Understanding Spigelian Hernia: Symptoms, Causes, and Surgical Repair
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer: What is a Spigelian hernia?
A Spigelian hernia is part of the intestine pushing through the tissue between the front abdominal muscles [1], typically causing a lump below and to the side of the belly button that appears when standing. Because of the risk of strangulation, surgery is usually recommended. Diagnosis uses an exam and often imaging, and most people do well after repair.
What the research says
Open and laparoscopic repair give similar results. In a nationwide Danish database study of 365 patients operated on for Spigelian hernia between 2007 and 2018, 80.5% had laparoscopic repair and 16.4% had emergency repair. There were no significant differences in 90-day readmission, 90-day reoperation, or later surgery for recurrence between open and laparoscopic repair, or between elective and emergency repair (Lode et al., World J Surg, 2023) [2].
These hernias are rare, and complications are a real concern. A 2023 case report summarizing the literature describes Spigelian hernias as making up 0.12% to 2.0% of all hernias, notes that diagnosis can be difficult because symptoms may be absent until complications arise, and cites figures of 24% becoming incarcerated and 27% leading to strangulation, which is why repair is recommended as soon as the diagnosis is made (Abraham et al., Cureus, 2023) [3].
Imaging helps confirm a hard-to-find hernia. A case report with a literature review recommends ultrasound as the first-line imaging test in suspected cases, with CT (including a prone-position scan in the reported case) to confirm, and prompt surgical repair to prevent subsequent strangulation (Shrestha et al., Int J Surg Case Rep, 2023) [4].
What Is a Spigelian Hernia?
A Spigelian hernia, also known as a lateral ventral hernia, is a specific type of abdominal wall defect. [1] [4] It occurs when abdominal contents, such as the small or large intestine, push through a weakened area in the Spigelian fascia. [1] [3] This is the fibrous tissue that separates the transversus abdominis muscle from the internal oblique muscle in the lower abdominal wall.
Unlike more common hernias at the belly button or groin, Spigelian hernias sit between the muscle layers. This position makes them hard to detect, because the hernia sac may stay hidden beneath the outer layer of abdominal fat or muscle, leading to a bulge that is only intermittently visible.
What are the symptoms of a Spigelian hernia?
The most recognizable sign is a lump or bulge in the lower abdomen, typically about two to three inches to either side of the belly button. The bulge is postural: it often becomes prominent when you stand up or strain but may disappear when you sit or lie down. A Spigelian hernia may also cause no symptoms at all. [1]
Symptom | Description |
|---|---|
Localized bulge | A lump 2–3 inches to the side of the midline in the lower belly |
Postural changes | The lump appears when standing and goes away when sitting or reclining |
Abdominal pain | Severe pain that comes and goes and may happen during a bowel movement or when lifting something heavy |
Tenderness | A tender spot in the lower belly to the right or left of the midline |
What causes a Spigelian hernia and who is at risk?
Spigelian hernias develop from a combination of muscle weakness and increased abdominal pressure. The transversus abdominis and internal oblique muscles can weaken as you age, and pregnancy may also weaken the abdominal muscles. [1] When these muscles are compromised, intestine can slip through the tissue that separates them. [1]
Medical conditions that increase pressure inside the abdomen can contribute. [1] These include a chronic cough (for example, from COPD), chronic constipation, liver disease that leads to ascites (fluid buildup in the belly), and obesity. [1] A direct blow to the lower belly can also lead to what is called a traumatic Spigelian hernia. [1]
Risk Factor | Impact on the Abdominal Wall |
|---|---|
Aging | Natural weakening of muscle and connective tissue over time |
Pregnancy | Stretching and weakening of the abdominal muscles |
Chronic pressure | Persistent strain from coughing (such as COPD), constipation, ascites, or obesity |
Physical trauma | A direct blow to the lower belly |
What are the possible complications of a Spigelian hernia?
Small Spigelian hernias may cause little discomfort, but large ones can cause serious problems. [1] Because the opening in the muscle wall is often narrow and firm, protruding tissue can become trapped, a condition called incarceration. A hernia can also grow large enough to block the intestine (bowel obstruction). [1]
The most dangerous complication is a strangulated hernia, in which the blood supply to the trapped intestine is cut off. Without blood, intestinal tissue starts to die (mesenteric ischemia) [1], and this is a medical emergency. Warning symptoms include sharp belly pain that comes in waves, a swelling sensation in the lower belly, severe constipation, nausea and vomiting, and redness or darker skin over the lump. [1] If you have these symptoms, call 911 or go to the emergency room. [1]
How is a Spigelian hernia diagnosed and treated?
Providers begin with a physical examination. [1] They may ask you to stand or stretch while standing to look for a bulge that goes away when you sit [1], or guide you through a Valsalva maneuver (taking a breath and bearing down as if having a bowel movement) to make the hernia visible. Because these hernias can be deep, imaging such as a CT scan or abdominal ultrasound is often used, and a laparoscopy may be done to confirm the diagnosis.
Hernia repair surgery is the standard and most common treatment. The surgeon pushes the intestine back into place and repairs the weakened muscle wall. [1] The repair may be open, laparoscopic, or robotic [1] [3], and your surgeon will discuss which option suits you. Like all surgeries, hernia repair can cause complications such as hematomas (blood collecting under the skin), seromas (fluid collecting at the surgery site), injury to nearby tissue, organs, or blood vessels, and surgical site infection. [1]
What is the outlook and recovery after Spigelian hernia repair?
For most people, surgery to repair the hernia resolves the problem. [1] Additional surgery may be needed if the hernia has caused complications. [1] Your surgeon will advise you on when to resume lifting and strenuous activity, which is usually restricted while you heal.
Surgery resolves the current hernia, but it is possible to develop another Spigelian hernia, so contact your provider if you have severe belly pain or a spot in your lower belly that is painful to touch. [1] Managing pressure-related risk factors such as chronic constipation, chronic cough, and obesity is also important.
Conclusion
Spigelian hernias are rare but need prompt medical attention because of their potential for serious complications. Recognizing the key sign, a side-belly bulge that changes with posture, is the first step toward effective management. With modern surgical techniques, most people recover well and the risk of an emergency is reduced.
What are the next steps if you have a Spigelian hernia?
If you notice an unusual lump or persistent pain in your lower abdomen that changes when you stand or move, schedule an appointment with a healthcare professional. Early diagnosis and planned surgical repair are the best ways to prevent a sudden medical emergency.
Related reading on Rinnit: Hernia Repair Surgery: Procedures, Recovery, and Outcomes
Frequently Asked Questions
Is a Spigelian hernia a medical emergency?
Not always, but it can become one if the intestine gets trapped or loses its blood supply (strangulation). Call 911 or go to the emergency room for sharp, wave-like belly pain, severe constipation, nausea or vomiting, or redness or darker skin over the lump.
Can a Spigelian hernia go away on its own?
No. A hernia is a physical defect in the muscle wall and will not heal without surgical repair.
Why does my lump disappear when I lie down?
When you are horizontal, pressure inside your abdomen falls and the protruding tissue can slip back inside the abdominal wall. The bump typically appears when you stand and goes away when you sit or lie down.
How is a Spigelian hernia different from an inguinal hernia?
An inguinal hernia occurs in the groin area, while a Spigelian hernia occurs higher up, on the side of the lower abdominal wall.
What is the Spigelian fascia?
The Spigelian fascia is the layer of fibrous tissue that separates the transversus abdominis and internal oblique muscles, where this type of hernia occurs.
Can pregnancy cause a Spigelian hernia?
Pregnancy may weaken the abdominal muscles, which can raise the risk.
What tests are used to find a Spigelian hernia?
Doctors start with a physical exam and often use CT scans or an abdominal ultrasound, because these hernias can sit deep within the muscle layers and be hard to see. A laparoscopy may be used to confirm the diagnosis.
Is surgery the only treatment?
Hernia repair surgery is the standard and most common treatment. Because of the risk of incarceration and strangulation, repair is usually recommended once the hernia is diagnosed.
What is robotic hernia repair?
Robotic hernia repair is a minimally invasive approach in which the surgeon uses a robotic system to perform the repair through small incisions. Repair may also be open or laparoscopic, and your surgeon will discuss your options.
How long is the recovery after surgery?
It depends on the type of repair and your overall health. Your surgeon will tell you when it is safe to resume lifting and strenuous activity.
Can a Spigelian hernia come back after surgery?
Surgery usually takes care of the problem, but it is possible to develop another Spigelian hernia.
Does a Spigelian hernia always cause pain?
No. Small Spigelian hernias may not cause painful symptoms, and some people only notice a bulge.
What is a lateral ventral hernia?
Lateral ventral hernia is another medical term for a Spigelian hernia, referring to its location on the side (lateral) of the front (ventral) abdominal wall.
Can obesity increase the risk?
Yes. Obesity increases pressure inside the abdomen, which can strain and eventually weaken the abdominal wall.
What should I avoid if I have a Spigelian hernia?
Avoid heavy lifting and activities that cause significant abdominal straining until you have talked with a surgeon.
References
Cleveland Clinic. Spigelian hernia. Cleveland Clinic. November 19, 2024. https://my.clevelandclinic.org/health/diseases/spigelian-hernia
Lode L, Jensen KK, Helgstrand F, et al. Outcomes after Spigelian hernia repair: a nationwide database study. World J Surg. 2023;47(5):1184–1189. PMID 36749361. https://doi.org/10.1007/s00268-023-06923-8
Abraham BT, Sheikhaden H, Lee JW, et al. Robotic ventral transabdominal preperitoneal repair of uncomplicated Spigelian hernia. Cureus. 2023;15(1):e34441. PMID 36874649. https://doi.org/10.7759/cureus.34441
Shrestha G, Adhil I, Adhikari SB, et al. Spigelian hernia: a rare case presentation and review of literature. Int J Surg Case Rep. 2023;105:108079. PMID 37003234. https://doi.org/10.1016/j.ijscr.2023.108079
Medical Disclaimer
This article is for informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
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