A hernia occurs when an organ or other tissue pushes out through the tissue wall in which it is enclosed. Hernias result from the enclosing tissue becoming weakened, may present as a bulge depending on their location, and may cause complications that require emergency surgery.
Definition & Facts
Common types of hernias include
- Inguinal hernias are a type of groin hernia in which internal organs like the intestines or bladder can squeeze through a part of the abdominal wall called the inguinal canal.
- Hiatal hernias occur when the stomach pushes through a part of the diaphragm called the hiatus, causing the flow of peptic acid into the esophagus.
- Incisional hernias result from the weakness in tissue caused by surgery and infections following surgery.
- Femoral hernias are another type of groin hernia in which a part of the intestine drops into the femoral canal. These are most common among pregnant women and obese women.
- Umbilical hernias occur near bellybutton, are usually present at birth, and often resolve on their own.
Symptoms & Complaints
If a hernia involving the intestines become strangulated and the oxygen supply to the tissue becomes compromised, a medical emergency can occur, causing symptoms such as severe pain, the inability to pass gas, and constipation. Trouble sleeping and disruption to one's daily routines may ensue. Hiatal hernias cause symptoms of gastroesophageal reflux disease such as heartburn, chest pain, and dry coughing.
Those who do heavy lifting, cough frequently, or are obese, are at the highest risk for developing a hernia. Inguinal hernias commonly affect men because of a weakness or opening in the inguinal canal following the descent of the testicles in male babies. The risk for incisional hernias can be increased by obesity and the presence of an infection in the surgical wound. Childbirth and pregnancy are common risk factors for femoral hernias. Straining during a bowel movement, urination or even while laughing are all causes of hernias.
Diagnosis & Tests
When diagnosing a potential hernia, a health care provider will perform a physical examination in which he or she visually inspects the body for noticeable bulges that may indicate hernias as well as touches the area that the patient points out as being uncomfortable or painful. If a bulge isn't visible, the doctor may ask the patient to cough, which can help him or her identify the hernia.
Hiatal hernias can be diagnosed via esophagram and endoscopy. These tests will help the health care professional identify the extent of the hernia and any damage. Blood tests can also be performed. These can assist also if the hernia has become obstructed or strangulated in assessing the presence of infection.
X-rays, MRIs or CT scans of the abdomen may be necessary to examine any complications of hernias such as incarceration or strangulation. Ultrasound is another imaging test that can spot femoral hernias.
Treatment & Therapy
Treatment for a hernia ranges from rest to invasive surgery. Umbilical hernias are usually present at birth and usually subside after two to three years of age. On the other hand, inguinal hernias require surgery and won't heal on their own. In the case of hiatal hernias, laparoscopic surgery may be performed to reposition the stomach, remove the part that is protruding, or strengthen the esophageal muscle.
Hernias typically require emergency surgery if they become incarcerated which means that the herniated tissue becomes stuck and obstructs organ function. This can occurs when a loop of the intestines becoming stuck in the hernia and obstructs the bowel. Hernias also require surgery if strangulation occurs, meaning that the obstruction is so severe that blood supply to the herniated tissue is reduced or nonexistent.
Surgeries to repair hernias commonly involve the use of stitches or a mesh net to strengthen the wall that has been weakened and herniated. Surgery that uses mesh reinforcement tends to have better long-term results but may increase the risk of infection and is a more invasive surgery. Surgery that uses stitches is less invasive but less effective in preventing recurrence.
Treatment of hernias can also focus on symptom reduction if the hernias are considered easily reducible, meaning that the protruding contents can be easily repositioned to where they originated. Treatment of hiatal hernias focuses on reduction of acid reflux symptoms. H-2 receptor blockers can help reduce acid levels as can proton-pump inhibitors. Over-the-counter antacids also assist with mitigating the reflux symptoms of hiatal hernias.
Once a patient has recovered from surgery, excessive or repetitive strain will be off limits for several weeks or longer. Once a patient appears to have fully recovered, brief physical therapy may be in order, but extreme hernias may require longer periods of therapy.
Prevention & Prophylaxis