What Is a Hernia?
A hernia occurs when an organ or fatty tissue squeezes
through a weak spot in a surrounding muscle or connective tissue called fascia.
The most common types of hernia are inguinal (inner groin), incisional
(resulting from an incision), femoral (outer groin), umbilical (belly button),
and hiatal (upper stomach).
In an inguinal hernia, the intestine or the bladder
protrudes through the abdominal wall or into the inguinal canal in the groin.
About 80% of all hernias are inguinal, and most occur in men because of a
natural weakness in this area.
In an incisional hernia, the intestine pushes through the
abdominal wall at the site of previous abdominal surgery. This type is most
common in elderly or overweight people who are inactive after abdominal
surgery.
A femoral hernia occurs when the intestine enters the canal
carrying the femoral artery into the upper thigh. Femoral hernias are most
common in women, especially those who are pregnant or obese.
In an umbilical hernia, part of the small intestine passes
through the abdominal wall near the navel. Common in newborns, it also commonly
afflicts obese women or those who have had many children.
Hernia Causes
Although abdominal hernias can be present at birth, others
develop later in life. Some involve pathways formed during fetal development,
existing openings in the abdominal cavity, or areas of abdominal wall weakness.
Any condition that increases the pressure of the abdominal
cavity may contribute to the formation or worsening of a hernia. Examples
include:
·
obesity,
·
heavy lifting,
·
coughing,
·
straining during a bowel movement or urination,
·
chronic lung disease, and
·
fluid in the abdominal cavity.
A family history of hernias can make you more likely to
develop a hernia.
Hernia Symptoms and Signs
The signs and symptoms of a hernia can range from noticing a
painless lump to the severely painful, tender, swollen protrusion of tissue
that you are unable to push back into the abdomen (an incarcerated strangulated
hernia).
Reducible hernia
·
It may appear as a new lump in the groin or
other abdominal area.
·
It may ache but is not tender when touched.
·
Sometimes pain precedes the discovery of the
lump.
·
The lump increases in size when standing or when
abdominal pressure is increased (such as coughing).
·
It may be reduced (pushed back into the abdomen)
unless very large.
Irreducible hernia
·
It may be an occasionally painful enlargement of
a previously reducible hernia that cannot be returned into the abdominal cavity
on its own or when you push it.
·
Some may be chronic (occur over a long term)
without pain.
·
An irreducible hernia is also known as an
incarcerated hernia.
·
It can lead to strangulation (blood supply being
cut off to tissue in the hernia).
·
Signs and symptoms of bowel obstruction may
occur, such as nausea and vomiting.
Strangulated hernia
·
This is an irreducible hernia in which the
entrapped intestine has its blood supply cut off.
·
Pain is always present, followed quickly by
tenderness and sometimes symptoms of bowel obstruction (nausea and vomiting).
·
The affected person may appear ill with or
without fever.
·
This condition is a surgical emergency.
Hernia Medical Treatment
Treatment of a hernia depends on whether it is reducible or
irreducible and possibly strangulated.
Reducible hernia
In general, all hernias should be repaired to avoid the
possibility of future intestinal strangulation.
If you have preexisting medical conditions that would make
surgery unsafe, your doctor may not repair your hernia but will watch it
closely.
Some hernias have or develop very large openings in the
abdominal wall, and closing the opening is complicated because of their large
size.
The treatment of every hernia is individualized, and a
discussion of the risks and benefits of surgical versus nonsurgical management
needs to take place between the doctor and patient.
Irreducible hernia
All acutely irreducible hernias need emergency treatment
because of the risk of strangulation.
An attempt to reduce (push back) the hernia will generally
be made, often after giving medicine for pain and muscle relaxation.
In cases in which the hernia has been strangulated for an
extended time, surgery is performed to check whether the intestinal tissue has
died and to repair the hernia.
In cases in which the length of time that the hernia was
irreducible was short and gangrenous bowel is not suspected, you may be
discharged from the hospital.
If a hernia that appears irreducible is finally reduced, it
is important to consider a surgical correction. These hernias have a
significantly higher risk of getting incarcerated again.