What is a hernia?
Hernias occur when an organ within your body protrudes out from the tissues or muscles that contain it and keep it in place because of a weakness in them. For example the intestines might protrude out through a weakness in the muscles of the abdomen forming a visible lump on the surface, which is by far the most common presentation of a hernia. Hernias commonly occur in the abdomen but sometimes you will find that they occur in the groin region as well. The most common types of hernias are as follows:
- Inguinal hernia – where your intestines protrude out through a weakness in the inguinal canal, which is a tube like structure present in the groin region.
- Umbilical hernia/ para-umbilical hernia – umbilical hernias are typically found in children who are less than 6 months old, due to the intestines which are protruding out through a weakness in the abdominal wall near the belly button. This condition usually resolves on its own as the baby grows bigger and the abdominal wall muscles become stronger, by about the age of 1 ½ years. Para-umbilical hernia is a similar condition found in adults, which requires surgical management.
- Hiatus hernia – this occurs when a part of your stomach pushes out through the muscle called the diaphragm which separates the abdominal cavity from the chest cavity.
- Incisional hernia – where you intestines protrude through an incision site when you have had previous abdominal surgeries.
How common is it?
Hernias are common in people over the age of 50 years, because the wear and tear of age is the commonest cause for the weakness that occurs. If they are present in children, it is most commonly due to a birth defect.
What causes the condition?
Hernias occur in any part of the body due to a combination of two factors, increased pressure and a weakness in the containing tissues. It is the increased pressure that pushes the organ out of the weakened spot in the surrounding wall. Sometimes the weakness can be present at birth itself or the weakness can develop with age. Factors that lead to increased pressure especially within the abdominal cavity include:
- Chronic cough or persistent sneezing
- Lifting of heavy objects frequently
Signs and symptoms:
Because there is protrusion of organs it gives rise to an abnormal lump. Depending on the area affected, the lump can appear in your groin area, your anterior abdominal wall, on either side of your belly button, the upper aspect of your thigh or event he scrotum. You will find that initially the lump protrudes out only when straining and then disappears on its own. After some time you may have to push it back manually, and then after further lapse of time you will find that the lump is permanent. Other associated symptoms include:
- Pain or a burning sensation in the affected region when coughing, sneezing or bending down
- A feeling of heaviness in your abdomen
In the case of a hiatus hernia, you will not be able to visualize a lump because it occurs internally. Symptoms that will be present will include those similar to gastritis, such as:
- Heart burn due to acid reflux
- Regurgitation of food or liquids
- Difficulty in swallowing
- Chest pain or discomfort
Diagnosing the condition:
Diagnosis is usually clinical. A visible lump in the affected region will give them a very good indication of what type of hernia it could be. The doctor will ask you to cough or strain during the examination, in order to see if the lump gets bigger.
In some cases if the doctors are not sure about the diagnosis they will ask you to do an ultrasound scan of the abdomen which will lead to a clearer diagnosis. This scan involves running probe over the surface of your abdomen after applying a gel.
In the case of a hiatus hernia, the diagnosis is made using a barium study or endoscopy. The barium study involves drinking a barium containing solution and then taking a series of X-rays afterwards, where the barium shows up well. An endoscopy involves passing a thin tube fitted with a fiber optic camera at one end into your throat and down into your stomach through your esophagus.
Treatment options for hernias vary depending on the size of the hernia as well as on the level of your discomfort.
For very small hernias that are not bothering you, lifestyle changes such as exercise to strengthen your muscles as well as to lose weight might help. Even dietary changes can play a role.
In the case of hiatus hernia where the main symptom is heart burn due to acid reflux, then over the counter drugs such as antacids, proton pump inhibitors and H2 receptor blockers will help.
If the hernia continues to grow in size and is causing you great discomfort then surgically repairing it would be the best option. Hernias can be repaired wither through open surgery or through laparoscopic surgery, which involves making three tiny incisions to pass miniature instruments through them, using which the surgery is conducted.
Not all hernias can be repaired laparoscopically, but this procedure is better than open surgery because it damages the surrounding tissue less, and therefore reduces your recovery time.
Follow-up of a patient with a hernia is done to look for possible complications such as:
- Bowel obstruction
- Strangulation – where the blood supply to the protruding intestine is cut of and the tissue dies
- And following repair, we should always be concerned about recurrence.
Preventing the condition:
Although you can’t completely make sure that our muscles don’t weaken at any point, you can reduce the strain you place on your body, by:
- Exercising and maintaining a healthy body weight
- Stop smoking
- Treating your cough or constipation on time
- Avoid lifting heavy weights