Hernias: Types, Symptoms, Repair Methods

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A hernia is defined as an abnormal protrusion, usually of part of an organ, through a weak point or tear in the thin muscular wall that holds the abdominal organs in place. This causes a bulging of the abdominal wall. Bulging is typically more noticeable when the abdominal muscles are tightened, thereby increasing the pressure in the abdomen. Hernias can occur in different areas, including:

• Incisional hernia: May occur through a scar after abdominal surgery.
• Femoral hernia: Appears as a bulge in the upper thigh. Occurs more often in women than in men.
• Inguinal hernia: Appears as a bulge in the groin or scrotum. Occurs more frequently in men than women.
• Umbilical hernia: A bulge around the belly button. Happens if the muscle around the navel doesn't close completely.

Hernias can be classified according to their anatomical location. Hernia examples include:

• Anal
• Abdominal
• Intracranial
• Pelvic, for example, obturator hernia
• Hernias of the nucleus pulposus of the intervertebral discs
• Diaphragmatic hernias and hiatal hernias (for example, para esophageal hernia of the stomach)

The hernia has three parts:

• The contents
• The hernial sac
• The orifice through which it herniates

A sportsman's hernia is a syndrome characterized by chronic groin pain in athletes and a dilated superficial ring of the inguinal canal, although a true hernia is not present.

A hiatus hernia occurs when the stomach protrudes into the mediastinum through the esophageal opening in the diaphragm.

Causes of hiatus hernia vary depending on each individual and include: improper heavy weight lifting, hard coughing bouts, sharp blows to the abdomen, and incorrect posture, obesity, straining during a bowel movement or urination (constipation, enlarged prostate), chronic lung disease, and also, fluid in the abdominal cavity (ascites). In addition, if muscles are weakened due to poor nutrition, smoking, and overexertion, hernias are more likely to occur.

Since many organs or parts of organs can herniate through many orifices, it is very difficult to give an exhaustive list of hernias, with all synonyms and eponyms.

Symptoms

• Constipation:

  Because a hernia is often created by a portion of the small intestine pressing through the abdominal wall, it can negatively affect the digestive system. By constricting the small intestine, a hernia can cause constipation and other digestive problems.

• Lumps:

  While there is not always an external lump or bulge with a hernia, it is the most common indicator that a hernia is present. Frequently, hernia bulges in women are less visible than in men, especially when lying down, complicating a hernia diagnosis. Other times, a lump is only present in times of stress, like when coughing. If there is a bulge that feels rigid or will not go back into the body, this is referred to as a strangulated hernia, and it requires immediate medical attention.

• Pain:

  The earliest warning sign that a patient may be suffering from a hernia is if they feel persistent pain in their lower abdomen or groin. Hernia sufferers usually first experience pain after some sort of singular movement like lifting, coughing, or twisting that puts strain on the abdominal wall. Often this pain will slowly subside and then come back immediately the next time that motion or action is repeated. Persistent pain is the easiest determinant of a chronic problem like a hernia.

Hernia Repairs

Each year, while an estimated 5 million Americans develop hernias, only 700,000 have them surgically repaired. Most physicians believe people avoid treating their hernias because they fear painful surgery. Today, there is little reason to fear. Hernia surgery is typically performed on an outpatient basis, and patients can return to most normal activities in a matter of a few days.

It is generally advisable to repair hernias quickly to prevent complications such as organ dysfunction, gangrene, and multiple organ dysfunction syndrome. Most abdominal hernias can be surgically repaired, and recovery rarely requires long-term changes in lifestyle. Uncomplicated hernias are principally repaired by pushing back, or "reducing", the herniated tissue, and then mending the weakness in muscle tissue (an operation called herniorrhaphy).

Hernias usually need to be surgically repaired to prevent intestinal damage and further complications. The surgery takes about an hour and is typically performed on an outpatient basis (which means the patient can go home the same day of the procedure). This surgery may be performed by an open repair (small incision over the herniated area) or by laparoscopic surgery (minimally invasive). Your surgeon will determine the best method of repair for your individual situation.

Most patients will be able to go home a few hours after surgery. If needed, a 23-hour extended recovery area is available. Typically, most patients feel fine within a few days after the surgery and resume normal eating habits and activities. Strenuous activity and exercise are restricted for 4 to 6 weeks after surgery.

Hernia Facts and Statistics

• The lifetime risk of a groin hernia is 27% for men and 3% for women.
• The frequency of surgical correction ranges from 10 per 100,000 (U.K.) to 28 per 100,000 (U.S.).
• Inguinal, femoral and abdominal hernias resulted in 32,000 deaths worldwide in 2013, or 0.5 per 100,000.

Groin hernias occur in approximately 2% of the adult population and 4% of infants. Their relative frequencies are:

• Inguinal 80%
• Incisional 10%
• Femoral 5%
• Umbilical 4%
• Epigastric <1%
• Other: <1%

Diagram of the Human Rectus Abdominis muscle. View further information regarding Diastasis Recti which generally presents as a mid-line domed, or bulging stomach, when rising from a lying position but is NOT a hernia.

Subtopics and Associated Subjects

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