Hernia - Overview
Hernias, the funny little bulges or lumps that some people have on their abdomen, groin, or even scrotum, are one of those common and benign health abnormalities that remain painless and harmless in some people for a long time since birth. However, they can be a matter of discomfort and pain in many others and requires immediate surgery called hernia repair.
How will you recognize a hernia?
Although hernias can be of different types and can appear at different locations, they can be identified mostly by the below symptoms:
- A soft lump or bulge in the groin or abdomen that you can hold and play with.
- A bulge in the groin or scrotum in men.
- A bulge that can be pushed back in or disappears when lying down.
- A bulge that increases in the size slowly over time.
- Pain or a burning or aching sensation at the site of the bulge
- Pain while coughing, bending over, or lifting heavy objects
- A heavy feeling in your groin.
However, the bulges or lumps occur in cases of external or outward hernias only. There can be internal hernias where the protrusions are inward, and therefore do not result in any bulge on our body surface.
Why a hernia happens?
Organs in our body such as small and large intestines, stomach, liver, etc. are kept in place by a thin muscular lining called peritoneum and a set of tissues called mesentery. A peritoneum layer also runs over the inner surface of our abdominal wall that may develop some weak spots due to bad health or strain.
A hernia is an abnormal displacement of an internal tissue or organ through the weakened lining of the abdominal wall. For example, it can be a portion of the small intestine or bowel that has pushed through a weak spot in the peritoneum on the inner side of the abdominal wall.
Factors that may cause peritoneum weakness include:
- A congenital defect such as failure of the abdominal wall to close properly in the womb,
- Frequent coughing and sneezing
Causes of strain that lead to a hernia, especially if your muscles are weak, include:
- The pregnant condition that puts pressure on your abdomen
- Strain when having a bowel movement, due to constipation
- Lifting heavyweight
- Fluid in the abdomen, or ascites
- Sudden weight gain
- Surgery in the area
- Persistent coughing or sneezing
A hernia can be congenital (originated from before your birth) or acquired due to the weakened abdomen or due to an injury. It can be external, protruding toward the outside of our body or internal, when it pushes deep under the skin. They can be pushed into and usually disappear when we lie down.
Common types of hernias and their symptoms:
An inguinal hernia
The most common type of hernias occur when intestines push through the lower abdominal wall near the inguinal canal.
A hiatal hernia
A hiatal hernia is caused if a part of our stomach protrudes up through the diaphragm into the chest cavity.
An umbilical hernia
This type of hernias are sometimes seen in babies under six months and caused when a portion of their intestine pokes out through the abdominal wall near their belly button, creating a bulge.
This type of hernia may occur after abdominal surgery. Your intestines may find the seam line in the abdomen as a weak spot and try to push through it.
Diagnosis of hernias:
For the inguinal or incisional hernias, diagnoses are pretty simple. Your doctor will check your body physically and feel the bulge in your abdomen or groin that gets larger when you stand, cough, or strain but disappears when you lie down.
Since the hiatal hernias are directed inward and do not create any bulge on the skin, the doctors use barium X-ray or endoscopy to diagnose them. Both are painless methods. In a barium X-ray process, a series of pictures of your digestive tract are taken after you are made to drink a liquid solution containing barium, to get better X-ray images. Endoscopy involves pushing a thin and flexible pipe down your throat to take pictures of your stomach position.
Umbilical hernias occur in babies and are often diagnosed by the doctors using an ultrasound. high-frequency sound waves are used in an ultrasound test to create an image of the structures inside the body.
Some hernias may not have any symptom for a long time, during when you may decide to wait and watch. But for certain types of hernias such as femoral hernias, if treatments are delayed there can be a chance of bowel strangulation within 2 years of time.
It is recommended to surgically repair a hernia to preempt the bowel strangulation because this is a complication where blood supply is cut off to an area of the intestine and requires an emergency procedure.
The common hernia repair is done by patching the hole in the abdominal wall with the surgical mesh to close the path of a hernia. This can be done by laparoscopic surgery as well as open surgery. Laparoscopic surgery offers much quicker recovery and returns to work than the open surgery.