What is hernia?
Hernia occurs when an internal part of the body, such as an organ or any fatty tissue, pushes or spills out through a weak spot in a surrounding muscle or tissue wall. There are many types of hernias.
The most common types of hernia include:
- Inguinal hernia (inner groin): This is the most common type of hernia, especially among men, and occurs when the intestines push through a weak spot or tear in the lower abdominal wall, often in the inguinal canal. This type of hernia is associated with ageing and occurs if the abdomen is repeatedly strained.
In men, the inguinal canal area is where the spermatic cord passes from the abdomen to the scrotum. This cord holds up the testicles.
In women, the inguinal canal contains a ligament that holds the uterus in position.
- Incisional hernia (resulting from an incision): This condition may occur to some people who have undergone abdominal surgery. The intestines may push through the incision scar or the surrounding, weak tissue.
- Femoral hernia (outer groin), umbilical (belly button): This condition tends to occur more in women than men. It occurs when fatty tissue or a part of your bowel spills through into your groin at the top of your inner thigh. Like inguinal hernia this type of hernia is associated with ageing, and occurs due to repeated strain on the abdomen.
- Hiatal hernia (upper stomach): This condition is most common in people over 50 years of age and occurs when part of the stomach protrudes up through the diaphragm into the chest cavity. Hiatal hernias can cause gastroesophageal reflux, which is when the stomach contents leak back into the esophagus, causing a burning sensation in the heart.
- Umbilical hernia: This type of hernia occurs when fatty tissue or a part of the bowel pokes through the abdomen near the belly button.
This condition can occur in infants if the opening in the abdomen through which the umbilical cord passes does not seal properly after birth.
Adults are affected by this condition if there is repeated strain on the abdomen.
A few other less common types of hernias are epigastric hernias, spigelian hernias, and diaphragmatic hernias, muscle hernias
How does hernia occur?
Hernias are usually caused by a combination of:
- Weakness in the muscles or connective tissues, caused by a disturbance or interruption in the body’s natural cycle of tissue breakdown and repair.
- Increased pressure or strain in the weak muscles or connective tissues.
Hernias overall can be divided into two categories:
- Congenital – This type can develop even before birth, though, it may not be diagnosed for weeks, months, or even years. This hernia which develops much later in life may actually be the result of a weakness that you have had since you were an infant.
- Acquired – This type occurs when the muscles or connective tissue in your abdomen become weak due to pressure, or are damaged due to any injury as you grow older.
As you age your body is constantly involved in a balanced cycle of building up and breaking down muscles and tissue. With age the enzymes that control this process can get out of balance. When your body cannot balance the build and repair cycle effectively, the muscles and tissue, especially in the groin area may become weak.
Common factors which can lead to weakened muscles include:
- poor nutrition
- advanced age
- lack of exercise
- leading a sedentary life
- heavy smoking
- drinking alcohol heavily
- medical operations
Once your abdominal wall becomes weak, anything that puts pressure on or strains those weak spots, like:
- chronic coughing
- heavy lifting
- damage due to surgery
can cause a hernia to develop.
The extra pressure forces fatty tissue or, in some cases, part of the intestine through a weak spot, creating a bulge that you may be able to see and feel under your skin.
As already mentioned above, there are various types of hernias based on where it occurs in the body.
Depending on its cause, a hernia can develop quickly or over a long period of time.
Who is prone to hernia?
Anyone can develop a hernia – at any age, whether the person is physically active or not.
You are at a higher risk of hernia if you:
- are a man, since men have a natural weakness in the groin area.
- are above 35 years, because as we age, our muscles and tissues naturally become weaker
- are born with a weakness in the muscles of the abdomen
- have close family relatives with hernias
- strain yourself by lifting heavy objects, especially, if it is sudden and you are not used to lifting heavy objects
- are overweight or obese, since that can strain your abdominal muscles
- suffer from heavy or chronic cough
- are frequently constipated and strain while having a bowel movement
- suffer from an accident or injury that tears the muscles or connective tissue in your abdomen
- are a heavy smoker, which can affect the body’s ability to produce enzymes which promote cell creation and growth.
What are the causes of hernia?
Common causes of muscle weakness which can ultimately lead to hernia include:
- failure of the abdominal wall to close properly in the womb, which is a congenital defect
- advanced age
- chronic coughing
- damage from injury or surgery
Factors that strain your body and may cause a hernia, especially if your muscles are weak, include:
- being pregnant, which puts pressure on your abdomen
- surgery which can weaken muscles
- fluid in the abdomen
- being constipated, causing you to strain while having a bowel movement
- lifting heavy weights
- obesity or sudden weight gain
- persistent coughing or sneezing
What are the symptoms of hernia? How is hernia diagnosed?
The common symptoms of inguinal, femoral, umbilical, and incisional hernias, include:
- a prominent swelling beneath the skin of the abdomen or the groin which can disappear when you lie down. It may feel tender or sore.
- a feeling of heavyweight in the abdomen which is at times accompanied by constipation or blood in the stool.
- discomfort in the abdomen or groin when coughing, lifting a weight or bending over.
Symptoms of a hiatal hernia may include
- upper abdominal pain
If your baby suffers from hernia, you may only be able to feel the bulge when their crying, which is the only symptom of an umbilical hernia in infants.
Symptoms of a hiatal hernia include:
- acid reflux, which is when stomach acid moves backwards into the oesophagus causing a burning sensation
- chest pain
- difficulty in swallowing
Some people may not have visible symptoms of hernia. In that case, it might show up during a routine medical exam or a physical exam for some other medical issue.
At the outset your doctor will ask for your medical history and then perform a physical examination to touch or feel the hernia. You may be asked to cough, bend, push, or lift. The hernia may get bigger when you do this.
In infants or children though, the hernia may not be easily seen, except when the child is crying or coughing.
The doctor may ask you to undergo Ultrasound or CT scans to look for a hernia.
If you may have a blockage in your bowel, you will be asked to take an x-ray of the abdomen.
What are the complications of hernia?
In rare cases, inguinal hernia repair can damage structures involved in the function of a man's testicles.
Another risk of hernia surgery is nerve damage, which can lead to numbness in the groin area.
If a part of your bowel was trapped or strangulated before surgery, it may lead to a bowel perforation or dead bowel.
- Strangulation: Pressure placed on the hernial contents may compromise the blood supply to a section of an organ or tissue, leading to ischemia, cell death and even gangrene. A strangulated hernia is life-threatening and requires immediate surgery.
- Obstruction: When part of the gut herniates, the bowel contents may no longer be able to pass through the herniated area, leading to cramps, absence of defecation and vomiting.
What is the treatment of hernia?
Surgery is the only treatment for hernia. Surgery may be more risky for patients with serious medical problems though.
The weakened abdominal wall tissue can be secured with surgery and also holes can be closed.
Surgery can be open or with the help of a laparoscope. Laparoscopic surgery has the advantages of smaller surgical cuts, faster recovery, and less pain after the procedure.
Questions answered by trusted doctors
Did you know?
Inguinal hernia is the most common
Approximately 75% of all hernias occur in the groin and is the most common general surgical disease. About 25% of males and 2% of females in India develop inguinal hernias.
Hernia more common in people of advanced age
Hernia mostly occurs in people who are over 50 years of age.
Children usually suffer from abdominal wall hernia
Between 10% and 30% of children have an abdominal wall hernia (umbilical hernia); most hernias of this type close spontaneously by age 1 year.
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