"I just can't do that anymore": a qualitative exploration of symptoms and function in patients living with abdominal...

Abdominal Wall Hernia (AWH) is a structurally and functionally disruptive condition often assessed through objective clinical variables such as position, size, reducibility, skin changes, and symptoms of obstruction suggesting the need for urgent treatment. However, little attention has been given to explore all the symptoms experienced. Many Health-Related Quality of Life (HRQoL) tools fail to capture the nuances of lived experience, especially around pain, restriction, and behavioural response. This study provides a qualitative examination of the symptomatology and functional impact of AWH as described from the patient's perspective.

This phenomenological study draws on 15 semi-structured interviews with patients living with AWH. Participants were sampled purposively across a spectrum of hernia complexity (VHWG grades 1-4). Transcripts were analysed using Interpretative Phenomenological Analysis (IPA) to generate superordinate and subordinate themes concerning symptoms and functional impact. Data analysis was triangulated between qualitative and surgical researchers.

The analysis revealed a superordinate theme of "Symptoms and Function," with three distinct but overlapping subordinate domains: management of pain, freedom of movement, and restriction and adaptation. Participants described persistent background pain, episodic sharp exacerbations, and visceral sensations (e.g., bloating and urinary urgency). Anticipatory vigilance shaped movement planning, with participants choreographing basic tasks and progressively surrendering valued activities across both leisure and employment. Restriction triggered inventive adaptations, including custom abdominal binders and adjusted routines.

AWH imposes a diffuse, dynamic and difficult burden on patients' bodies and lives, extending far beyond the anatomical boundaries typically measured in clinical practice. Participants described a constellation of physical symptoms, including pain, visceral discomfort, and movement restriction. Our findings highlight that functional limitation in AWH is a biopsychosocial phenomenon. These experiences resonate with pain-psychology frameworks and demonstrate the limitations of reductionist surgical assessments. Effective interventions must match the complexity of lived experience, combining surgical, psychological, and rehabilitative strategies.