A hernia is a protrusion of a body part through the wall of the muscle or tissue that holds it. Most hernias occur in the abdominal cavity. A regular physical examination performed by a doctor can diagnose a hernia. Generally swelling of the hernia is seen when standing upright and then entering. Back during rest, an ultrasound examination can help diagnose a hernia.
The most common types of hernias are:
- Inguinal hernia: In men, the inguinal canal is the conduit for the spermatic cord and blood vessels leading to the testicles. In women, the inguinal canal contains ligaments that provide support for the uterus. In an inguinal hernia, fatty tissue or part of the intestine protrudes into the inner groin. 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 rarer than inguinal hernias and mainly affect older women.
- Umbilical hernia: Fat tissue or part of the intestine protrudes through the abdomen near the navel (belly button).
- Hiatal (hiatus) hernia: Part of the stomach pushing into the chest cavity through an opening in the diaphragm (the horizontal sheet of muscle that separates the chest from the abdomen).
What causes hernias?
Inguinal and femoral hernias are caused by muscle weakness that may be present from birth, or related to aging and repeated strain on the abdominal and groin areas. The tension may come from physical activity, obesity, pregnancy, frequent coughing, or straining on the toilet due to constipation.
Adults may get an umbilical hernia by straining in the abdominal area, being overweight, having a severe cough that lasts a long time or after giving birth.
The causes of a hiatal hernia are not fully understood, but the weakening of the diaphragm with age or pressure on the abdomen may play a role.
What are the symptoms of a hernia?
Hernias in the abdomen or groin may produce a visible lump or bulge that can be pushed back, or which may disappear when lying down. Laughter, crying, coughing, straining during a bowel movement, or physical activity can make the lump appear again .
Other hernia symptoms include:
- Swelling or bulge in the groin or scrotum (sac containing the testicles).
- Increased pain at the site of the bulge.
- Pain when lifting.
- Increase in the size of the bulge over time.
- Dull pain sensation.
- A feeling of fullness or signs of intestinal obstruction.
In the case of a hiatal hernia there is no bulge on the outside of the body. Instead, symptoms may include heartburn, indigestion, difficulty swallowing, frequent regurgitation (bringing food back in) and chest pain.
How are hernias diagnosed?
It's usually possible to see or feel a bulge in the area where the hernia has occurred with a physical exam. As part of the typical male physical exam for an inguinal hernia, the doctor feels the area around the testicles and groin when the patient is asked to cough. In some cases, soft tissue imaging such as a CT scan will accurately diagnose the condition.
What can happen if a hernia is not treated?
Apart from umbilical hernias in babies, hernias will not go away on their own. Over time, hernias can grow larger and be more painful or they can cause complications.
Untreated complications of an inguinal or femoral hernia may include:
- Obstruction (intention): Part of the intestine is trapped in the inguinal canal, causing nausea, vomiting, abdominal pain, and a painful lump in the groin.
- Ischemic : The trapped part of the intestine is not getting a blood supply . In such cases, emergency surgery (within hours of it occurring) is required to prevent tissue death.
How to prevent hernias?
- Maintain ideal body weight by eating healthy foods and exercising.
- Eat enough fruits, vegetables and whole grains to avoid constipation.
- Use the correct tools when lifting weights or heavy objects. Avoid lifting anything that is beyond your ability.
- See a doctor if you are sick with persistent coughing or sneezing.
- Avoid smoking, because this habit can cause a cough that triggers a hernia.
How is the treatment of hernias?
Hernias usually don't heal on their own, and surgery may be the only way to fix them. However, your doctor will recommend the best therapy for your hernia, and may refer you to a surgeon. If the surgeon deems it necessary to repair your hernia, they will tailor the repair method that best suits your needs.
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 4 to 5 years of age .
If an adult has an umbilical hernia, surgery is usually recommended because the condition will not get better on its own and the risk of complications is higher.
One of three types of hernia surgery may be performed:
- Open surgery , in which an incision is made into the body at the hernia site. The protruding tissue is reattached and the weakened muscle wall is sutured back. Sometimes a type of mesh is implanted in the area to provide extra support.
- Laparoscopic surgery involves the same type of repair. However, instead of cutting the outside of the abdomen or groin, small incisions are made to allow the insertion of surgical instruments to complete the procedure.
- Robotic hernia repair , like laparoscopic surgery, uses a laparoscope, and is done with small incisions. With robotic surgery, the surgeon sits at a console in the operating room, and handles surgical instruments from the console. While robotic surgery can be used for some smaller hernias, or areas of weakness, it can now also be used to reconstruct the abdominal wall .
Article written by dr. Jefri, Sp.B (General Surgeon Specialist at EMC Tangerang Hospital).