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A HERNIA

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A HERNIA

A hernia occurs when an organ or fatty tissue pushes through an opening or weak spot in a surrounding muscle or tissue that holds it together or where it is normally contained.

  • Hernias are more common in the abdomen, but can also appear in the belly button, groin areas or in the upper thigh.
  • Most hernias are usually not life-threatening, but they do not go away on their own.
  • Hernias may produce no symptoms at all or may cause slight to severe pain.
  • The most common types are inguinal (inner groin), femoral (outer groin), incisional (resulting from the incision), hiatal (upper stomach), umbilical (belly button).
  • In an inguinal hernia, the intestine or the bladder bulges through a weak spot or tear in the lower abdominal wall, often in the inguinal canal. The inguinal canal is found in the groin. In men, it is an opening that allows the spermatic cord and testicle to descend into the abdomen and scrotum shortly after birth. The opening is supposed to close tightly after the testicle descends, but sometimes the canal doesn’t close properly and leaves a weakened area prone to a hernia. If stress is placed on that area later in life, the weakened tissue can allow a portion of the bowel to slide through the opening, causing a bulge. An inguinal hernia is not likely to occur in women as there is no need for an opening in the inguinal canal to allow for the descent of testicles. In women, the canal contains a ligament that helps hold the uterus in place.
  • In a femoral hernia, the intestine enters the opening in the floor of the abdomen where there is space for the femoral artery and vein to pass from the abdomen to the upper thigh. This is more common in women because of their wider bone structure, especially those who are obese or pregnant. A femoral hernia will appear as a bulge near the groin or thigh just below the inguinal ligaments. They are uncommon and account for 3% of all hernias.
  • In an incisional hernia, the intestine pushes through the abdominal wall at the site of previous surgery. This may be through the incision scar or the surrounding weakened tissue.
  • In a hiatal hernia, the upper stomach slides through the hiatus, an opening in the diaphragm through which the esophagus passes from the chest to into the abdomen.
  • In an umbilical hernia, part of the small intestine passes through the abdominal wall near the navel. It is very common in newborns and does not need treatment unless complications occur.
  • The inguinal, femoral and abdominal hernia was present in 18.5 million people and resulted in 59,800 death in 2015.
  • An untreated hernia may result in strangulation, where blood flow is cut off to part of the intestine. A strangulated hernia is a life- threatening and may require immediate surgery

CAUSES

A hernia may be congenital, be present at birth or may develop over time in areas of weakness within the abdominal wall.

Anything that can cause an increased pressure in the abdomen can cause a hernia, this may include:

  • Chronic or persistent coughing and sneezing
  • Lifting heavy objects
  • Diarrhea or constipation which causes straining when having a bowel movement
  • Fluid in the abdomen
  • Being pregnancy, which put pressure on the abdomen

In addition, obesity, poor nutrition, and smoking may weaken the muscle and may increase the chances of having a hernia.

Symptoms

  • Pain or discomfort in the affected area especially when bending, coughing or lifting
  • Pressure or feeling of heaviness in the abdomen
  • Nausea, vomiting or fever due to bowel obstruction
  • A burning or aching sensation at the bulge

DIAGNOSIS AND TREATMENT

A physical examination is all that is required in making a diagnosis. If you have an obvious hernia and you are healthy, the doctor may not require any other tests. If you have symptoms such as pain in body part with lifting or straining, the doctor may feel the area while you are standing or coughing because standing and coughing may make a hernia prominent. The doctor will check for the bulge in the suspected area. if the diagnosis is not readily apparent, the doctor may order an imaging test, such as abdominal ultrasound, MRI, or CT scan.

TREATMENT

If no symptom exist and the hernia is not affecting your daily routine or does not cause severe pain, the usual course of action is to watch and wait.

Surgery is recommended for some type of a hernia to prevent complications such as bowel obstruction or strangulation. Two main surgical options are available, they are:

  • Open surgical repair where a hernia is closed using sutures, mesh or both, and the surgical wound in the skin is closed with sutures or surgical glue. This may require a longer recovery process and you may be unable to move around normally for up to 6 weeks.
  • Laparoscopic repair where the operation is guided by a small camera and a light and surgical instruments are inserted through a small incision. This surgery has a short recovery time but the risk of reoccurrence is high.

The type of operation depends on the clinical situation and the urgency of surgery.