What is Hernia?

Every organ in our body is special and we do not realize their functioning unless and until there is a symptom of malfunction. Besides this, organs within a body cavity can also go out-of-place. What happens then? Let’s know something about hernias here.

What is a hernia?
A hernia is a medical condition that occurs when the contents of a body cavity bulge out of the area where they are normally contained. These contents that bulge out are usually portions of intestine or abdominal fatty tissue that are enclosed in the thin membrane that naturally lines the inside of the cavity. Theoretically, hernias can happen anywhere in our body, but most common place of occurrence is in the abdomen between the rib cage and the groin.

Types of Hernias:

The most common types of hernia are inguinal (inner groin), incisional (resulting from an incision), femoral (outer groin), umbilical (belly button), and hiatal (upper stomach).

Some rare abdominal-wall hernias are: the spigelian (occurs along the edge of the rectus abdominus muscle through the spigelian fascia), obturator (in women, protrudes from the pelvic cavity through an opening in the pelvic bone (obturator foramen), epigastric (occurring between the navel and the lower part of the rib cage in the midline of the abdomen).

A sports hernia is different. Unlike the other types, it does not create a hole in abdominal wall and no bulge is seen. So, it becomes difficult to diagnose. It is a tear to the oblique abdominal muscles.

Causes of Hernia: The cause of some hernias cannot be exactly pinpointed, but mostly result from increased pressure within the abdomen, a weak spot in the abdominal wall, or a combination of both. Hiatal hernias commonly develop in pregnant women and overweight people due to the increased pressure on the abdominal wall. In men, an inguinal hernia will commonly develop in the groin, specifically in a region called the inguinal canal. In women, inguinal hernias are rare, but can develop where the tissue that binds the uterus exits from the abdomen and joins with the tissue surrounding the vaginal opening. Umbilical hernias may be present at birth. In adults, they may develop when there is a weakness in the tissue in the umbilical area combined with increased pressure on the abdominal wall.

Symptoms of Hernia:

1. Inguinal Hernia: Discomfort while bending over or during lifting. A small lump in the groin region is seen which grows bigger with activities like coughing. This bulge usually disappears with lying down, but if this does not happen and if a person experiences nausea, vomiting or abdominal pain, then it means that the hernia has become obstructed (no blood flow) or strangulated and strangulation may lead to a life-threatening condition called gangrene (decay or death of body tissues) that may account for an emergent surgery. Strangulation symptoms are pain, swelling, discolored, bluish or red skin, vomiting, and an inability to urinate. These hernias may not show themselves until when the abdominal wall is weakened due to sustained coughing, lifting, or straining during a bowel movement.

2. Incisional Hernia: Caused due to stretching of scar tissue that forms after surgery and occurs due to constant pressure of abdominal contents on the scar. Not all abdominal surgeries will lead to incisional hernia, but any full thickness abdominal incision can leave a weakness and make that area prone to hernia. Usually a proper closure and adequate post-operative measure avoids the problem. However, sometimes despite the best care, a person may develop the hernia or it may be predicted, depending on the patient’s general condition and the type of surgery performed.

3. Femoral Hernia: Occurs when the contents of the abdomen (usually part of the small intestine) push through a weak point or tear the thin muscular wall of the abdomen, which holds the abdominal organs in place. Some of this type may be by birth and some noted in old age. A femoral hernia is a bulge in the upper part of the thigh near the groin.

4.Umbilical Hernia: pregnancy, the umbilical cord passes through a small opening in the baby's abdominal muscles. The opening should normally close just after birth. If the muscles don't join completely in the midline of the abdomen, this weakness in the abdominal wall may cause an umbilical hernia at birth or later in life.

5. Hiatal Hernia: Normally no symptoms occur initially, but once the sphincter muscle surrounding the esophagus (food pipe) becomes weak, symptoms like heartburn, belching, regurgitation, sharp pain or even bleeding may occur. There may be choking, coughing or breathlessness while asleep. All these happen because the valve between the stomach and esophagus (food pipe) does not remain closed and acid spills into the esophagus from the stomach.

Treatment for Hernia:

Surgery or repair is the best treatment option for hernia. However, surgery will be avoided if the hernia has a large opening in the abdominal wall as it becomes complicated to close this and strangulation (compromised blood supply leading to gangrene) is almost impossible with large openings, and if there is risk with surgery or if surgery needs to be delayed then surgical belts and binders do help to some extent in some type of hernias. Activities like coughing, lifting, straining cause increased intra-abdominal pressure and have to be avoided to prevent further increase of the hernia size. So, it is up to the surgeon to decide if the patient requires surgery based on conditions like if the hernia is reducible (can be pushed back into the abdomen by putting manual pressure), irreducible, or partly strangulated.

According to the National Center for Health Statistics, approximately 5 million Americans have an abdominal hernia. The hernias are 5 times more common in men than in women, and the most common type in both men and women is the inguinal or groin type. So, there is nothing alarming if any hernia is identified. It is wise to seek prompt medical attention and go for a repair at the earliest when advised.

Watch the Video: Hernia repair surgery

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