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What is hernia

What is Hernia?

A hernia is a bulge of an internal organ through weakness or abnormal opening in the wall of the cavity in which it normally resides (generally the intestines from the abdomen comes out through the defect in the muscles). A hernia usually presents as painless lump in the groin (the area where leg and abdomen meet) which disappears on lying down.

Most hernias are detected by a surgeon during a physical examination

Causes & Contributing Risk Factors for Hernia

Anyone can develop hernias at any age, or it can be present at birth. Sometimes hernia may be without any reason or true cause may be unknown Hernias are caused by a combination of muscle weakness and strain.
 
Muscle weakness may be due to the congenital defect, old age or after some surgery.

The increased pressure of the abdomen cavity such as in obesity, pregnancy, heavy weight lifting, straining during bowel movement or urination (chronic constipation or enlarged prostate), persistent coughing, sneezing.

What are the Symptoms of Hernia?

  • The most common symptom of a hernia is a painless lump in the groin or in males a bulge in the scrotum. 
  • This may present with straining while lifting heavy objects, during a bowel movement, coughing or sneezing. 
  • The lump may disappear on lying down or even with gentle pressure. A small hernia may not even be noticed and may only be detected during a routine examination. 
  • Severe continuous pain, redness, and tenderness are signs that a hernia may be entrapped or strangulated. 
  • A hernia is dangerous if it gets trapped in the weak spot in the abdominal wall (obstructed Hernia) and blood supply cut off (strangulated Hernia). Strangulated hernia is an emergency requiring surgery.

How to Diagnose Hernia?

A hernia is usually diagnosed by a surgeon through a simple physical examination. He can feel a hernia by placing a finger in the groin and asking the patient to a cough (impulse on coughing).

A hernia that bulges out with abdominal pressure but returns inside the body when the pressure is gone or with gentle pressure from the outside is a reducible hernia.

A Hernia that remains outside is “irreducible” or incarcerated hernia.

If bulging tissue loses blood flow it is the strangulated hernia.

Functional classification of Hernia:

Grade I

  • Swelling appears on coughing/straining and disappears on lying down

  • Defect size finger breadth

Grade II

  • Small, indirect, incomplete reducible hernia

  • Swelling limited to inguinal canal

  • Moderate size direct hernia

  • Swelling present on standing and reduces in the supine position

  • Defect thumb size

  • Small indirect reducible

  • Reducible femoral hernia

Grade III

  • Moderate size indirect reducible

  • Swelling extends up to neck of the scrotum but not to the testis

  • Large reducible direct hernia

  • Recurrent groin hernia

Grade IV

  • Large, reducible, indirect

  • Sac extending up to testis

Grade V

  • Large complete indirect inguinal hernia partially reducible or irreducible
  • Irreducible femoral hernia

Types of Hernia:

Inguinal (Groin)

Inguinal (Groin) Inguinal hernias appear as a bulge in the groin. They are more common in men than women. Patients may develop small intermittent bulges that show up while performing strenuous tasks.

Femoral Hernias

Femoral hernias are relatively rare type of hernia that occurs below the groin crease on the anterior thigh. These hernias are far more common in females.

Umbilical Hernias

At the navel or belly button. Most common type of ventral hernia.

Ventral Hernias

Ventral hernias occur on the anterior (front) abdominal wall at areas of weakness. It may occur as a result of prior surgery, coughing, heavy lifting, obesity, smoking or other disorders. Types of ventral hernias.

Epigastric Hernias

Middle of the abdomen above the belly button and below the breast bone.These hernias contain fatty tissue and often quite small.

Congenital Diaphragmatic Hernia (CDH)

Present at birth abdominal organs may slip in to the chest cavity.
Hiatus Hernia (diaphragmatic hernia) - stomach or other organs of abdomen slips into chest through the diaphragm (muscle that separates the abdomen from the chest and help in breathing).

Stomach or other organs of abdomen may enter into the chest. Hiatal hernias may be incidental finding in chest X-Ray or may present as heartburn, regurgitation, reflux, chest pain, difficulty swallowing or painful swallowing.

Hiatal hernias can be treated with medication and diets changes, but sometimes require surgery.

Incisional Hernia: Occurs at the site of a prior abdominal incision. Parastomal Hernia: Occurs at the site of a colostomy, ileostomy or other stoma (intestines sutured to the skin).

Spigelian Hernia: Occurs in the lower quadrants of the abdomen, usually at or below the level of the belly button.
Sports Hernia: Sports hernias are small, painful hernias as a result of a tear in the abdominal wall. Most common in athletes in sports that involve twisting the leg while running full speed. Most patients present with persistent groin pain that lasts for months despite adequate rest.

Treatment of Hernia- Medicine or Surgery?

There is no acceptable medical treatment of hernia. Once a hernia has developed it will tend to enlarge and cause discomfort. Delayed hernia repair can result in complications.

If a loop of bowel gets caught in the hernia it may become obstructed or its blood supply may be cut off (strangulated). This could then become a life-threatening situation. Since hernias can be repaired effectively and with minimal risk most surgeons therefore recommend that surgery for hernia should be performed as an elective procedure unless there are other serious medical problems.
There are two main options for hernia repair (Read more about surgical options for hernia)

Prevention of Hernia?

Hernia results from combination of weakness in the muscles and strain on body
  • Maintain healthy weight: healthy weight is determined by your height measured by BMI (Body mass Index) Overweight causes stress on body. Consult your dietician for diet and exercise plan.
  • Coughing should be shown to doctor. Quit smoking
  • Allergy causing excess sneezing and coughing should be treated
  • Eat fruits, vegetables and grains to avoid constipation
  • Do not lift weight more than you can handle