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Hernia
A hernia happens when an internal organ pushes through a weak spot in your muscle or tissue. There are several types of hernia that you can experience including, inguinal hernias, femoral hernias, umbilical hernias and hiatal hernias. If you have a hernia, it’s important to treat it quickly.
Overview
What is a hernia?
A hernia occurs when an internal organ or other body part protrudes through the wall of muscle or tissue that normally contains it. Most hernias occur within the abdominal cavity, between the chest and the hips.
When you have a hernia, treatment will start with your primary care provider. If you need surgery to repair the hernia, you’ll be referred to a general surgeon or a Laparoscopic Surgeon.
Types of Hernia
How many types of Hernia are?
There are various types of Hernia. The most common forms of hernia are:
- Inguinal Hernia:
In men, the inguinal canal is a passageway for the spermatic cord and blood vessels leading to the testicles. In women, the inguinal canal contains the round ligament that gives support for the womb. In an inguinal hernia, fatty tissue or a part of the intestine pokes into the groin at the top of the inner thigh. This is the most common type of hernia, and affects men more often than women. - Femoral Hernia:
Fatty tissue or part of the intestine protrudes into the groin at the top of the inner thigh. Femoral hernias are much less common than inguinal hernias and mainly affect older women. - Umbilical hernia:
Fatty tissue or part of the intestine pushes through the abdomen near the navel (belly button). - Hiatal (hiatus) Hernia:
Part of the stomach pushes up into the chest cavity through an opening in the diaphragm (the horizontal sheet of muscle that separates the chest from the abdomen).
Other types of hernias include:
- Incisional Hernia:
Tissue protrudes through the site of an abdominal scar from a remote abdominal or pelvic operation. - Epigastric Hernia:
Fatty tissue protrudes through the abdominal area between the navel and lower part of the sternum (breastbone). - Spigelian hernia:
The intestine pushes through the abdomen at the side of the abdominal muscle, below the navel. - Diaphragmatic Hernia:
Organs in the abdomen move into the chest through an opening in the diaphragm.
How common are hernias?
Of all hernias that occur:
- 75 to 80% are inguinal or femoral.
- 2% are incisional or ventral.
- 3 to 10% are umbilical, affecting 10 to 20% of newborns; most close by themselves by 5 years of age.
- 1 to 3% are other types.
Symptoms & Causes
What causes a hernia?
Inguinal and femoral hernias are due to weakened muscles that may have been present since birth, or are associated with aging and repeated strains on the abdominal and groin areas. Such strain may come from physical exertion, obesity, pregnancy, frequent coughing, or straining on the toilet due to constipation.
Adults may get an umbilical hernia by straining the abdominal area, being overweight, having a long-lasting heavy cough or after giving birth.
The cause of hiatal hernias is not fully understood, but a weakening of the diaphragm with age or pressure on the abdomen could play a part.
What are the symptoms of a hernia?
A hernia in the abdomen or groin can produce a noticeable lump or bulge that can be pushed back in, or that can disappear when lying down. Laughing, crying, coughing, straining during a bowel movement, or physical activity may make the lump reappear after it has been pushed in. More symptoms of a hernia include:
- Swelling or bulge in the groin or scrotum (the pouch that contains the testicles).
- Increased pain at the site of the bulge.
- Pain while lifting.
- Increase in the bulge size over time.
- A dull aching sensation.
- A sense of feeling full or signs of bowel obstruction.
In the case of hiatal hernias there are no bulges on the outside of the body. Instead, symptoms may include heartburn, indigestion, difficulty swallowing, frequent regurgitation (bringing food back up) and chest pain.
Diagnosis & Tests
How is a hernia diagnosed?
It is usually possible to see or feel a bulge in the area where a hernia has occurred by physical exam. As part of a male’s typical physical exam for inguinal hernias, the doctor feels the area around the testicles and groin while the patient is asked to cough. In some cases, soft-tissue imaging like a CT scan will accurately diagnose the condition.
Management & Treatment
What kind of doctor do you see for a hernia?
When you have a hernia, treatment will start with your primary care provider. If you need surgery to repair the hernia, you’ll be referred to a general or laparoscopic surgeon. In fact, ventral hernia repairs are one of the most common operations Indian general & Laparoscopic surgeons perform.
If you think you have a hernia, don’t wait to seek help. A neglected hernia can grow larger and more painful — this can lead to complications and possibly emergency surgery. Early repair is more successful, less risky and offers a better recovery and outcome.
How is a hernia treated?
Hernias usually do not get better on their own, and surgery may be the only way to repair them. However, your doctor will recommend the best therapy to address your hernia, and may refer you to a surgeon. If the surgeon thinks it is necessary to repair your hernia, then the surgeon will tailor the method of repair that best meets your needs.>/p>
In the case of an umbilical hernia in a child, surgery may be recommended if the hernia is large or if it has not healed by the age of 4 to 5 years old. By this age, a child can usually avoid surgical complications.
If an adult has an umbilical hernia, surgery is usually recommended because the condition will not likely improve on its own and the risk of complications is higher.
One of three types of hernia surgery can be performed:
- Open Surgery
in which a cut is made into the body at the location of the hernia. The protruding tissue is set back in place and the weakened muscle wall is stitched back together. Sometimes a type of mesh is implanted in the area to provide extra support.
- Laparoscopic Surgery
involves the same type of repairs. However, instead of a cut to the outside of the abdomen or groin, tiny incisions are made to allow for the insertion of surgical tools to complete the procedure.
What can happen if a hernia is not treated?
Other than umbilical hernias in babies, hernias will not disappear on their own. Over time, a hernia can grow larger and more painful or can develop complications.
Complications of an untreated inguinal or femoral hernia may include:
- Obstruction (incarceration):
Part of the intestine becomes stuck in the inguinal canal, causing nausea, vomiting, stomach pain, and a painful lump in the groin. - Strangulation:
Part of the intestine is trapped in a way that cuts off its blood supply. In such cases, emergency surgery (within hours of occurring) is necessary to prevent tissue death.
Prevention
How can a hernia be prevented?
- Maintain ideal body weight by eating a healthy diet and exercising.
- Eat enough fruits, vegetables and whole grains to avoid constipation.
- Use correct form when lifting weights or heavy objects. Avoid lifting anything that is beyond your ability.
- See a doctor when you are ill with persistent coughs or sneezing.
- Don’t smoke, as the habit can lead to coughing that triggers a hernia.
Frequently Asked Questions
- Avoid heavy lifting when you can. Lifting puts stress on the groin.
- When you must lift, don't bend over. Lift objects by using the legs, not the back.
- Eat high-fiber foods and drink plenty of water. This helps prevent constipation and straining during bowel movements.
- Maintain a healthy body weight.
Anyone can develop a ventral hernia, but those who’ve had abdominal surgery have a higher risk. If you have an incision that disrupts the abdominal wall, the scar will never be as strong as the original tissue. This makes it more likely that you’ll develop a hernia, known as an incisional hernia, along the incision area. This occurs in up to 30% of patients who have open abdominal surgery.
Pregnancy is a risk factor that makes women more susceptible to developing another type of ventral hernia near the belly button, called an umbilical hernia. The umbilicus is the thinnest part of the abdominal wall. It’s a very common site to develop a hernia, whether you’re a man or a woman.
First, it’s important to understand that both men and women can develop inguinal hernias. People often believe that only men get them, and for anatomical reasons, they do have a higher risk. But women can certainly have inguinal hernias, too.
Many experts agree that women are likely underdiagnosed for this condition because they tend to have different symptoms than men. Women may not have a noticeable bulge. If symptoms indicate a possible hernia but your doctor cannot confirm it by an exam, an MRI can provide definitive evidence.
Inguinal hernias in women are more likely to become emergencies. Women also have a greater chance of developing complications than in men. So, we typically recommend surgical repair after diagnosis.
Men with inguinal hernias often may put off surgery if they’re not symptomatic. Studies of men with inguinal hernias indicate the risk of having an emergency, like part of the bowel getting stuck or strangled in the muscle gap, is quite low. But because hernias tend to grow larger or cause symptoms over time, most men will require surgery within 10 years of hernia diagnosis.
There are two surgical treatments for inguinal hernias. Minimally invasive surgery is often performed laparoscopically, requiring only keyhole-size incisions through which a tiny camera and instruments can be inserted to make repairs. Minimally invasive robotic surgery (similar to laparoscopy, but surgeons use a controller to move instruments) is also an option. With minimally invasive surgery, patients are back to their regular activity within two weeks. Open surgery is the other treatment option — recovery takes four to six weeks.
For both men and women, repair is recommended for most abdominal hernias. The exception is if you have risk factors for complications or hernia recurrence, such as obesity or poorly controlled diabetes. It’s better to get those conditions under control before surgery. Some patients do not have symptoms and may decide to delay repair after discussion of the risks and benefits with their surgeon.
Surgical options and recovery time for ventral hernias vary widely because these hernias come in all shapes and sizes. A small umbilical or incisional hernia can often be treated on an outpatient basis. However, repairing more complicated hernias may require a hospital stay of one to five days.