What is hernia?
A hernia occurs when an organ pushes through an opening in the muscle or tissue that holds it in place.
- An abdominal hernia occurs when an organ or other piece of tissue protrudes through a weakening in one of the muscle walls that encloses the abdominal cavity.
- A hernia usually shows up as a bulge in the abdomen, upper thigh, belly button and groin areas.
What are the different types of hernia?
- Inguinal hernia – The most common type of hernia; it’s more common in men than women. This is because a man’s testicles descend through the inguinal canal shortly after birth, and the canal is supposed to close almost completely behind them. It develops in the inner groin region (inguinal canal).
- Incisional hernia – Can occur from previous incision (after you’ve had an abdominal surgery).
- Femoral hernia – Can occur in outer groin region.
- Umbilical hernia – Can occur in children and babies under 6 months old at abdominal wall near the bellybutton/navel.
- Hiatal hernia – Can occur when the upper stomach squeezes through the hiatus, an opening in the diaphragm.
What causes hernias?
Ultimately, all hernias are caused by 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. Sometimes, the muscle weakness is present at birth; more often, it occurs later in life. Anything that causes an increase in pressure with muscle weakness in the abdomen can cause a hernia, including:
- Lifting heavy objects without stabilising the abdominal muscles
- Diarrhoea or constipation
- Persistent coughing or sneezing
In addition, obesity, poor nutrition, and smoking, can all weaken muscles and make hernias more likely.
How common are hernias?
People from the 40-70 year age group are most prone to develop hernia. Male to female ratio is normally 7:1.
How is hernia detected?
A physical exam is usually all that’s needed to diagnose a hernia. Your doctor will check for a bulge in the area. Because standing and coughing can make a hernia more prominent, you’ll likely be asked to stand and cough or strain.
What are the symptoms of hernia?
There are three kinds of symptoms of hernia; each of these are explained below:
- It may appear as a new lump in the groin or other abdominal area.
- It may ache but is not tender when touched.
- Sometimes pain precedes the discovery of the lump.
- The lump increases in size when standing or when abdominal pressure is increased (such as coughing).
- It may be reduced (pushed back into the abdomen) unless very large.
- It may be an occasionally painful enlargement of a previously reducible hernia that cannot be returned into the abdominal cavity on its own or when you push it.
- Some may be chronic (occur over a long term) without pain.
- An irreducible hernia is also known as an incarcerated hernia.
- It can lead to strangulation (blood supply being cut off to tissue in the hernia).
- Signs and symptoms of bowel obstruction may occur, such as nausea and vomiting.
- This is an irreducible hernia in which the entrapped intestine has its blood supply cut off.
- Pain is always present, followed quickly by tenderness and sometimes symptoms of bowel obstruction (nausea and vomiting).
- The affected person may appear ill with or without fever.
- This condition is a surgical emergency.
What are the treatment options available?
The need for treatment depends on the size of your hernia and the severity of your symptoms. Treatment options for a hernia include lifestyle changes and medication.
Lifestyle changes- Dietary changes can often treat the symptoms of a hiatal hernia, but won’t make the hernia go away. Avoid large or heavy meals, don’t lie down or bend over after a meal, and keep your body weight in a healthy range.
Medication- If you have a hiatal hernia, over-the-counter and prescription medications that reduce stomach acid can relieve your discomfort and improve symptoms. These include antacids, H-2 receptor blockers, and proton pump inhibitors.
A hernia patient has two surgical treatment options available to them, depending on their particular case. Each of these are explained below:
- Open hernia repair
- Laparoscopic hernia repair
Open Hernia Repair
- In open hernia repair, also called herniorrhaphy, a person is given local anesthesia in the abdomen or spine to numb the area, general anaesthesia to sedate or help the person sleep, or a combination of the two. Then the surgeon makes an incision in the groin, moves the hernia back into the abdomen, and reinforces the muscle wall with stitches. Usually the area of muscle weakness is reinforced with a synthetic mesh or screen to provide additional support; an operation called hernioplasty.
Laparoscopic Inguinal Hernia Repair
- Laparoscopic surgery is performed using general anaesthesia. The surgeon makes several small incisions in the lower abdomen and inserts a laparoscope – a thin tube with a tiny video camera attached to one end. The camera sends a magnified image from inside the body to a monitor, giving the surgeon a close-up view of the hernia and surrounding tissue. While viewing the monitor, the surgeon uses instruments to carefully repair the hernia using synthetic mesh.
- People who undergo laparoscopic surgery generally experience a somewhat shorter recovery time. However, the doctor may determine whether the laparoscopic surgery is the best option or not if the hernia is very large or the person has had pelvic surgery.
- Most adults experience discomfort after surgery and require pain medication. Vigorous activity and heavy lifting are restricted for several weeks. The doctor will discuss when the patient may safely return to work. Infants and children also experience some discomfort but usually resume normal activities after several days.