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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:
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.
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
• 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
These are a number of factors that increase your risk for developing a hernia. These include:
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
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.
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:
Risk factors for acute complications of hernia complication include:
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:
Risks of waiting
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:
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.
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:
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
It’s helpful to write down a list of questions before your appointment. Here are some questions you might ask:
Some resources that may be helpful for learning more about hernias include:
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