DISEASE

Hernia

OVERVIEW | CAUSES | RISK FACTORS | SYMPTOMS | COMPLICATION | DIAGNOSIS | TREATMENT | PREVENTION | REFERENCES

Hernia

OVERVIEW

A hernia occurs when an internal organ or other body part protrudes through the wall of muscle or tissue that normally contains it. Most hernias occur within the abdominal cavity, between the chest and the hips.

The most common forms of hernia are:

Inguinal hernia: In men, the inguinal canal is a passageway for the spermatic cord and blood vessels leading to the testicles. In women, the inguinal canal contains the round ligament that gives support for the womb. In an inguinal hernia, fatty tissue or a part of the intestine pokes into the groin at the top of the inner thigh. This is the most common type of hernia, and affects men more often than women.
Femoral hernia: Fatty tissue or part of the intestine protrudes into the groin at the top of the inner thigh. Femoral hernias are much less common than inguinal hernias and mainly affect older women.
Umbilical hernia: Fatty tissue or part of the intestine pushes through the abdomen near the navel (belly button).
Hiatal (hiatus) hernia: Part of the stomach pushes up into the chest cavity through an opening in the diaphragm (the horizontal sheet of muscle that separates the chest from the abdomen).

Other types of hernias include:

Incisional hernia: Tissue protrudes through the site of an abdominal scar from a remote abdominal or pelvic operation.
Epigastric hernia: Fatty tissue protrudes through the abdominal area between the navel and lower part of the sternum (breastbone).
Spigelian hernia: The intestine pushes through the abdomen at the side of the abdominal muscle, below the navel.
Diaphragmatic hernia: Organs in the abdomen move into the chest through an opening in the diaphragm.

CAUSES

Inguinal and femoral hernias are due to weakened muscles that may have been present since birth, or are associated with aging and repeated strains on the abdominal and groin areas. Such strain may come from physical exertion, obesity, pregnancy, frequent coughing, or straining on the toilet due to constipation.

Adults may get an umbilical hernia by straining the abdominal area, being overweight, having a long-lasting heavy cough or after giving birth.

The cause of hiatal hernias is not fully understood, but a weakening of the diaphragm with age or pressure on the abdomen could play a part.

RISK FACTORS

All hernias are result of a combination of pressure and an opening or weakness of muscle or fascia; the pressure pushes an organ or tissue through the opening or weak spot. Anything that causes an increase in pressure in the abdomen can cause a hernia, including: Lifting heavy objects without stabilizing the abdominal muscles, diarrhea or constipation or persistent coughing or sneezing. In addition, obesity & poor nutrition can all weaken muscles and lead to hernia progression to larger size.

SYMPTOMS

A hernia in the abdomen or groin can produce a noticeable lump or bulge that can be pushed back in, or that can disappear when lying down. Laughing, crying, coughing, straining during a bowel movement, or physical activity may make the lump reappear after it has been pushed in. More symptoms of a hernia include:

Swelling or bulge in the groin or scrotum (the pouch that contains the testicles).
Increased pain at the site of the bulge.
Pain while lifting.
Increase in the bulge size over time.
A dull aching sensation.
A sense of feeling full or signs of bowel obstruction.

In the case of hiatal hernias there are no bulges on the outside of the body. Instead, symptoms may include heartburn, indigestion, difficulty swallowing, frequent regurgitation (bringing food back up) and chest pain.

COMPLICATIONS

Long standing & untreated hernia that strangulates may result in gangrene (death of tissue), which is a life-threatening condition and requires emergency surgical treatment. Symptoms of strangulation include pain, swelling, discoloured bluish or red skin, vomiting, and an inability to urinate.

DIAGNOSIS

It is usually possible to see or feel a bulge in the area where a hernia has occurred by physical exam. As part of a male’s typical physical exam for inguinal hernias, the doctor feels the area around the testicles and groin while the patient is asked to cough. In some cases, soft-tissue imaging like a CT scan will accurately diagnose the condition.

TREATMENT

If you think you have a hernia, don’t wait to seek help. A neglected hernia can grow larger and more painful — this can lead to complications and possibly emergency surgery. Early repair is more successful, less risky and offers a better recovery and outcome.

Hernias usually do not get better on their own, and surgery may be the only way to repair them. Although surgical options depend on individual circumstances, including the location of the hernia, there are two main types of surgical intervention for hernia:

Open surgery
Laparoscopic operation (keyhole surgery)

Open surgical repair closes the hernia using sutures, mesh, or both, and the surgical wound in the skin is closed with sutures, staples, or surgical glue.

Laparoscopic repair is used for repeat operations to avoid previous scars, and while usually more expensive, is less likely to cause complications such as infection.

Surgical repair of a hernia guided by a laparoscope allows for the use of smaller incisions, enabling a faster recovery from the operation.

The hernia is repaired in the same way as in open surgery, but it is guided by a small camera and a light introduced through a tube. Surgical instruments are inserted through another small incision. The abdomen is inflated with gas to help the surgeon see better and give them space to work; the whole operation is performed under general anesthetic.

PREVENTION

Maintain ideal body weight by eating a healthy diet and exercising.
Eat enough fruits, vegetables and whole grains to avoid constipation.
Use correct form when lifting weights or heavy objects. Avoid lifting anything that is beyond your ability.
See a doctor when you are ill with persistent coughs or sneezing.
Don’t smoke, as the habit can lead to coughing that triggers a hernia.