Hernia

Hernia’s can be classified further. The classification is also based on the cause of the Hernia. The major types of Hernia are:

• Inguinal Hernias- They occur when the intestines push through a weak spot or tear in the lower abdominal wall (inguinal canal).This is the most common type of Hernia and nearly 2% of all men are susceptible to develop this type of Hernia. This type of hernia is due to the presence of a weak spot in the groin area where the male testicles descend during fetal development. This hernia may descend into the scrotum in men and into the folds of the vagina in women.
• Femoral Hernia– They occur through the opening in the base of the abdomen point where the femoral artery and vein pass through to the leg. This type it usually found in women and are caused in childbirth, pregnancy, chromic constipation, obesity, lifting heavy weights and during chronic coughing.
• Umbilical Hernias- This type of Hernialeads to an abnormal bulge formation in the belly button (generally in newborns). Here the weakening is in the belly or the navel area where the umbilical cord is attached. This type of Hernia is mainly seen in children and few adults. In small children the umbilical hernia fades as the child ages , however in adults, umbilical hernia can only be treated through surgery.
• Epigastric Hernias– This type of Hernia is cause whenweakness occurs in the midline of the abdominal wall. In this the fat pushes out through a weakness in the wall of the abdomen between the umbilicus (belly button) and sternum to form a lump. Chronic stomach ache is the best symptom of this type of Hernia.
• Obturator Hernias- They occur in the obturator canal, which is the connection of the abdominal cavity to the leg and contains the obturator artery, vein, and nerve. They are a rare type of Hernia and occur in the pelvic region that contains the abdominal contents. This type of hernia is most common in women and especially common in women who have lost a lot of weight recently. Such type of hernia presents itself with pain in the medial region of the thigh, extending to the knee.
• Incisional Hernias– They occur due to a complication in abdominal surgery, in the abdominal cavity. They are caused when a surgeon cuts into the abdominal muscles leaving them weak and vulnerable. Hernias can develop in these incisions during the weeks, months or even years post surgery. Lifestyle aspects such as smoking, lifting weight or certain medicines can further complicate the Hernia formation.
• Hiatal Hernias– Such hernias occur when part of the stomach pushes through the opening in the diaphragm where the esophagus passes from the chest into the abdomen. Such hernias can cause the food and acid to backtrack causing heartburn. The symptoms associated with this type of hernia is belching, difficulty in swallowing, chest or abdominal pain vomiting, feeling full after meals, GI bleeding or passing blood in stool or urine.
• Sliding Hiatal Hernia– They occur when the lower esophagus and portions of the stomach slide through the diaphragm into the chest.
• Paraesophageal Hernias occur when only the stomach herniates into the chest alongside the esophagus.They are usually found in the gastro-esophageal junctions.
• Traumatic Diaphragmatic Hernias may happen due to major injury that may lead to weakening or tearing of the diaphragm muscle allowing the abdominal organs to push into the chest cavity
• Congenital Diaphragmatic Hernias– They are rare and are caused by failure of the diaphragm to completely form and close during fetal development. They are characterized by a condition in which a hole in the diaphragm allows abdominal organs to move into the chest, which prevents the lungs from developing normally, resulting in pulmonary hypoplasia.

Hernias are caused due a combination of muscle, strain and weakness. Depending on the strain and the weakness of the muscle, hernia develops.

The common causes of muscle weakness are:

• Congenital defect is the failure of the abdominal wall to close properly in the womb
• Age
• Chronic coughing
• Damage due to injury or surgery
• Pregnancy can put pressure on the abdomen
• Constipation can cause strain when having bowel movements
• Lifting heavy weights
• Fluid in the abdomenor Ascites
• Obesity
• Persistent chronic Sneezing

Factors that increase the risk of developing Hernia:

• Personal or family history of hernias
• Obesity
• Chronic coughing and sneezing
• Smoking that may trigger chronic coughing
• Pre existing conditions such as cystic fibrosis can increase the chances of developing Hernia.

Different types of hernias can present themselves in signs and symptoms differently. However there are certain signs that are common for majority.

The usual sign shall include a lump or a bulge in the affected area. You might be able to touch the bulge and feel that something is wrong and protruding out.

In case of Inguinal Hernia:

• Bulge or lump in the affected area
• Lump on either side of your pubic bone where your groin and thigh meet if you are suffering from inguinal hernia
• In case of umbilical hernia in babies one can feel the bulge when he or she is crying
• Pain or discomfort in the lower abdomen during bending, lifting weight or coughing
• Weakness, pressure, or a feeling of heaviness in the abdomen
• Burning, gurgling, or aching sensation at the site of the bulge

In case of Hiatal Hernia:

• Acid reflux
• Chest pain
• Difficulty in swallowing

Inguinal or incisional hernias are usually diagnosed through a physical examination by trying to detect the bulge in your abdomen or groin region that becomes prominent when you stand, cough or strain. Hiatal Hernia is diagnosed with the help of barium X-ray or endoscopy. Umbilical Hernia can be diagnosed with the help of ultrasound on babies.

Treatment of Hernia:

Some of the Hernias are caused due to incorrect habits in the lifestyle. The same can affect the health adversely and cause morbidity. It is important to change the lifestyle as per the doctor’s recommendations and follow the medications as prescribed by the specialists.

• Avoid large or heavy meals
• Avoid spicy or tomato-based foods
• Avoid smoking
• Keep your weight in check

If the hernia as inspected and diagnosed by the doctor cannot be treated through medications then the options available are:

• Suturing: A few minor muscular defects and weakness areas can be closed by suturing. This is a simple surgical technique.
• Mesh: It is a prosthetic material that is inserted through an incision in the abdomen or the groin, depending on the location of the hernia. The mesh provides the support to the weakened area and reduces tension on the wound. It reduces pain and chances of reoccurrence of the hernia.
• Laparoscopic surgery and placement of mesh: In this few incisions are made with a small camera and miniaturized surgical equipment is used for the procedure. The mesh is securely placed in the wound area and such a surgery ensures quicker recovery and no scars.

How to prevent Hernia:

• Avoid smoking
• Visiting a doctor immediately to diagnose persistent cough at an early stage
• Maintain a healthy body weight
• Avoid straining during bowel movement and urination
• Avoid lifting heavy weights