What is a hernia? A hernia is the protrusion of an organ through the wall that normally contains it. Abdominal wall hernias are caused by a tear or defect in the abdominal muscle layers. The protruding organs cause a lump at the hernia site. Hernias usually occur in the weaker areas of the abdominal wall. These are the belly button, the groins and surgical scars. The belly button is the site through which embrionic blood vessels to the placenta pass through before birth, giving rise to umbilical hernias. The groin area in men is the site through which the blood vessels to the testicles pass leading to inguinal hernias. Surgical scars are areas weakened by previous abdominal surgery and can become the site of incisional hernias. The second main factor that contributes to the occurrence of a hernia is how much strain or force is put on the abdominal wall during physical activity, especially heavy lifting. This causes the weak area to tear, leaving an opening through which abdominal organs can pass. The most common hernias are inguinal hernias (groin hernias).
What are the symptoms?
- pain or discomfort in the groin area, the belly button or a surgical scar.
- a bulge that can be pushed back in
- a bulge that cannot be pushed back in. This may be a potentially life-threatening problem, especially when accompanied with pain, nausea and vomiting, because bowel may be trapped in the hernia opening.
How does a hernia develop and is it dangerous?
Obesity, pregnancy, heavy lifting, chronic coughing, constipation and straining to pass stools can cause the intestine to push against the abdominal wall, and a part of intestine may slip through the weak spot, creating a lump.
The lump may disappear when you lie down as the piece of bowel moves back into the abdomen, and reappear when you stand up or are straining to pass a stool. The hernia itself is harmless.
A hernia can be dangerous if it gets trapped in the weak spot in the abdominal wall and becomes tender. The lump no longer disappears when lying down and cannot be pushed back either. This is known as a strangulated hernia. If the intestinal loop is damaged, its contents can leak out. Gangrene and peritonitis, which can be life-threatening, may occur as a result. Strangulation is an emergency requiring urgent surgery.
There are two types of groin hernias:
- indirect inguinal hernia which is common in children - they may be present at birth - and young people. They are mostly seen in males but can also occur in females.
- direct inguinal hernias mostly afflict adults, especially middle-aged and elderly men.
How are hernias treated?
Surgery is the only effective cure for all hernias.
In elderly men with direct inguinal hernias, surgery is only necessary if the hernia is causing discomfort or there is risk of strangulation. It is difficult to predict this risk however, while the risk of inguinal hernia surgery is very small. This is why your doctor will often suggest that you have the operation to avoid complications.
All indirect inguinal hernias should be treated surgically, if the patient is fit enough for the operation because the risk of strangulation is high.
Umbilical hernias and incisional hernias are usually operated as well, as they tend to increase in size over time. Surgery involves closure of the muscle defect with strong sutures. Sometimes the repair is re-enforced with a patch of synthetic material, to reduce the chance of recurrence.
What kind of surgery is used for inguinal hernias?
The operation for a groin hernia is one of the commonest surgical procedures. It is usually carried out under a spinal anesthetic but a local anesthetic, or a general anesthetic can also be used.
Most operations are done through a cut in the groin which is three to four inches long. It can be on an outpatient basis or an overnight stay in hospital at the most. During the operation, the surgeon will push your intestine back into the abdominal cavity and bring other tissue around the hernia to help cover the opening (the hernial defect). If there is not enough strong tissue available around the hernia, the surgeon may place a mesh over the weak spot in the abdominal wall.
Normal activities can usually be resumed within two weeks of the operation and the chance of a recurrence of the hernia after surgery is extremely small (less than 1 per cent).
The operation can also be performed using keyhole surgery. The only advantage of this is that patients can return to normal vigorous activity a little sooner. Laparoscopic surgery may not be recommended for very large hernias. The long-term recurrence rate of hernias after keyhole surgery is not yet known.
How can I help prevent a hernia?
Although there is no way to prevent hernias due to a congenital weakness or family history, you can help reduce your risk for an inguinal hernia. Follow a healthy diet that is high in fiber and drink plenty of fluids to prevent constipation, maintain a healthy weight through diet and exercise, and avoid cigarette smoking, which can cause chronic coughs. If your job requires heavy lifting, learn the proper way to lift and wear a support garment.
