A hernia is a weakness or defect in the abdominal wall, known as the hernia defect, which is the anatomical opening or weakness that allows tissue to protrude. It may be present from birth or develop over a period of time. If the defect is large enough, abdominal contents such as the bowels or other soft tissue may protrude through the defect, causing a lump or bulge felt by the patient. Hernias form when tissue pushes through these weak spots in the abdominal wall.
Hernias develop at certain sites which have a natural tendency to be weak: the groin, umbilicus (belly button), and previous surgical incisions. Weakness in connective tissue can also contribute to hernia formation.
Introduction to Hernias
A hernia occurs when there is a weakness or hole in the muscular wall of the abdomen, allowing internal organs or other tissue to push through. This can result in a noticeable bulge, discomfort, or even severe pain, depending on the type of hernia and its location. Most hernias develop in areas where the abdominal wall is naturally weaker, such as the groin, belly button, or sites of previous surgery. Inguinal hernias, abdominal hernias, and umbilical hernias are among the most common types, each presenting unique challenges and symptoms. Recognizing hernia symptoms early and understanding the available treatment options, including minimally invasive surgery and laparoscopic surgery, is crucial for preventing complications. Surgical repair is often recommended to restore the integrity of the abdominal wall and prevent further issues, especially when a hernia causes significant discomfort or risk to internal organs.
Types of Hernias
There are several types of hernias, each with its own characteristics and risk factors. Inguinal hernias are the most common, occurring in the groin area where the abdominal wall is naturally weaker. These are especially prevalent in men due to the anatomy of the inguinal canal. Umbilical hernias develop near the belly button and are frequently seen in infants, though adults can also be affected. Incisional hernias may form at the site of a previous abdominal surgery, as scar tissue can create a weak spot in the abdominal wall. Femoral hernias, which also occur in the groin but lower down, are more common in women and can sometimes be mistaken for inguinal hernias. Hiatal hernias involve the stomach pushing up through the diaphragm into the chest cavity, often leading to symptoms like heartburn or chest discomfort. Epigastric hernias appear between the belly button and the breastbone, where fatty tissue or part of the intestine pokes through the abdominal muscles. Identifying the specific type of hernia is essential for choosing the most effective treatment, whether that involves open surgery, minimally invasive surgery, or laparoscopic surgery.
Signs and Symptoms
Most abdominal hernias present as a bulge or lump, especially when standing or straining.
- Lump in the groin area or at the top of the inner thigh when standing/straining & disappears when reclining
- Pain at the site of the lump, especially when lifting a heavy object
- Discomfort or pressure sensation that may worsen during physical activity, coughing, or bearing down during bowel movements
- Swelling of the scrotum
- Excruciating abdominal pain (if you have strangulation)
- Nausea, vomiting, loss of appetite & pain (if intestinal obstruction occurs)
- Hernia feel: Sensations of pressure, dull ache, sharp pain, or discomfort at the site of the hernia
Not all hernias cause symptoms; some may only be noticed as a visible bulge or lump, especially during certain activities or positions.
A hernia is diagnosed through a physical examination and, if needed, imaging tests to confirm the diagnosis and assess its severity.
Course of Inguinal Hernias
Once a hernia has developed, it will tend to enlarge over time if left untreated and cause discomfort. Hernias tend to get bigger and more symptomatic as time passes. If a loop of bowel gets caught in the hernia, it may become obstructed, or its blood supply may be cut off. This could then become a life-threatening situation. Large hernias are at greater risk for complications and may require surgery sooner. Some hernias require surgery to prevent serious complications such as bowel obstruction or strangulation. Immediate medical attention is necessary if symptoms of strangulation or obstruction occur. Since hernias can be repaired effectively and with minimal risk, most surgeons, therefore, recommend that hernias be repaired when diagnosed, unless there is a serious medical problem that makes it too risky. Traumatic injury can also cause hernia formation by weakening the abdominal wall.
Treatment for Hernia repair (Surgery)
There are several surgical options for treating hernia, including open surgical repair and keyhole surgery (also known as laparoscopic surgery). The choice of surgical method depends on the type and complexity of the hernia, as well as patient-specific factors.
The standard method, known as open surgical repair, involves making an incision in the abdominal wall. Normal healthy tissues are cut until the area of weakness is found. This area, the hernia, is then repaired with sutures. Often, a prosthetic material, such as mesh or another plastic material, is sutured in place to strengthen the area of weakness. After the repair, the surgical wound is closed with sutures, staples, or glue. It is important to note that wound infection is a potential complication of the surgical wound, which can impact recovery and may contribute to the development of an incisional hernia.
Keyhole surgery, or laparoscopic hernia repair, is a minimally invasive technique that uses smaller incisions. Specialized surgical instruments and a laparoscope with a camera are inserted through these incisions. In robotic procedures, the surgeon controls the instruments from a console, allowing for enhanced precision. Keyhole surgery is associated with reduced complications, faster recovery, and is particularly suitable for repeat procedures or complex cases.
Prior surgery, especially abdominal operations, increases the risk of developing an incisional hernia, which is a hernia occurring at the site of a previous surgical wound.
Specific procedures include inguinal hernia repair, which addresses hernias in the groin area and can be performed using open or keyhole techniques, and umbilical hernia repair, which is indicated for children whose umbilical hernias have not closed naturally or are large. Post-operative care for all hernia repairs includes monitoring for complications, such as wound infection, and ensuring normal bowel movements.
Living with a Hernia
Living with a hernia can impact your daily life, as symptoms like discomfort, pain, or a noticeable bulge may limit your activities. Tasks that involve heavy lifting, straining, or bending can worsen hernia symptoms and should be avoided when possible. It’s important to listen to your body and take breaks to prevent aggravating the hernia. Maintaining a healthy weight, eating a balanced diet, and staying active with gentle exercise can help reduce the risk of complications. If you notice changes in your hernia symptoms, such as increased pain, swelling, or signs of bowel obstruction, seek medical attention promptly. Severe pain or sudden changes may indicate a strangulated hernia, which requires immediate surgery. Diagnosis typically involves a physical exam and a review of your medical history, and sometimes imaging tests are used to confirm the type and severity of the hernia.
Prevention and Management
Preventing hernias starts with addressing risk factors like obesity, smoking, and activities that put excessive strain on the abdominal muscles, such as heavy lifting. Adopting a healthy lifestyle with regular exercise and a balanced diet can help strengthen the abdominal wall and lower your risk of developing a hernia. If you have a family history of hernias or have undergone previous abdominal surgery, it’s important to be vigilant for hernia symptoms and seek medical attention if they arise. Management often involves surgical repair, which can be performed using open surgery, laparoscopic surgery, or minimally invasive surgery, depending on the type and severity of the hernia and your overall health. In some cases, if the hernia is small and not causing symptoms, your doctor may recommend monitoring it with regular check-ups. By understanding the causes, symptoms, and treatment options for hernias, you can take proactive steps to prevent complications, reduce severe pain, and improve your quality of life.
