What Causes Abdominal Swelling On Standing Up?

Posted on Tue, 29 Apr 2014

Question: Hello, I'm inquiring on behalf of my father. He is 60 years old, slightly overweight by maybe 20 lbs, otherwise very fit having lifted weights all his life and played football. Four days ago he said he started feeling a lump in his stomach and that it hurts and makes him nauseous. He did no heavy lifting and no strenuous activity. He thinks its a type of hernia, since its located just above his belly button on his right side, disappears when he lies down and it can only really be felt when he is standing or tenses his abdomen. He has complained about it at others times over the last 15 years, usually it recurs after some kind of heavy stress or activity, lasts for a couple weeks to months and then disappears again. He describes the pain as similar to that of a muscle tear or getting punched in the stomach and then the ache after. The pain comes and goes, doesn't hurt when he is lying down, doesn't hurt to do situps and can't be triggered by any specific motion or action. It is not constant but lately has seemed like it is wearing him down, like a muscle injury might. He has complained of nausea and dizziness but he is also dehydrated, we are driving across the Peruvian Deserts into Chile, so I know that that is affecting him too. The "lump" is just smaller than a half a dollar, its hard to tell exact size because it doesn't protrude beyond the normal skin level and surface, you have to push into the skin to feel it in the muscle. To me feels harder than i would think a hernia would feel, I would expect it to feel softer, to me this feels more like scar tissue or dense muscle mass. So I guess my question is: is there a type of hernia that receeds and then acts up? Is it possible he has a recurring hernia that subsides without surgery? Can the abdomen wall heal and then retear in the same place having jever been operated on? Can the abdomen wall tear in such a way that it injures the muscle without creating a hernia? Are there other types of injuries to the abdomen or stomah that would fit what I have described? I got him a wide elastic belt support, intended for use after surgeries and to support the stomach after injuries. He is wearing it almost constantly. Good or bad or nuetral? We are in a third world country with no hope of advanced medical attention within the next two weeks. So, while I'm sure a standard response would be to tell us to just get it checked out, I would really appreciate an in depth analysis and any further diagnostic or treatment advice. Thank you so much. XXXXXXX

Answered by Dr. Ashish Verma (40 minutes later)

Brief Answer: its mostly a hernia only Detailed Answer: Hi XXXXXXX A swelling that reduces on lying down and reappears on standing or doing sternous activities is nothing but a hernia. During lying down the abdominal muscles relax and the content falls back inside, on standing or doing activities the intarabdominal pressure increses and it forces the contents back into the defect. Your father is mostly having an umblical or para-umblical hernia. The abdominal defect does not closes by itself anytime and the recurrent pain may be due to the content which gets trapped in the defect during activities. There are only two type of structures that can get struck there, either the bowel or the omemtum (intraabdominal fat). When omentum gets struck the pain will be less, but when the bowel gets entrapped the pain will be more severe. Moreover, in a symptomatic hernia, which is causing severe pain, activities that cause pain should noy be done. So ask your father to stop his workout till he get that repaired. Also he should avoid lifting heavy objects. That belt should be worn after lying down and the hernia has completely disappeared. Then wearing that he should get up and do his daily activities. He can remove it on lying down again. The hard lump that you had felt could be the omentum at that time. Pain occurs during activities as the abdominal muscles contract during thst time leading to narrowing of the defect and thus hampering the blood supply of the content of hernia causing its ischemia and pain. This if prolonged can lead to gangrene of the entrapped content. So avoid workout till you get it repaired. You may get an ultrasound of his abdomen on reaching back to quantify the size and location of thd defect and the content. This will help in the planning of surgical repair. Hope, i have been helpful. Dr. Ashish Verma

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Ashish Verma (19 hours later)

Hello again Dr. XXXXXXX Thank you for the detailed reply. Your explanation makes sense given what he is experiencing. Surgery is not an option for us at this time, at least for 4-6 months down the road, unless it becomes an emergency situation. So I have a few more questions, if you don't mind, that will help me a lot in managing this injury for my father. I will number them below to make it easier for you to answer: 1. Would losing weight and doing exercises to strengthen the abdominal muscles cause the opening in his abdominal wall to reduce in size thus lessening the size of the hernia? My father is overweight and thinks that if he gets serious about losing weight it will reduce the pressure on his abdomen. Situps do not cause him any pain. Also, this has been a recurring injury, most probably caused from weight lifting about 20 years ago. He will go years with no problems and then all of a sudden it will bulge out for between 1-2.5 months and then it will disappear again. 2. Is it physically possible for a hernia to naturally heal? Is the abdominal wall torn or separated and why doesnt it heal like any other muscle injury? 3. Should he eat as little as possible to avoid filling his stomach and reduce pressure on his abs? Does a full stomach effect the hernia and does it effect the intensity of pain he feels? Or is it unrelated? 4. Since surgery is a long way off, what other suggestions can you recommend that would help us safely manage this injury? Inactivity is going to be very difficult since we are doing aid work down here. Lying down is only possible at night, when we have finished driving for the day and set up the tent or find a hotel. So our options are very limited. Whatver treatments you can suggest will be very helpful. 5. Are there any concrete symptons you can tell me that would indicate he is in danger of getting gangrene in the bowel or other trapped content? Am I correct in thinking that as long as the bulge resides when he lies down, he is in no immediate danger? I am the family self taught nurse since we are far removed from professional medical help most of the time and I have medical and anatomy programs on my laptop that I use for research. So all of your advice and information will be put to intelligent use. I really appreciate whatever you can tell me and all the details. Thank you! XXXXXXX W.

Follow up: Dr. Ashish Verma (1 hour later)

Also, doctor, heat packs seem to relieve the pain and soreness. But I've read to treat hernias with ice. Which is better? Does it hurt anything to put heat on it? thank you, XXXXXXX

Answered by Dr. Ashish Verma (2 hours later)

Brief Answer: surgery is the only correction Detailed Answer: Hi XXXXXXX First a few anatomical and developmental basics. As told earlier, the hernia is in midline mostly, its either a paraumblical or umblical hernia. And in midline of the abdominal wall there are no muscles, there is just a thick fascia joining muscles of both sides, called the linea XXXXXXX In utero, before birth, the intestines of the fetus lie outside his abdominal cavity via a defect that forms the future umblicus after the intestines moves inside. This defect sometimes fails to close completely in some people, and though this defect the umblical hernia comes out. There are chances the this defect was present at birth in your father, and was too small to cause ant symptoms, as he grew up to adult size, the defect also increased in size, and following his weight lifting, due to excessive increase in intra abdominal pressure, the defect increased further to a stage to cause hernia and pain. So, with this background info, lets come to your specific queries- 1- its unlikely that continuing what has increased the severity of a condition, will help in any way. Loosing weight is not going to help as far as hernia is concerned. He can loose weight by dieting and walking, even jogging and running, but abdominal exercises are not recommended at this point of time. He can do situps, as they are for leg muscles, and are not causing him any problem with the hernia. 2- this defect is not any muscular injury, so no question of healing. It can only be repaired by surgical closure by suturing and mesh placement. 3- Eating less will help in reducing weight, but not the hernia. The increase in intraabdominal pressure by a full stomach is negligible as compared to that during weight lifting and abdominal exercise. 4- As i had told earlier, you can use the belt as i had explained, till you get the surgery done. Apply it in lying down position only, after fully reducing the hernia. 5- Pain is the only symptom you need to look for as that is the earliest. Constipation and vomiting sets in later. When ever there is increased pain in the area, make him lie down and ask him to try relax his abdomen muscles. This will help to reduce the hernia, and prevent it from going into gangrene. As long as the hernia (buldge) is reduced, i.e. its is inside the abdomen, there is no danger. But if the pain does not subsides by this, of the hernia does not reduces, then it means its gone into obstruction, and if left unattended, may go into gangrene (suggested by severe pain in touching or pressing the abdomen, along with or without constipation and/or vomiting). So surgical intervention will be needed as soon as possible. Hope, that i have answered to all your queries. If you dont have further queries, you may close this discussion and rate the response. Regards Dr. Ashish Verma

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Above answer was peer-reviewed by : Dr. Vinay Bhardwaj