CONDITIONS

Hernia

What Is Hernia

A hernia is the protrusion of an organ or piece of tissue from it’s normally contained space. Part of an organ is displaced and protrudes through the wall of the cavity containing it. Hernia often involves the intestine at a weak point in the abdominal wall, which is constructed of layers of different muscles and tissues. Weak spots can develop in these layers, which can allow contents of the abdominal cavity to intrude. Hernias may be present at birth (congenital) or develop any time thereafter (acquired).

Many people have abdominal hernias. As much as 10% of the US population will develop some type of hernia during their lifetime—and more 500,000 hernia operations are performed in the United States each year. While women account for only 8% of the hernias that are diagnosed, those that afflict women are usually small and internal, and are more hidden, rarely causing an obvious bulge. Women’s hernias commonly entrap abdominal fat and compress nerves.

The most common types of hernia are:

  • Inguinal. Inner groin. Approximately 96% of groin hernias are Inguinal. The intestine or bladder protrudes through the abdominal wall or into the inguinal canal in the groin
  • Incisional. Resulting from an incision, when someone has this type of hernia, the intestine pushes through the abdominal wall at the site of a previous abdominal surgery. Most common in the elderly or overweight people who are inactive after surgery
  • Femoral. Outer groin.  These are most common in women, occurring when the intestine enters the canal carrying the femoral artery into the upper thigh
  • Hiatal. Upper stomach. This type of hernia happens when the upper stomach squeezes through the hiatus—an opening in the diaphragm through which the esophagus passes
  • Umbilical.  These hernias occur around the belly button as a result of the weakened nature of the abdominal wall in this area. Women are particularly vulnerable to this hernia
    Other types of hernias include:
  • Obdurator.  These are in the pelvic floor, found in women who have had multiple pregnancies, or lost significant weight
  • Traumatic diaphragmatic. This type of hernia occurs due to major injury where blunt trauma weakens or tears diaphragm muscle
  • Spigelian. This occurs on the outer edges of he rectus abdominus muscle. It is quite rare, occurring as a complication of abdominal surgery
  • Muscle. Part of your muscle pushes through the abdomen, sometimes after a sports injury

Most of the time hernias don’t cause problems—it’s actually possible to have a hernia your entire life.  This means the hernia is reducible—meaning that you can either lie down or take your finger and push and the bulge in the groin will disappear. This means the intestinal contents go back to the correct location.  If it is not reducible by lying down or using a finger or having a physician manipulate it, it is considered irreducible and there is cause for concern. When hernias cause pain it is also reason for concern.

What Causes Hernia

Most hernias develop in the abdominal wall, which runs from just below the breastbone down into your groin. The wall is similar to rubber on a tire—it protects and surrounds your organs much as a tire protects and surrounds the air-filled tube inside it. When a weakness presents in the abdominal wall, it creates the environment for a hernia. Once a hernia develops,  it is generally progressive—once it forms, it typically get worse.


A number of factors can increase risk of developing a hernia, among them:

•    Age (muscle begins to weaken as we get older)
•    General health
•    Congenital disorders
•    A strain from heavy lifting


Typically, hernias develop when a section of the abdominal wall wears down or tears. This happens when:
•    An area of your abdominal wall is weak at birth
•    An area of your abdominal wall weakens over time due to pregnancy, aging, surgery, injury


Certain medical problems and activities can put pressure on the abdominal wall, resulting in a hernia. These include:

•    Being overweight or obese
•    Physical exertion
•    Smoking
•    Poor nutrition
•    Accumulation of fluid in the peritoneal cavity of the abdomen. Also called ascites.
•    Long-term cough
•    Cystic fibrosis. A genetic disorder that affects mostly the lungs but also the pancreas, liver, kidneys and intestine.
•    Straining to urinate
•    Cystic fibrosis
•    Chronic constipation
•    Congenital problems
•    Ehlers-Danlos Syndrome.  A genetic disorder characterized by decreased collagen and weakening of connective tissue

Risk Factors For Hernia

These are a number of factors that increase your risk for developing a hernia. These include:

  • Age. Fibrous muscles and tissues weaken naturally over time
  • Being a man. You’re far more likely to develop a hernia if your’re male. The vast majority of newborns and children who develop hernia are boys. Women, however, are more prone to femoral hernias, due to a wider pelvic structure
  • Prior muscle injuries. These can lead to weakening of muscle tissue. Sports injuries or sudden movements can cause spinal hernias if a disc becomes dislocated.
  • Chronic constipation. Straining during bowel movements is a common cause of hernias
  • Chronic cough
  • Family History. Individuals with a family history of hernias are more likely to develop them
  •  Surgery. Those who have had prior abdominal surgery are more at risk
  •  Certain medical conditions. Individuals who have cystic fibrosis, or who suffer from conditions that increase internal body pressure or a disorder of the connective and muscle tissues are more likely to develop a hernia.
  • History of hernia. If you have had a hernia, you’re more likely to develop another, often on the other side from where you had the first.
  • Smoking
  • Being overweight or obese. Being moderately to severely overweight puts added pressure on your abdomen and abdominal muscles, which can make you more prone to hernia.
  • Lifting and straining
  • Previous surgical incisions
  • Pregnancy. Being pregnant, and especially sustaining multiple pregnancies, can weaken abdominal muscles  and cause increased pressure in the abdomen, which can increase risk of hernia.

Diagnosing Hernia

To diagnose a hernia a physician will perform a physical exam. The hernia is often obvious and no other test is required if you are otherwise healthy. However, a woman’s hernia is typically smaller than a man’s, and often internal, thus there is not always an obvious bulge. If the person has hernia symptoms (i.e.: dull ache in the groin or other body area), the doctor may feel the area while increasing abdominal pressure, having the patient stand or cough, which pieces of abdominal fat can protrude – pressing on nerves and causing pain

The doctor will ask questions like:

•    When was the hernia first noticed (if it was noticed before the visit)?
•    Does the lump come and go or can it be pushed inside?
•    Has the lump grown larger and more painful?

Your doctor may use the following diagnostic tests to confirm the presence of a hernia:

•    X-rays. X-rays can determine a bowel obstruction while an ultrasound can find a femoral hernia.
•    MRI.  Doctors often don’t ‘think hernia’ when women mention their pelvic pain. An MRI can diagnose inguinal hernias—small holes in a layer of muscle through
•    CT scans are another tool used

Symptoms of Hernia

Typically there are no symptoms, though some people have discomfort or pain. Standing, straining or lifting heavy objects can worsen the discomfort.  Eventually a hernia sufferer can complain about a bump that is sore or growing.  If a hernia gets bigger it may get stuck inside the hold and lose its blood supply, necessitating emergency care

These are symptoms to look for:

•    Pelvic discomfort
•    Groin spasms (this is often the result of an athletic injury)
•    Vomiting. This can be a sign of a hernia forming. If vomiting is accompanied by a fever, groin pains or accelerated heartbeat, seek a doctor’s care immediately
•    Fever. A temperature of over 100 F along with pains in the abdominal region or vomiting can mean a hernia
•    Accelerated heart rate. The heart rate speeds up when you are sick and/or stressed. If it doesn’t slow down after you relax for a while, see a doctor
•    Abdominal pain.  Pain in the stomach or midsection all the way down the groin area can be indicative of a hernia.  Typically, hernia pains are on the side of the abdominal region, or near the pelvic areas. If pain doesn’t subside after using ice or resting a day or two, consult a physician
•    Trouble walking. This occurs when the groin is affected by an injury
•    Swelling. When hernias are internal, particularly umbilical hernias, swelling occurs
•    Burning. This symptom is often reported when the hernia is growing.

Prognosis

More than half a million hernia repair operations are performed each year in the United States, making it one of the most common operations performed. Patients generally recover quickly and do well after surgery, however all surgeries are associated with some risk. Be sure to speak with your doctor about possible risks and complications. Exact prognosis depends on the type and size of the hernia.


Operative complications. Approximately 7 % of those having hernia repair surgery have complications. Most are short term and treatable. These complications include recurrence (most common) and wound infection. Some possible complications include:

  • Adverse reaction to the mesh used to close the hernia
  • Adhesions—bands of scar-like tissue—and injuries to nerves, blood vessels, or organs in the operative area
  • Infection
  • Chronic pain
  • Hernia recurrence

Risk factors for acute complications of hernia complication include:

  • Older age
  • Longer duration of hernia
  • Strangulation. This is something to consider when contemplating surgery. A  hernia in which the blood supply of the herniated viscus is so constricted by swelling and congestion that the circulation is arrested.  This can result in intestinal obstruction. Risk varies with the location and size of the hernia and how long it has been present.

Living With Hernia

People can live with hernias for years and have no problem, while some sufferers experience chronic pain, yet continue to put off surgery.  The reality is that hernias don’t repair themselves. They will continue to get bigger, and potentially more dangerous. Which brings us to the question of whether or not you should fix your hernia via an operation.

Should you have surgery? Questions to ask yourself:

  • How is the hernia affecting you?  The most common symptom is pain.  Others are a feeling of heaviness in the belly or groin. These symptoms can interfere with day-to-day activities.  If you have pain your doctor will likely recommend surgery
  • What if symptoms are minimal and your lifestyle is not hampered in any way? The doctor may prescribe watchful waiting

Risks of waiting

  • Hernias can become incarcerated, which means that they can become trapped outside the abdominal wall, causing a strangulated hernia which is dangerous
  • Hernias grow—and the bigger they get, the more symptoms increase.  As well, the bigger the hernia gets, if and when you finally have surgery, the risks will be greater, and the recovery more difficult
  • Your overall health can change. You are growing older, other health issues might crop up, which may make surgery more difficult at that point.
  • Getting the hernia fixed sooner versus later also means you might be a candidate for laparoscopic hernia surgery, which is less invasive and you are back on your feet quicker.

Prevention

There is little you can do to prevent areas of the abdominal wall from becoming weak, which can predispose you to developing a hernia. And a hernia may be present at birth. However, there are some things you can do that can help you prevent hernias:

  • Lose weight if you are overweight
  • Eat a diet of high fiber foods with whole grains and fruits and vegetables to prevent straining with bowel movements and constipation
  • Control allergies so that you don’t sneeze in excess
  • Exercise to strengthen the abdominal muscles
  • If you have to lift heavy objects, learn the proper way to do so

Common Treatment

Hernias are repaired with either open or laparoscopic surgery. The latter procedure is less invasive, and uses a tiny camera and miniaturized surgical equipment to repair the hernia, through just a few small incisions. Treatment depends on whether the hernia is reducible, or irreducible and possibly strangulated.  In cases of hernias with a large opening, surgery is not recommended.  Trusses, surgical belts or bindings may be prescribed to hold back the protrusion; however, these devices should not be used for a femoral hernia.

Reducible Hernia

  • Surgery is often considered to be the best treatment for a hernia to avoid the possibility of future intestinal strangulation. However, if you have a pre-existing medical condition that would make surgery unsafe, the doctor may choose to watch the hernia closely rather than repair it
  • Hiatal hernias that are not severe can be managed by lifestyle changes such as losing weight and taking medications for acid reflux

Irreducible Hernia

  • All acutely irreducible hernias need emergency treatment due to the high risk of strangulation.
  • An attempt will be made to reduce (push back) the hernia. Medicine for pain and muscle relaxation will likely be prescribed. If unsuccessful, emergency surgery will be performed
  • If the intestinal contents of the hernia had the blood supply cut off, the development of gangrenous (dead) bowel is possible within six hours
  • In cases where the hernia has been strangulated for an extended time, surgery is performed in order to check whether the intestinal tissue has died, and also of course to repair the hernia
  • In cases where the length of time the hernia was irreducible was short and gangrenous bowel is not suspected, surgery might not be performed
  • If a hernia that was irreducible is finally reduced, a surgical repair will be strongly considered

Complementary and Alternative Treatment

Here are some alternative treatments for hernias that can provide relief from symptoms. They are not a cure and should not be used as a replacement for conventional medical advice. Indeed, you should consult with a doctor before trying any home treatment:

  • Licorice root.  May encourage healing of damaged areas in the stomach lining and esophagus caused by a hernia
  • Ginger root.  Helps protect the esophagus and stomach from damage due to buildup of gastric acids and bile
  • Chamomile.   Acid reflux can happen as a result of hernias in the abdominal region. Chamomile can soothe the lining of the digestive tract and reduce the production of stomach acids
  • Acupuncture. Stimulation of certain pressure points can help reduce pain and discomfort.
  • Hawthornia. This herbal supplement helps strengthen muscles that support and protect the internal organs.
  • Ice compresses.  Helps reduce pain and swelling
  • Sleep with upper part of your body propped on pillows. You can also try raising the head of your bed.

When To Contact A Doctor

Hernias are not generally life threatening, but it’s important to understand when they become an emergency. If you suspect a hernia, consult a doctor.

Non-emergency hernia. If the hernia is not tender and is easy to reduce (push back into the abdomen), you should still consult a physician, but it is not an emergency situation.  Ask your doctor for a referral to a surgeon, so that you have the option for elective surgery. It is best to avoid emergency surgery, in the event the hernia becomes irreducible or strangulated.

Emergency hernia. If the hernia suddenly becomes painful, tender or irreducible (cannot be pushed back inside), go to the ER. Strangulation (cut off blood supply) of the intestine within the hernia sac can lead to a gangrenous or dead bowel within six hours

Questions For A Doctor

It’s helpful to write down a list of questions before your appointment. Here are some questions you might ask:

  • What type of hernia do I have?
  • How should I take care of it?
  • Can I just wait and see if it gets worse?
  • What do I do if the hernia suddenly feels painful and swollen or gets larger?
  • What is the best surgical repair option – laparoscopic or open?

Resources

Some resources that may be helpful for learning more about hernias include:

Hernia Info

Medical News Today