What is a hernia?
A hernia is an abnormal protrusion of an organ or a part of it through a weak point in the abdominal wall. A hernia usually consists of a piece of the bowel or a part of the omentum which is a fatty tissue that hangs down from your large intestine.
Even though the abdominal wall is made up of several muscles and tissue, weak points may develop in these layers allowing contents of your abdomen to protrude out. These weak spots may develop either at birth (congenital) or later in life (acquired). Any condition that may increase the pressure inside your abdomen (intraabdominal pressure) such as coughing, straining or any other activity that requires powerful muscle effort may contribute to produce a hernia.
Causes of hernia
For a hernia to be produced, 2 factors need to be present; a weak abdominal wall and an increased intraabdominal pressure.
Factors that may weaken your abdominal wall are:
- A congenital defect that may prevent the abdominal wall from closing properly in the womb.
- After an injury or surgery of your abdomen.
- Obesity – The fat separates your muscles and tissues making them weak.
Factors that may increase your intraabdominal pressure are:
- Chronic cough
- Constipation – This causes you to strain during defaecation.
- Difficulty in passing urine (Straining during micturition).
- Heavy weight lifting
- Fluid in your abdomen, a condition known as ascites.
What are the symptoms of a hernia?
The signs and symptoms of a hernia vary according to the site and its severity but here are some of the common symptoms of a hernia:
- A visible bulge or lump in the affected area
- The lump gets bigger when coughing, straining or standing up
- The lump disappears on lying down
- Pain or discomfort especially when carrying heavy objects, straining or bending down
In babies, the hernias may become visible as they start to cry.
What are the different types of hernia?
There are several types of hernias according to its site of development. Hernias can usually appear either on the anterior abdominal wall (Ventral hernias) or in the groin region (groin hernias).
- Epigastric hernia
Theses hernias develop in the epigastrium, the region between your breast bone and belly button. Epigastric hernias are commonly seen in men like manual labourers between 30 to 45 years of age. These hernias are the size of a small pea consisting of a protrusion of fat only.
- Umbilical hernia
Umbilical hernias appear when the abdominal contents bulge out through the umbilicus or belly button. This type of hernias is very common in new-borns. You may notice a bulge around the baby’s belly button especially when they cry.
These are the only type of hernias which goes away on their own, usually by the time the child is about 1 year old. If they do not disappear by this time, then they may need surgery to correct it.
- Spigelian hernia
This is a very rare type of hernia. Both males and females are equally affected.
- Inguinal hernia
Inguinal hernias are the most common type of hernias. Nine out of 10 hernias are often inguinal hernias. The inguinal region is in the groin area. Males are more affected than females and are mostly common in the middle age.
During foetal development in males, the testes and spermatic cord develop in your abdomen. Later, the testes and the spermatic cord will descend down to your groin through this inguinal canal. After the testes descend, the opening created for this descent is supposed close tightly. But in some, these layers do not fuse completely and are weak and therefore hernias can develop. In females, the inguinal canal consists of a ligament that helps to hold the uterus in place.
- Femoral hernia
Femoral hernias appear near your groin or thigh. These are quite uncommon and are occur mostly in females.
- Obturator hernia
These are the least common forms of hernia in the pelvic floor. The hernia occurs through the obturator canal which is another passage from the abdomen to your leg carrying the obturator artery, vein and nerve. This type of hernias is common among older females who have had multiple pregnancies and have lost a significant amount of weight in a short period of time.
Another common type of hernia is an incisional hernia which typically appears after a surgery. Following a surgery, the site of repair will be weak and therefore is a potential site for the development of hernias.
Hiatus hernia occurs when a part of your stomach slides up through an opening in the diaphragm. This type of hernia is most common in patients above 50 years of age. If it occurs in a child, it is usually due to a birth defect. Most common symptom of hiatal hernias is gastric acid reflux.
What is a strangulated hernia?
A hernia becomes strangulated when the blood supply to its contents become severely reduced. This usually occurs when the neck of the hernial sac is narrow. Symptoms of a strangulated hernia include:
- A sudden colicky pain over the site which is followed by a generalised abdominal pain.
- Irreducible ( Unable to push back the contents inside)
Strangulated hernias require immediate attention. If no action is taken as quickly as possible, the trapped bowel and tissue may eventually die.
How are hernias diagnosed?
Hernias are typically diagnosed by a physical examination. Your doctor may feel for a bulge in your abdomen or groin which gets bigger when you cough, strain or stand up. Some hernias like the femoral and obturator hernias are difficult to diagnose just by physical examination. They may need additional investigations such as a CT scan for diagnosis.
Other tests that may be useful in the diagnosis of hernia include:
- X-rays – A chest X-ray is useful to confirm the diagnosis of a hiatal hernia.
- Endoscopy – This procedure passes a small tube with an attached camera down your throat and into the food pipe and stomach. This helps to visualize the inside of your upper digestive system.
- Ultrasound scan – This is usually done in small babies with umbilical hernias.
How are adult ventral and groin hernias managed?
The treatment will depend on the type of hernia, it’s size and the severity of the symptoms. Surgery is the only definitive treatment option. This can be done as an open or keyhole operation.
However, if your hernia is small and symptomless, then watchful waiting is a reasonable approach. If this is the case, then regular follow-up and a few lifestyle modifications are suggested. This will not fix the hernia, but will help in maintaining it in its current state.
- Stop smoking
- Maintain your body weight in a healthy range
- Managing constipation
- Seeing your GP if you have early signs of prostatism