A hernia occurs when an organ or piece of tissue bulges through a weakened section in the abdominal wall. This bump may result in a visible bulge under your skin. Hernias can occur within the chest, hips and abdominal cavity. While some hernias may cause minor symptoms, others may result in a medical emergency.
What causes a hernia?
A hernia is usually associated with muscle degeneration that occurs with ageing, or caused by repeated strain on the groin and abdominal areas, such as heavy lifting, coughing, pregnancy, or straining from chronic constipation. Newborns can get hernias too; such hernias are usually present from birth and may also require surgery.
The following groups of people are more susceptible to developing a hernia:
- The elderly
- Pregnant women
- Those with a family history of hernias
- Smokers
- Overweight or obese individuals
- Those with chronic constipation, chronic cough or urinary flow problems
- Disorders with collagen formation
- Babies born prematurely or with a low birth weight
What are some of the symptoms associated with getting a hernia?
A hernia first presents itself as a noticeable bulge or lump that can be pushed back in or can disappear when lying down. This lump may reappear when crying, laughing, coughing or during physical activity. You may also feel some discomfort or pain around the lump. Other symptoms include:
- Swelling of bulge in the scrotum or groin for males
- Dull aching sensation
- Increase in pain at the site of the bulge
- Pain while lifting
- Increase in bulge size over time
- Signs of bowel obstruction: abdominal distension, vomiting and constipation
In the case of a diaphragmatic hiatal hernia (I will discuss more about later), there are no bulges present and symptoms differ from the above. They include indigestion, heartburn, difficulty swallowing and chest pain.
What are the various types of hernia that may occur?
Inguinal hernia
Inguinal hernia is the most common form of hernia and accounts for about 75-80% of hernia cases. This hernia develops near the groin, around the inguinal canal. In men, the inguinal canal provides a passageway for the spermatic cord and blood vessels to enter the testicles; in women, the inguinal canal contains the round ligament that supports the womb. When a part of the intestine or fatty tissue bulges into the groin, a hernia forms.
Thus, inguinal hernia is also known as groin hernia and affects more men than women. This type of hernia is usually characterized with a dull pain or discomfort as the groin area.
Femoral hernia
A femoral hernia occurs when fatty tissue or part of the intestine pushes through a weak point in the groin adjacent to the femoral artery and vein. As the neck of the femoral hernia is very small, the risk for strangulation of the herniated intestine or fat is higher. Surgery is therefore urgently recommended. Femoral hernias is more common in women than men.
Umbilical hernia
An umbilical hernia occurs when abdominal organs push through an area of weakness around the belly button. It is usually presents as a visible bulge around or within the belly button that worsens when you cough or strain. Umbilical hernias affect about 10-20% of newborns and most close by themselves once the child reaches 5 years of age. Otherwise, surgery is usually recommended.
Hiatal hernia
A hiatal hernia occurs when part of the stomach pushes up into the chest cavity through the diaphragm. Patients with hiatal hernias are more likely to experience acid reflux. Hiatal hernias are either present from birth or develops as one ages.
Incisional hernia
An incisional hernia results from a surgical wound that has not healed completely after abdominal surgery. The terms “incisional hernia” and “ventral hernia” are used interchangeably. Ventral hernias can present as a very large defect (up to 20cm) or as multiple smaller defects.
What are my treatment options if I get a hernia?
Surgery is the best treatment option since hernias do not heal on their own. An early surgical repair prevents the hernia from progressing into a strangulated hernia, where part of the intestine is trapped without a blood supply, leading to tissue death. If your hernia is not severe, your doctor may recommend conservative treatment especially if the surgical risks outweigh the benefits of surgery. Conservative treatment may include wearing a hernia truss.
There are three types of hernia surgery:
Open hernia surgery
A cut is made to push the protruding tissue back in place and stitch the weakened muscle wall back together. A synthetic mesh is usually stitched in to provide extra support.
Laparoscopic hernia surgery
Tiny incisions are made instead of a big cut to achieve the same results as an open surgery. This surgical approach is technically more challenging because of the limited space that the surgeon operates in.
Robotic hernia repair
With robotic surgery, the surgeon handles the surgical instruments while seated at a console in the operating room. Otherwise, the surgical approach and the instruments are similar to laparoscopic surgery.Robotic surgery can be used for smaller hernias and to reconstruct the abdominal wall. As each type of surgery has its benefits and risks, your surgeon should discuss these with you and provide the right advice. Factors such as your age and overall health condition are important considerations.
