Hernia

Hernia

A hernia occurs when an internal part of the body (such as the intestine), pushes through a weakness in the overlying muscle wall, resulting in a soft lump.

Hernia symptoms

Symptoms include a sudden pain when straining or lifting which often eases after the intial period of pain or discomfort.  A soft lump can often be felt in the lower abdomen or groin area depending on which type. The lump may come and go as the internal part moves in and out of the gap in the muscle wall. Sometimes the lump will completely disappear when lying down or grow bigger when coughing or sneezing which may also trigger pain. There are several types of hernia which are classified based on location with the two most common types being an inguinal hernia and a femoral hernia.

Inguinal hernia

Symptoms - An ingroinal hernia occurs when part of the internal tissue which can be fat, muscle or intestine bulge through a weakness in the overlying abdominal wall causing pain, discomfort and other complications. Symptoms include pain in the groin during exercise. The pain is likely to increase when coughing or sneezing. A bulge in the groin area which often disappears when you lay down.

If it is not treated further contents of the abdomen such as the intestines can protrude causing it to grow. The intestines can become pinched, causing blockages and ischema which is a lack of blood to the area which can eventually cause fatal consequences.

This is a protrusion of the contents of the abdomen (belly) through the inguinal canal. It usually appears as a swelling in the groin area. Eighty percent are inguinal, men are 25 times more likely to suffer an inguinal one and 5% of the population could suffer at some point.

Inguinals can either be direct or indirect. Direct happens when part of the abdomen pushes through a weak point in the abdominal wall and into the inguinal canal. Indirect ones occur when part of the abdomen bulges through the deep inguinal ring (this is less common and occurs due to a birth defect). The herniating tissues are at risk of complications such as strangulation (pinching) which can cause intestinal blockages and may cut off the blood supply which requires immediate treatment.

Treatment - You should see a Doctor immediately if you suspect you have one. It will not get better through rest. A doctor or surgeon will need to operate. If the abdominal wall is ruptured it will not get better by resting and surgery to repair it will be needed. Operations should be performed at the earliest convenience. Injuries with complications such as strangulation may require emergency surgery. These are the most common form which occur right in the crease of the groin. They account for 3 out of 4 hernias and are more common in men than women.

Femoral hernia

These are the next most common form and occur a little lower down into the top of the leg and are more common in women. They are usually smaller than the inguinal.

They occur when part of the internal tissue which can include fat, muscle, intestines, etc bulge through a weakness in the overlying abdominal wall and appear in the very top of the leg, at the front of the hip.

Symptoms - A lump in the groin area slightly below that of an Inguinal hernia, although it is nearly impossible to tell sometimes. Pain is usually felt when exercising but not as frequently on coughing and sneezing like an inguinal.

Ten percent are femoral and will look like a swelling in the upper thigh. They occur just below Inguinal ones, at a weak point called the femoral canal. They are more common in women, especially older and frail women.

The tissues are also at risk of complications such as strangulation (pinching) which can cause intestinal blockages and may cut off the blood supply which requires immediate treatment. So if you think you may have one, seek medical attention as soon as possible.

Treatment - You should see a Doctor immediately if you suspect a hernia. It will not get better through rest. A doctor or surgeon will operate. If the abdominal wall is ruptured it will not get better by resting and surgery will be needed. Operations should be performed at the earliest convenience.

Other types of hernia

  • Umbilical occurs near the belly button. These are present from birth and if they require action will be treated in childhood.
  • Incisional occur when the tissue pushes through an old wound or a scar. They are most common when the scar hasn't healed well or has had an infection and usually occur within two years of the initial injury.
  • Hiatus hernias occur when part of the intestines push upwards from the abdomen into the chest cavity through a hole in the diaphragm

Causes and Risk Factors

Hernias are more common in men than women, with 1 in 4 men suffering a hernia at some point in their life, compared to only 3 women in every 100! They often develop due to a sudden strain or force, often lifting something heavy for example. But this is not always the case. They may also appear for no apparent reason.

Other risk factors include:

  • Age - The older you are the higher your risk.
  • Weight - Overweight and obese people are more likely to suffer.
  • Long-term coughing - Coughing places a strain on the abdominal wall.
  • Long-term constipation.

Complications

Generally, hernias are more of an annoyance than a danger, but it is important to get it checked out. This is because, in a few cases, it becomes 'strangulated'. Basically, what this means is that the part of the intestine poking through the hole in the muscle wall is being constricted, which can result in the blood supply to those tissues being cut off. This can lead to death of the tissues and so is a medical emergency. In a few other cases, it can result in an obstruction in the bowel, which again requires urgent medical attention.

Treatment

Whilst the treatment of most is not urgent, it is usually recommended to have a hernia surgically repaired. Generally this is because it will more than likely just get bigger and more uncomfortable and secondly there is always a risk of it strangulating if it is not repaired.

The operation is fairly routine and takes only an hour or so to perform. In most cases the patient can go home the next day and return to work in around a week. The procedure usually involves using a piece of mesh to repair to hole in the abdominal wall.