Hernia:
Let the sun never set or rise on a small bowel obstruction.
Adage expressing urgency for early operation to avoid possible fatality.
CHIDAMBARAM HOSPITAL
चिदंबरम अस्पताल,
ചിദംബരം ഹോസ്പിറ്റൽ
சிதம்பரம் மருத்துவமனை,
திசையன்விளை.627657
What Is a Hernia?
A
hernia occurs when an organ pushes through an opening in the muscle or tissue
that holds it in place. For example, the intestines may break through a
weakened area in the abdominal wall.
Hernias
are most common in the abdomen, but they can also appear in the upper thigh,
belly button, and groin areas. Most hernias are not immediately life
threatening, but they don’t
go away on their own and can require surgery to prevent potentially dangerous
complications.
Common Hernia Types
Inguinal Hernia
Inguinal
hernias are the most common type of hernia. They make up about 70 percent of
all hernias, according to the British Hernia Centre (BHC). These hernias occur when the intestines push through a
weak spot or tear in the lower abdominal wall, often in the inguinal canal.
The
inguinal canal is found in your groin. In men, it is the area 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 helps hold the
uterus in place.
This
type of hernia is more common in men than in women. This is because a man’s testicles descend through the inguinal canal shortly
after birth, and the canal is supposed to close almost completely behind them.
Sometimes, the canal does not close properly and leaves a weakened area prone
to hernias.
Hiatal Hernia
A
hiatal hernia occurs when part of your stomach protrudes up through the
diaphragm into your chest. The diaphragm is a sheet of muscle that helps you
breathe by contracting and drawing air into the lungs. It separates the organs
in your abdomen from those in your chest.
This
type of hernia is most common in patients over 50 years old. If a child has the
condition, it’s
typically caused by a congenital (birth) defect. Hiatal hernias almost always
cause gastroesophageal reflux, which is when the stomach contents leak backward
into the esophagus, causing a burning sensation.
Umbilical Hernia
Umbilical
hernias can occur in children and babies under 6 months old. This happens when
their intestines bulge through their abdominal wall near their bellybutton. You
may notice a bulge in or near your child’s
bellybutton, especially when they’re
crying.
An
umbilical hernia is the only kind that often goes away on its own, typically by
the time the child is 1 year old. If the hernia has not gone away by this
point, surgery may be used to correct it.
Incisional Hernia
Incisional
hernias can occur after you’ve
had abdominal surgery. Your intestines may push through the incision scar or
the surrounding, weakened tissue.
What Causes a Hernia?
Hernias
are caused by a combination of muscle weakness and strain. Depending on its
cause, a hernia can develop quickly or over a long period of time.
Common
causes of muscle weakness include:
- failure of the abdominal wall to close properly in the womb, which is a congenital defect
- 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)
- being constipated, which causes you to strain when having a bowel movement
- heavy weight lifting
- fluid in the abdomen, or ascites
- suddenly gaining weight
- persistent coughing or sneezing
Am I at Risk for a Hernia?
The
factors that increase your risk of developing a hernia include:
- a personal or family history of hernias
- being overweight or obese
- a chronic cough
- chronic constipation
- smoking, which can trigger a chronic cough
Conditions
such as cystic fibrosis can also indirectly increase your risk of developing a
hernia. Cystic fibrosis impairs the function of the lungs, causing a chronic
cough.
What Are the Symptoms of a Hernia?
The
most common symptom of a hernia is a bulge or lump in the affected area. In the
case of an inguinal hernia, you may notice a lump on either side of your pubic
bone where your groin and thigh meet. You’re
more likely to feel your hernia through touch when you’re standing up.
If
your baby has a hernia, you may only be able to feel the bulge when he or she
is crying. A bulge is typically the only symptom of an umbilical hernia.
Other
common symptoms of an inguinal hernia include:
- pain or discomfort in the affected area (usually the lower abdomen), especially when bending over, coughing, or lifting
- weakness, pressure, or a feeling of heaviness in the abdomen
- a burning, gurgling, or aching sensation at the site of the bulge
Other
symptoms of a hiatal hernia include:
- acid reflux, which is when stomach acid moves backward into the esophagus causing a burning sensation
- chest pain
- difficulty swallowing
In
some cases, hernias have no symptoms. You may not know you have a hernia unless
it shows up during a routine physical or a medical exam for an unrelated
problem.
How Is a Hernia Diagnosed?
Inguinal
or incisional hernias are usually diagnosed through a physical examination.
Your doctor may feel for a bulge in your abdomen or groin that gets larger when
you stand, cough, or strain.
If
you have a hiatal hernia, your doctor may diagnosed it with a barium X-ray or endoscopy.
These tests allow your doctor to see the internal location of your stomach:
- A barium X-ray is a series of X-ray pictures of your digestive tract. The pictures are recorded after you’ve finished drinking a liquid solution containing barium, which shows up well on the X-ray images.
- An endoscopy involves threading a small camera attached to a tube down your throat and into your esophagus and stomach.
If
your child has an umbilical hernia, your doctor may perform an
ultrasound. An ultrasound uses high-frequency sound waves to create an
image of the
structures inside the body.
Treatment Options for a Hernia
Whether
or not you need treatment depends on the size of your hernia and the severity
of your symptoms. Your doctor may simply monitor your hernia for possible
complications. Treatment options for a hernia include:
Lifestyle Changes
Dietary
changes can often treat the symptoms of a hiatal hernia. Avoid large or heavy
meals, don’t lie down or bend over after a meal,
and keep your body weight in a healthy range.
If
these changes in diet don’t
eliminate your discomfort, you may need surgery to correct the hernia. You can
also improve symptoms by avoiding foods that cause acid reflux or heartburn,
such as spicy foods and tomato-based foods. Additionally, you can avoid reflux
by losing weight and giving up cigarettes.
Medication
If
you have a hiatal hernia, over-the-counter and prescription medications that
reduce stomach acid can relieve your discomfort and improve symptoms. These
include antacids, H-2 receptor blockers, and proton pump inhibitors.
Surgery
If
your hernia is growing larger or causing pain, your doctor may decide
that it’s best to operate. Your doctor may repair your hernia by
sewing the hole in the abdominal wall closed during surgery. This is
most
commonly done by patching the hole with surgical mesh.
Hernias
can be repaired with either open or laparoscopic surgery. Laparoscopic
surgery uses a tiny camera and miniaturized surgical equipment to
repair the hernia using only a few small incisions. Laparoscopic surgery
is
less damaging to the surrounding tissue.
Open
surgery requires a longer recovery process. You may be unable to move around
normally for up to six weeks. Laparoscopic surgery has a much shorter recovery
time. However, the risk of your hernia reoccurring is higher. In addition, not
all hernias are suitable for laparoscopic repair, including those in which a
portion of your intestines has moved down into the scrotum.
Potential Complications of a Hernia
If
left untreated, your hernia may grow and become more painful. A portion of your
intestine could become trapped in the abdominal wall. This can obstruct your
bowel, causing severe pain, nausea, and constipation. An untreated hernia can
also put too much pressure on nearby tissues, which can cause swelling and pain
in the surrounding area.
If
the trapped section of your intestines doesn’t get enough blood flow, strangulation occurs. This can cause the intestinal
tissue to become infected or die. A strangulated hernia is life-threatening and
requires immediate medical care.
Preventing a Hernia
- not smoking
- seeing your doctor when you’re sick to avoid developing a persistent cough
- maintaining a healthy body weight
- avoiding straining during bowel movements or urination
- lifting objects with your knees and not your back
- avoiding lifting weights that are too heavy for you
Outlook
It’s important to recognize the early
signs of a hernia. An untreated hernia will not go away on its own. However,
with early medical care or lifestyle changes, you can minimize the effects of a
hernia and
