Hernia

Overview

A hernia happens when a part of an individual's body, such as the intestine, pushes through a weak spot in the muscle or tissue. It can feel like a bulge or lump, often in the groin or belly area. While some hernias don't cause problems, others can be painful and may need surgery to fix. One can prevent hernias by maintaining a healthy weight, avoiding heavy lifting, and eating a diet rich in fibre to also manage constipation.

What is Hernia?

Hernia is a medical condition that occurs when part of an individual's internal organ protrudes through a weakened area or an opening in the tissue or muscle that contains it. While some types of hernias involve one of the abdominal organs bulging through the abdominal walls, others may affect the diaphragm. This condition can develop slowly because of regular muscle wear and tear and one's increasing age. In many cases, hernia can result from a traumatic injury, or surgery or can simply be a birth defect.

Types of Hernia

The following are the different types of hernia:

Inguinal Hernia: It forms when part of the intestine protrudes through a weakened area in the lower belly into the inguinal canal, causing a bulge in the groin. One may notice a lump between the area where the groin and thigh meet, being more visible when coughing, straining, or standing.

Hiatal Hernia: Instead of impacting the abdominal wall, this hernia-type affects the diaphragm. Through this hernia opening, part of the stomach protrudes into the chest. One may feel chest pain, heartburn, and a sour taste in their mouth.

Femoral Hernia: Prevalent in older women, these hernias protrude into the femoral canal, located exactly beneath the inguinal canal. A lump may be visible in the upper thigh.

Congenital Diaphragmatic Hernia: It is a fatal birth defect that affects newborns and premature babies. The hernia occurs during foetal development when the baby’s developing organs slip through the diaphragm hole, crowding the lungs.

Umbilical Hernia: This hernia type is more prevalent in newborn babies or premature ones. It occurs when part of the intestine or fat protrudes through the muscles adjacent to the bellybutton.

Incisional Hernia: A common complication of abdominal surgery, incisional hernia develops when tissues push through a former incision in the weakened abdominal wall (owing to a previous surgery). This hernia can occur in people who are involved in certain activities (strenuous exercises, weight gain, and pregnancy) before recovering from their surgery cut.

Ventral Hernia: This is the hernia type that develops through the front abdomen wall when tissues or organs push through a weakened area in the abdominal wall. This may involve the incisional hernias and umbilical hernias. Symptoms may include constipation, vomiting, and shooting pain during physical activity.

The other less common types of hernia include:

Epigastric Hernia: More common in individuals assigned male at birth and men between the ages of 20 and 50, this rare hernia type develops in the middle of the breastbone and bellybutton. This condition may be caused when fat is pushed into the abdominal wall muscle, through a hole, and creates an aching bulge.

Spigelian Hernia: This rare hernia type accounts for about less than 2% of all abdominal wall hernias. More common in individuals assigned female at birth and over the age of 60, this hernia occurs when abdominal tissues push into the Spigelian fascia through a hole.

Perineal Hernia: A rare hernia type, more common in women, occurs when the abdominal tissue pushes against the pelvic floor and creates a hole. This condition is often caused by pregnancy, injury, or surgery. About less than 7% of individuals who have undergone pelvic surgery are at higher risk.

Symptoms of Hernia

Symptoms of hernia depend on its type, as not all of the hernias exhibit symptoms. However, a common sign of the medical issue involves a visible bulge or a lump that appears in some particular physical positions or during certain activities, which also goes back inside at other times (while lying down). This condition can also lead to other symptoms such as feeling pressure, pinching, or a dull pain when the hernia bulges out.

The bulging out of the hernia may occur when one is lifting, bending down coughing, straining, or laughing. For individuals with inguinal hernia, they may feel a lump on either side of their public bone. Hiatal hernias, on the other hand, cause certain symptoms such as chest pain, heartburn, and trouble swallowing.

Causes of Hernia

Hernia is oftentimes a repetitive stress injury, which may appear when a fascia or a weakness in the connective tissue or muscle enables an organ or distant tissues to create pressure against the skin’s barrier. Common causes that lead to muscle weakness include ageing, multiple pregnancies, constipation, ascites, heavy weight lifting, strenuous exercises, a traumatic surgery or injury, congenital condition (developing during birth), and obesity.

Some other risk factors that increase an individual’s risk for developing a hernia include being in a job that involves prolonged hours of standing or lifting heavy weights, chronic allergies or cough, diarrhoea, and a medical history of pelvic or abdomen surgery.

The risk for a child developing a congenital hernia includes having cystic fibrosis, being born prematurely, having congenital hip dysplasia, or other conditions such as connective tissue disorder, undescended testicles, and problems in the urinary or reproductive systems.

Diagnosis of Hernia

A doctor may often only rely on a physical examination to diagnose hernias, based on their type. In the process, the expert may see or feel the hernia or cough or even ask the patient to adjust their position for the hernia to emerge. Following this, the doctor will determine the severity of the condition by evaluating if they can make the hernia go back in.

The patient may also be asked certain questions including the first time they noticed the bulge if they experienced other symptoms, their lifestyle, and occupation, whether they have undergone any groin area or abdominal surgery, and family or personal history of hernias.

The medical expert may also order certain imaging tests to confirm their diagnosis. These may include an abdominal MRI scan, abdominal ultrasound, and abdominal CT scan. In case of a hiatal hernia, the doctor may be required to diagnose the inside of the stomach and recommend an endoscopy or an x-ray of the digestive tract.

Treatment for Hernia

Treatment for hernia generally includes surgical repair, however, it depends on various factors including the nature of the hernia and if it comes out occasionally. Using a wait-and-watch approach, a doctor recommends a hernia repair surgery where they push the hernia back into place and use surgical mesh to reinforce the barrier.

As hernias worsen over time, for a severe herniated tissue a doctor may recommend laparoscopic surgery or robotic surgery for hernia repair. For a congenital umbilical hernia, an umbilical hernia repair may be required if it doesn't go away as the child grows up. Hital hernia in individuals may be treated with Nissen fundoplication if that type of hernia causes chronic acid reflux.

Prevention of Hernia

Hernia cannot always be prevented from developing, however, implementing lifestyle changes can help to alleviate the risk of occurrence. This involves quitting smoking, maintaining optimal body weight, avoiding straining during bowel movements, managing persistent cough and allergy, eating fibre-rich food, performing strength-based exercises, and not lifting heavy equipment.

Myths and Facts About Hernia

Following are the myths and facts related to hernia:

Myth 1: Hernias Only Affect Men
Fact: While this condition is more common in individuals assigned male at birth, women can also develop it, especially after delivering a child.

Myth 2: Hernia is a Condition that Goes Away on its Own
Fact: No, hernia does not go away spontaneously. Leaving it untreated for a prolonged period may worsen its nature and require surgery removal promptly.

Myth 3: Weight Loss is the Only Treatment for Hernia
Fact: Weight loss helps alleviate the risk of developing a hernia, improving one's overall health. However, a surgical removal process is usually required to treat the disease.

Myth 4: Living with Hernia is Always Very Painful
Fact: There are many types of Hernias that cause minimal or no pain, especially during their early stages. However, with its enlargement, the condition can be very painful and uncomfortable for individuals.

Myth 5: Only Obese People are Affected by Hernia
Fact: While being obese increases the chances of developing the condition, individuals of all body weights can develop hernias.