Hernia

hernia

Part of an organ or sac which forms the lining of the peritoneum gets dislodged. Hernia occurs when it protrudes out through a hole or a weak point of the abdominal wall. Hernias are classified according to their anatomical location.

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Causes of Hernia

  • Chronic cough
  • Cystic fibrosis
  • Chronic constipation and straining hard during bowel movements
  • Straining to urinate due to enlarged prostate
  • Extra weight
  • Fluid in the abdomen
  • Poor nutrition
  • Peritoneal dialysis
  • Smoking
  • Overexertion
  • Undescended testicles

Symptoms of Hernia

  • Discomfort and pain which worsens while straining and lifting heavy objects
  • Feeling of a sore bump that is growing
  • Nausea, vomiting and not being able to pass gas or bowel movements upon strangulation

How to diagnose Hernia?

Physical examination This actually helps to feel the hernia upon coughing, bending, pushing or lifting.
Ultrasound scan With the help of high frequency sound waves, the ultrasound machine produces images of various parts of the body.
CT Scan Computed tomography scan uses x-rays to take images of the affected organ from different angles.

Types of hernias

Inguinal hernia

Inguinal hernia occurs in the abdominal wall called the inguinal canal. The contents of the abdominal cavity such as the intestines protrude through the inguinal canal. Inguinal hernias are located above the crease of the leg and in the lower abdomen, close to the pubic area. Inguinal hernias are repaired through tension repair, tension free and laparoscopic tension free techniques.
Inguinal hernia can be classified as direct inguinal hernia and indirect inguinal hernia.

Direct inguinal hernia

 A weakness of the floor of the inguinal canal develops usually in men above the age of 40.
Indirect inguinal hernia This is as a result of a natural weakness of the inguinal ring. Failure of embryonic closure of the internal inguinal ring after a man’s testicle passes through it causes indirect inguinal hernia.

Ventral hernia

Ventral hernia is also called incision hernia. This usually occurs at the healed site of past surgery on the abdomen. The skin in that area is weak and thin. There is a bulge of the abdominal wall at the midline. These can appear days, months or even years after surgery. The patient may or may not feel the symptoms. Ventral hernias are treated surgically with mesh placement surgery, laparoscopic removal and open surgery. If untreated ventral hernias can cause complications such as incarceration and strangulation.

Femoral hernia

A femoral hernia is also called a femorocele. Femoral hernia occurs when a viscus or an intra-abdominal organ protrudes through a weak point of the containing wall. The bulge is located near the groin and thigh. The femoral artery, smaller veins and nerves are all contained in the femoral canal. In women, pregnancy and childbirth also contribute to the cause of femoral hernia. The intestinal sac drops into the femoral canal space due to a weakness in the lower groin. Femoral hernias are not life threatening but might require surgery and its recurrence is very low.

Umbilical hernia

Umbilical hernia occurs predominantly due to weakness from blood vessel in the umbilical cord. It develops as a painless lump near the navel. It is a harmless condition and occurs commonly in infants. In babies, the belly button protrudes when they cry. But infant hernias heal by themselves by about three to four years of age. Umbilical hernias can affect adults too and do not resolve so easily. In adults they occur due to abdominal pressure caused by obesity.

Epigastric hernia

 Epigastric hernias appear in the upper, central part of the abdomen called the epigastrium. These hernias can cause tissue damage when fat and other tissues are trapped inside its opening. It is more common in men due to opening of muscles and tendons in the upper abdominal wall between the breast bone and the umbilicus. Epigastric hernia is in many ways, similar to umbilical hernia as it occurs in infants too and heals itself as they age.

Hiatal hernia

Hiatal hernia occurs due to a weakness or opening in the diaphragm. The stomach protrudes upward into the chest through a space in the diaphragm. Large hiatal hernias cause food and acid reflux leading to heart burn and pain. Medications usually relieve this condition but very large hiatal hernias might require surgical interventions.
Diagnosis Majority of herniae do not require any investigations for diagnosis. And they need to be repaired surgically either by open or laparoscopic methods.