdominal wall. It forms through a defect in a specific layer of connective tissue called the Spigelian fascia, which is located between two groups of abdominal muscles. Because it develops between muscle layers rather than through all of them, the hernia sac often spreads out internally instead of creating a distinct, visible bulge on the surface.
This hernia typically occurs in an area known as the “Spigelian hernia belt,” a band on the lower abdomen to the side of the belly button. This unusual positioning is why many people experience pain without a palpable lump.
Typical Spigelian Hernia Symptoms to Watch For
Since a visible bulge is often absent, it’s important to pay attention to other Spigelian hernia symptoms.
- Localized Abdominal Pain: The most common symptom is a sharp or dull pain on one side of the lower abdomen. This pain often worsens with activities that increase abdominal pressure, like coughing, lifting, or straining during a bowel movement.
- A Tender Spot: You may feel a tender spot on your lower belly, to the right or left of your midline.
- An Intermittent Bulge: In some cases, especially in thinner individuals, a small, soft lump may appear when standing or straining and then disappear when lying down.
- Changes in Bowel Function: If the hernia involves the intestine, it can lead to symptoms like constipation or changes in stool.
When a Spigelian Hernia Becomes an Emergency
A Spigelian hernia has a high risk of becoming “incarcerated” (trapped) or “strangulated” (when the blood supply to the trapped tissue is cut off). This is a life-threatening medical emergency.
Seek immediate medical attention if you experience:
- Sudden, severe, and worsening abdominal pain.
- Nausea and vomiting.
- Fever.
- The hernia bulge (if present) becomes firm, tender, or changes color to red or purple.
- You are unable to pass gas or have a bowel movement.
The Crucial Role of Imaging in Spigelian Hernia Diagnosis
Because the symptoms can be vague and a bulge is often absent, a Spigelian hernia diagnosis can be challenging with a physical exam alone.10 This is where advanced imaging plays a vital role.
Why a Physical Exam May Not Be Enough
An experienced surgeon will perform a physical exam, checking for tenderness or a bulge while you are standing and asking you to cough or strain (a Valsalva maneuver) to increase abdominal pressure.10 However, because the hernia is hidden between muscle layers, it may not be palpable, especially in patients with more body fat. If clinical suspicion is high but the exam is inconclusive, imaging is the next step.
Advanced Imaging for a Definitive Diagnosis
To confirm a Spigelian hernia diagnosis, your doctor will likely order an imaging test:
- Ultrasound: This is often the first-line imaging modality. It is a simple, non-invasive test that uses sound waves to create images of the abdominal wall. An ultrasound is most effective when performed while you are standing or straining to help visualize the hernia.
- Computed Tomography (CT) Scan: A CT scan is the most reliable imaging study for diagnosing a Spigelian hernia. It provides detailed cross-sectional images of the abdominal wall, clearly showing the hernia defect and identifying what tissues are protruding through it (such as fat or bowel).
In some rare cases, a diagnostic laparoscopy (a minimally invasive surgical procedure) may be used to both find and repair the hernia at the same time.
The Basic Treatment Path: Repairing a Spigelian Hernia
Unlike some other hernias where a “watchful waiting” approach might be considered, surgery is the recommended treatment for a Spigelian hernia in nearly all cases.
Why Surgery is Advised
Due to the narrow and rigid nature of the defect in the Spigelian fascia, this type of hernia has a high risk of incarceration and strangulation. To prevent these dangerous complications, surgeons advise repairing the hernia soon after it is diagnosed.
A Simple Overview of Repair Options
The goal of surgery is to return the protruding tissue to the abdomen and repair the weak spot in the muscle wall.
- Open Surgery: In a traditional open repair, the surgeon makes a single incision over the hernia site to directly access and fix the defect.1 This method may be used for larger or more complex hernias.
- Laparoscopic (Minimally Invasive) Surgery: This is often the preferred approach. The surgeon makes a few small “keyhole” incisions and uses a laparoscope (a thin tube with a camera) and specialized instruments to perform the repair from inside the abdomen. This technique offers significant benefits, including less post-operative pain, smaller scars, and a faster recovery.
- Robotic Surgery: This is an advanced form of laparoscopic surgery where the surgeon controls robotic arms from a console, allowing for enhanced precision and control, especially for complex repairs.
In most modern repairs, a sterile surgical mesh is used to reinforce the weakened area. This provides a strong, durable repair and significantly reduces the risk of the hernia returning.
Expert Spigelian Hernia Treatment in Bangalore: The ARKA Anugraha Advantage
When dealing with a rare and complex condition like a Spigelian hernia, the expertise of your surgical team is paramount. In Bengaluru, ARKA Anugraha Hospital is a premier institution for hernia care, formally recognized as a ‘Centre of Excellence in Hernia Surgery’.
Our surgical center is led by Dr. M. Ramesh, a pioneer in laparoscopic surgery with over 40 years of experience, and supported by a world-class team specializing in advanced minimally invasive techniques. This focus on laparoscopic and robotic repair means our patients benefit from smaller incisions, less post-operative pain, and a significantly faster return to their daily lives, often with a hospital stay of less than 24 hours.
What truly distinguishes ARKA Anugraha Hospital is our unique integrative and functional medicine approach. We understand that surgery is just one part of the healing journey. Our philosophy is to treat the whole person, not just the hernia. We support our surgical patients with:
- Holistic Pain Management: We go beyond standard pain medication, integrating evidence-based therapies like acupuncture and guided meditation to minimize post-surgical discomfort.
- Nutritional Optimization: Our team provides nutritional guidance to support your body’s natural healing processes and prevent issues like constipation that can strain the surgical repair.
- Personalized, Compassionate Care: From your initial consultation for a Spigelian hernia diagnosis to your final follow-up, our dedicated team provides care that is tailored to your individual needs, ensuring you feel supported every step of the way.
Frequently Asked Questions (FAQ)
Q1: Is a Spigelian hernia dangerous?
A: Yes, a Spigelian hernia is considered more dangerous than other common hernias because it has a high risk of strangulation, where the blood supply to the trapped tissue is cut off. This is a medical emergency, which is why prompt surgical repair is almost always recommended.
Q2: Why can’t I feel a lump with my Spigelian hernia?
A: A Spigelian hernia forms between layers of abdominal muscle, rather than pushing directly out through the fat layer under the skin. This means the bulge is often “hidden” internally, causing pain without a visible or palpable lump on the surface.
Q3: Is surgery always necessary for a Spigelian hernia?
A: Yes. Due to the high risk of complications like bowel obstruction or strangulation, “watchful waiting” is not recommended. Surgical repair is the mainstay of treatment to prevent a potential emergency.
Q4: What is the recovery time for a laparoscopic Spigelian hernia repair?
A: Recovery is generally quick with minimally invasive surgery. Most patients can return to light activities and desk work within one to two weeks. Strenuous activity and heavy lifting should be avoided for about four to six weeks to allow the repair to heal fully.
Q5: Why should I choose ARKA Anugraha for Spigelian hernia treatment in Bangalore?
A: ARKA Anugraha Hospital is an accredited ‘Centre of Excellence in Hernia Surgery’. We offer world-class expertise in diagnosing and treating rare hernias like the Spigelian hernia, specializing in minimally invasive laparoscopic and robotic surgery for less pain and a faster recovery. Our unique integrative medicine approach supports your entire healing journey with holistic pain management and personalized care plans.
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