What you need to know: How to handle a hernia

A hernia is when an internal organ pushes through a weak spot in your muscle or tissue that normally contains it. Most hernias occur in the abdominal cavity, between the chest and the hips.

There are several types of hernias that one can experience, including inguinal hernias, femoral hernias, umbilical hernias and Hiatal hernias. It’s important to treat them quickly. If you think you have a hernia, don’t wait to seek help. A neglected hernia can grow larger and more painful and this can lead to complications and possibly emergency surgery.

Early repair is more successful, less risky and offers a better recovery and outcome.

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The most common forms of hernia are:

Inguinal hernia: In men, the inguinal canal is a passageway for the spermatic cord and blood vessels leading to the testicles. In women, the inguinal canal contains the round ligament that gives support for the womb. In an inguinal hernia, fatty tissue or a part of the intestine pokes into the groin at the top of the inner thigh.

This is the most common type of hernia, and affects men more often than women.

• Umbilical hernia: Fatty tissue or part of the intestine pushes through the abdomen near the navel (belly button).
• Hiatal (hiatus) hernia: Part of the stomach pushes up into the chest cavity through an opening in the diaphragm (the horizontal sheet of muscle that separates the chest from the abdomen).
• Incisional hernia: Tissue protrudes through the site of an abdominal scar from a remote abdominal or pelvic operation.
• Epigastric hernia: Fatty tissue protrudes through the abdominal area between the navel and lower part of the sternum (breastbone).
• Spigelian hernia: The intestine pushes through the abdomen at the side of the abdominal muscle, below the navel.
• Diaphragmatic hernia: Organs in the abdomen move into the chest through an opening in the diaphragm.
• Femoral hernia: Fatty tissue or part of the intestine protrudes into the groin at the top of the inner thigh. Femoral hernias are much less common than inguinal hernias and mainly affect older people.

CAUSES

There are various causes for the different types of hernias. Inguinal and femoral hernias are due to weakened muscles that may have been present since birth or are associated with ageing and repeated strains on the abdominal and
groin areas.

Such strain may come from physical exertion, obesity, pregnancy, frequent coughing, or straining on the toilet
due to constipation.

Adults may get an umbilical hernia by straining the abdominal area, being overweight, having a long-lasting heavy cough or after giving birth.

The cause of hiatal hernias is not fully understood, but a weakening of the diaphragm with pressure on the abdomen could play a part.

SYMPTOMS

• A hernia in the abdomen or groin can produce a noticeable lump or bulge that can be pushed back in.
• Laughing, crying, coughing, straining during a bowel movement, or physical activity may make the lump reappear after it has been pushed in.

More symptoms of a hernia include:

• Swelling or bulge in the groin or scrotum;
• Increased pain at the site of the
  bulge;
• Pain while lifting;
• Increase in the bulge size over time;
• A dull aching sensation;
• A sense of feeling full or signs of bowel obstruction.
  

In the case of hiatal hernias, there are no bulges on the outside of the body. Instead, symptoms
may include:

Heartburn, indigestion, difficulty swallowing, frequent regurgitation or vomiting and chest pain.

DIAGNOSIS AND TESTS

It is usually possible to see or feel a bulge in the area where a hernia has occurred. As part of a male’s typical physical
exam for inguinal hernias, the doctor feels the area around the testicles and groin while the patient is asked to cough.

In some cases, soft-tissue imaging like a CT scan will accurately diagnose the condition.

TREATMENT

When you have a hernia, treatment will start with your nurse or doctor. If you need surgery to repair the hernia, you’ll be referred to a surgeon. Hernias usually do not get better on their own, and surgery may be the only way.

In the case of an umbilical hernia in a child, surgery may be recommended if the hernia is large or if it has not healed by the age of four to five years old.

By this age, a child can usually avoid surgical complications. If an adult has an umbilical hernia, surgery is recommended because the condition will not likely improve on its own and the risk of complications is higher.

One of two types of hernia surgery can be performed:

• Open surgery, in which a cut is made into the body at the location of the hernia. The protruding tissue is set back in place and the weakened muscle wall is stitched back together. Sometimes a type of mesh is implanted in the area
  to provide extra support.
• Laparoscopic surgery involves tiny incisions to allow for insertion of surgical tools to complete the procedure.