Can It Still Be a Ventral Hernia?

I was told by my PCP that he thought I may have a "large ventral hernia" and sent me to a General Surgeon, who did an abdominal exam and says it is diastasis recti...Could it really be a hernia? The bulge is quite large and when I sit, it feels like a lump under my rib cage. I also have severe reflux, for which the surgeon gave me Nexium...Get "lump" sensation from almost all foods and reflux with waterbrash, whether it be bland like toast or spicy like tacos. Should I get a second opinion?

Doctor Answers 3

Ventral hernia or diastasis requires examination by a plastic surgeon.

With respect to your personal physician, a large abdominal bulge may indeed be a ventral hernia, and he was wise and caring to send you to a general surgeon, who has the expertise AND anatomic experience from many abdominal operations to properly make this diagnosis. I would absolutely trust your general surgeon consultant's diagnosis. However, you also have symptoms of GERD (gastro-esophageal reflux disease), which is mostly unrelated to your abdominal bulge, despite your description of "lump" sensation with most foods. Nexium is an appropriate medication choice, but you may need more than the little purple pill. I hope your general surgeon arranged for follow-up visits by him or a gastroenterologist--this is essential to keep tabs on your GERD treatment. Sometimes surgery (by a general surgeon) is needed to treat unresponsive or precancerous GERD (Yes, it's that serious!), particularly if it's longstanding.

You didn't mention your height or weight. If you are overweight, this adversely affects both GERD symptoms and your abdominal bulge, but doesn't necessarily CAUSE either. The GERD symptoms may be caused by anatomic weakness in the diaphragm near the E-G (esophageal-gastric) junction, often called a hiatal hernia. The abdominal bulge is caused by a stretching or weakness (often after childbirth or weight gain) in the abdominal wall fascia between the rectus abdominis muscles (the rectus diastasis). You should consider losing weight before any thoughts of cosmetic surgery, as this will help not only the bulge, "lump" sensation, and GERD symptoms, but will give your plastic surgeon a better starting point for abdominal wall (diastasis) repair, which can be done as part of a cosmetic tummy tuck.

BTW, if you are hoping that you can get a tummy tuck covered by insurance because you have an abdominal wall hernia, diastasis, and/or GERD, you will be disappointed. Tummy tuck is considered cosmetic, and the cost responsibility is entirely the patient's. If a ventral hernia is repaired during the course of a cosmetic operation, there might be additional costs charged by your surgeon and the facility, and a portion of these additional charges may be covered by your insurance. Don't plan on a "reduction" in your bill, as MORE work needs to be done in cases like yours, and insurance almost never covers it all. Just so you know!

At this point you may be interested in the guidance by a fully-trained, experienced, ABPS-certified plastic surgeon who has (in many cases) full training in General Surgery. Many plastic surgeons (myself included) completed full general surgery residencies, became certified by the American Board of Surgery, and went on to specialty training and American Board of Plastic Surgery certification after our plastic surgery fellowships. Even though we no longer practice general surgery (and likely do not take general surgery re-certification examinations), we still retain the knowledge and capability to deal with abdominal wall problems, including hernias, reconstructive concerns, and of course, whatever is necessary to deal with your cosmetic issues once the other important medical problems are sorted out! Best wishes!

Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

Do I have diastasis recti or a haernia.

To answer your question with any kind of validity you have to provide us with more information. Hernias in that area are usually due to previous surgery. Did you have surgery.,how many pregnancies, any twins? Diastasis is at it's widest by the belly bottom. The examination is very important to tell the difference. I think you need a second opinion may be a plastic surgeon.

Farhad Rafizadeh, MD
Morristown Plastic Surgeon
4.9 out of 5 stars 48 reviews

Can It Still Be a Ventral Hernia?

Now request a scan or sonogram of the abdomen to see if a study can determine the exact issue, hernia vs large diastasis recti. Than request another opinion. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.