Everything about Hernias: symptoms, causes, treatments, types and more

What is a hernia?

A hernia is defined as “a condition in which part of an organ is displaced and protrudes through the wall of the cavity containing it.” The most common type of hernia occurs in various places of the abdominal wall, which often involves the intestine protruding from a weak spot in the abdominal wall cavity. Hernias present as a bulge in the area and sometimes can be moved or retracted back into the cavity. There are several different types of hernias, however, and each will have their own symptoms and treatments.

Types of hernias

Most hernias are defined and named according to their anatomical area. They generally happen someone in or near the abdominal cavity where there are strong walls of connective tissue (known as fascia) that keep the organs in their place. The most common types of hernias are:

1. Inguinal hernia: These are the most common type of hernias. They’re much more common in men than women and occur in the pelvic area at the leg crease, around the inguinal canal where men’s testicles descend from before birth. When the testes descend, it leaves an open space and this area should seal naturally on its own, but if it doesn’t, it leaves the walls weakened, and contents of the intestine may protrude into the space.

2. Ventral hernia: Also known as an incisional hernia, it occurs at the site of previous surgery in the abdomen. They can show up anywhere from a day to several years after surgery.

3. Femoral hernia: This is a groin hernia that is more common in women than men and presents just under the groin crease.

4. Umbilical hernia: These occur near the belly button. Because of the blood vessels of the umbilical cord, it has a natural weakness for intestines to protrude through. These hernias are very common in infants and children after birth and can last up to 3 or 4 years, but very often will resolve on their own. Umbilical hernias can also occur in adults, but these will not repair themselves and need treatment so they do not worsen over time.

5. Epigastric hernia: These occur in the upper abdominal wall and are more common in men than women. It usually occurs on a line that goes from the breast bone to the navel.

6. Hiatal hernia: This is a different type of hernia from the others because it happens in the diaphragm, which is the muscle that separates the chest and abdominal cavities. Part of the stomach, rather than intestines, pushes up through the diaphragm.

Causes and Risk Factors

Causes of hernias vary on the type and location of the protrusion. Additionally, the cause is not always known and can happen congenitally (at birth) or spontaneously. Below are the most common risk factors and causes of the different types of hernias, many of which are the same or similar.

1. Inguinal hernia: There is often no apparent cause of inguinal hernias, but risk factors include a pre-existing weak spot in the inguinal canal, excessive pressure in the abdomen, straining during urination or bowel movements, heavy lifting, abdominal fluid (ascites), obesity, pregnancy, and forceful chronic coughing or sneezing.

2. Ventral hernias: The most common cause is abdominal surgery. The scar tissue weakens and allows a protrusion of the intestines. Risk factors also include pregnancy, obesity, bowel injuries, family history, and constant moving or lifting of heavy objects.
3. Femoral hernias: These are more commonly found in women than men as a result of pregnancy and labor. Obesity is also a common risk factor because of the excess abdominal pressure.

4. Umbilical hernia: As these occur because of the weakened tissue from blood vessels of the umbilical cord, this is often a congenital hernia found in infants because the muscle where the umbilical cord was doesn’t close completely after it’s cut. Umbilical hernias in adults are generally caused by too much abdominal pressure, obesity, multiple pregnancies, previous abdominal surgery, or excess abdominal fluid.
5. Epigastric hernia: This is another type of hernia that is generally congenital in nature, very often fixing itself. It’s similar to an umbilical hernia, but just higher up on that central line. When it occurs in adults, it’s usually because of abdominal wall weaknesses, heavy lifting, excessive coughing, obesity, and constant straining to urinate or move bowels.

6. Hiatal hernia: There is currently no known cause for this type of hernia in the diaphragm. However, it is likely due to weakened muscle tissue between abdominal and chest cavities. Risk factors include smoking, obesity, and aging, occurring most often in people over 50 years.

Signs and Symptoms of Hernias

Many of the signs and symptoms of hernias are the same, no matter where they are located. For inguinal, ventral, femoral, epigastric, and umbilical hernias, symptoms include:
• Obvious swelling in the area, usually just under the skin of the abdomen and groin. It may feel like a bulge and sometimes will disappear when lying down flat. If the bulge does not go away when lying down, it may be strangulated/incarcerated and would require immediate medical attention
• Feeling a heaviness in the abdomen. This is often followed by constipation and/or blood in the stool
• Straining with bowel movements and urination
• Abdominal or groin discomfort when bending over or lifting something
• Prolonged walking and standing can cause discomfort in the area
• Discomfort with sneezing, coughing, or laughing
• Feelings of pressure or weakness in the groin area
• Pain in the area that ranges from sharp and sudden to dull and achy
• Progressively worsening pain throughout the day

Most small hiatal hernias will not cause any signs or symptoms of discomfort; however, larger hernias have symptoms that include: • GERD (gastroesophageal reflux disease) because this hernia interferes with the barrier that prevents acid and stomach contents from regurgitating. Symptoms of GERD include heartburn, nausea, and acidic regurgitation.
• Excessive belching
• Difficulty swallowing
• Fatigue
• Chest pain

Hernia Treatments

Treatments will depend on type of hernia and its severity. Also, it depends on whether or not the hernia is incarcerated/strangulated, reducible or nonreducible, etc. Incarcerated hernias are quite severe because the tissues have become trapped and cut off from blood supply, which results in strangulation of the tissues. This is also known as a nonreducible hernia because the tissues cannot be moved back into place by lying down or gentle pressure. Nonreducible incarcerated hernias can lead to massive complications including gangrene and tissue necrosis, which is why these are considered medical emergencies and in dire need of surgical intervention.

Many hernias, especially those found in children like epigastric and umbilical, will resolve on their own without any form of intervention. Noninvasive treatments used for mild reducible hernias include medications to control stomach and reflux and lifestyle changes such as no heavy lifting, weight loss, avoiding large meals, smoking cessation, and raising the head of the bed 4 to 6 inches at night (this can be done with extra pillows). Unfortunately, sometimes these changes don’t yield good results and can lead to complications like lung aspiration, anemia due to slow bleeding and incarceration, in which case surgery will be needed.

There are several hernia repair techniques depending on severity of the problem and location. For abdominally located hernias, there is a very simple technique known as tension repair where they open the area over the hernia, push it back in and close the incision with stitches. This has a 15% to 50% recurrence rate depending on hernia location. Other techniques include tension-free and laparoscopic tension-free repairs which are bit more extensive and include using mesh to strengthen and seal the walls.

Small hiatal hernias generally do not yield any symptoms and don’t need treatment; however, when larger hiatal hernias are present, the symptoms can be excessively uncomfortable. Medications usually prescribed to help control symptoms include antacids and drugs to reduce and block acid production so the esophagus can heal. A small number of patients will need surgical intervention for hiatal hernias, and this is only when it is an emergency where the hernia has become incarcerated or causes pulmonary conditions. The procedures used involve opening the area over the protrusion, pushing it back down and tightening the area of the diaphragm where the weakness is. Some patients may also need esophageal repair because of acid erosion and reconstructing the esophageal sphincter (which prohibits acid reflux and is generally weakened in these cases).

If you are experiencing painful or uncomfortable symptoms and the hernia is not reducible, it will be important to seek medical attention immediately to avoid further complications.

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