A hernia is a bulge caused by the tissue pushing through the wall of muscle that’s holding it in. Most hernias are abdominal hernias. This means they happen in the belly and groin areas.
You may have a hernia if you can feel a soft lump in your belly or groin or in a scar where you had surgery in the past. The lump may go away when you press on it or lie down. It may be painful, especially when you cough, bend over, or lift something heavy.
Types of Hernia:
Femoral hernias sometimes appear as a painful lump in the inner upper part of the thigh or groin. The lump can often be pushed back in or disappears when you lie down. Lump may appear while you cough.
Femoral hernias can be repaired using surgery to push the bulge back into place and strengthen the weakness in the abdominal wall.
Causes of Femoral Hernia:
The exact cause of hernias are unknown. Straining of femoral canal muscles will lead to hernias, few of the factors lead to overstraining of muscles are listed below:
- Chronic constipation
- Heavy lifting
- Being overweight
- Difficult urination
- Chronic coughing
Symptoms of Femoral Hernia:
Some of the severe symptoms may signify the femoral hernia in obstructing the intestines. This is a life risk condition where intestinal or bowel tissue to dies. Few severe symptoms of femoral hernia include:
- Severe stomach pain
- Sudden groin pain
This is a medical emergency and you need to approach the doctor or emergency care immediately.
Complications of Femoral Hernia:
- Obstruction: This is a complication where a section of the bowel becomes stuck in the femoral canal, causing nausea, vomiting and sometimes stomach pain, as well as a painful lump in the groin.
- Strangulation: This is a complication where a section of bowel becomes trapped and its blood supply is cut off; this requires emergency surgery within hours to release the trapped tissue and restore its blood supply, so it doesn’t die.
Surgery gets rid of the hernia and prevents any serious complications, although there’s a chance of it returning after the operation.
Surgical Options for Femoral Hernia:
There are 2 ways of repairing femoral hernia, which are following:
In this type of treating option, surgeon will do an incision and the lump will be pushed back into the abdomen. Once the procedure is done, will stitch the incision and patient will be moved to post-op for observation.
Laparoscopy Surgery / Keyhole Surgery:
Laparoscopy or keyhole surgery refers to surgical procedure with minimal incision. Surgeon will do few small incisions which allows the surgeon to use various special instruments to repair the hernia. As the name indicates the incision will be in the size of a keyhole.
Most people make a full recovery from femoral hernia repair within six weeks, although many people can return to driving, work and light activities within two weeks.
An umbilical hernia occurs when the abdominal wall layers does not join back completely. The umbilical cord connects a mother and her fetus while in the womb during pregnancy. The umbilical cord of the baby will pass through a tiny opening between their abdominal wall muscles. In most of the cases, the hole closes soon after the birth.
Umbilical hernia occurs also because the intestine or the other tissues from inside the abdominal cavity bulge through the weak region around the belly button. About 20 percent of babies are born with an umbilical hernia.
Umbilical hernias are generally painless and will not cause any discomfort. About 90 percent of umbilical hernias will close on their own.
If at all if the umbilical hernia does not close even when the child is at the age of 4 years, then it will require treatment.
Causes of Umbilical Hernia:
The main cause of umbilical hernia is because of not completely closing of the umbilical cord region after the delivery.
However there are few factors which cause the umbilical hernia, which are listed below:
- Multiple pregnancies in gestation (Twins, triplets, quadruplets etc.)
- Frequent pregnancies
- Suffering with heavy cough
- Abdominal surgery
- Excess fluid in the abdominal cavity
Symptoms of Umbilical Hernia:
Umbilical Hernia will have a small bulge near the umbilicus (commonly called as naval). Generally umbilical hernia is not painful for babies but however parents may feel discomfort if the hernia is large in size. Below are few symptoms:
- Bulge becomes painful
- Child vomiting
- Swelling at the bulge
- Change in the bulge color
- Pain/tenderness while pushing the bulge flat against the abdomen
Risk Factors of Umbilical Hernia:
Main risk factors of umbilical hernia include:
Age: infants, especially those preterm babies have a higher risk of having an umbilical hernia
Coughing: Chronic cough will be a major risk because the force of coughing applies pressure to the abdominal wall.
Being obese: Obese children and adults have a significantly higher risk of developing an umbilical hernia, compared with individuals of normal weight for their height and age.
Multiple pregnancies: The risk of an umbilical hernia is higher if the woman has multiple pregnancies like twins, triplets etc.
Treatments for Umbilical Hernia:
Generally umbilical hernia will be closed automatically when baby grows up. Doctor suggests for surgery when:
- The hernia grows after the child is more than 1 year
- The bulge is still there, when child is at age 4
- Causing peristalsis, if the intestines are within the hernial sac, preventing or reducing the movement of the intestines.
- If the hernia becomes trapped
Umbilical Hernia Surgery:
Umbilical hernia surgery is a small procedure where the bulge is pushed back into place and to make the abdominal wall stronger. In many cases, the patient can be discharged on the same day. The surgeon makes an incision at the base of the belly button and pushes either the enlarged lump or bowel back into the abdomen. Muscle layers are stitched over the weak area in the abdomen wall, which strengthens the layer. Sometimes, the surgeon will place a pressure dressing, which remains as it is for 4-5 days.
Complication of Umbilical Hernia Surgery:
The only complication with umbilical hernia surgery is if the blood supply is completely cut off, there is a potential risk of gangrene and life-threatening infection.
An incisional hernia is a hernia usually occurs at or close to the surgical incisions that were made from previous abdominal surgeries. It occurs when the incision which has been made in order to get to an internal organ such as appendix or intestine or other tissues fails to heal properly with the time. Incisional hernias are very common when compared to other types of hernias. Approximately 33 percent of people who undergo an abdominal surgery will experience an incisional hernia. They are most likely to occur within three to six months after surgery, but can happen even after years or at any time. Most of the time, an incisional hernia occurs along a vertical incision.
Causes of Incisional Hernia:
An incisional hernia can be a result of a weakened abdominal muscle due to a surgical incision. The weakening of abdominal muscles can occur for a number of specific reasons which include:
- Being overweight
- Use of steroid medicines
- Participating in excessive or premature physical activity after surgery
- Have had a wound infection after the surgery
- Had more than one surgery using the same incision
- Being pregnant
- An increased abdominal pressure in any way before the surgical incision gets healed completely
Symptoms of an incisional hernia:
An individual with an incisional hernia can experience a specific set of symptoms. Some of the common symptoms of an incisional hernia are fever, swelling and increased pressure on the tissue. A list of symptoms which help to detect the occurrence of an incisional hernia include:
- Foul-smelling drainage from the incision
- The appearance of bulging lump of mass on the scar
- Bowel obstruction due to the restricted blood circulation to the intestines
- Red streaks or redness at the site of incision indicates an infection
- Protrusion of an internal segment from the surgical wound
- Digestive disorders and jaundice
Complications of an incisional hernia:
An incisional hernia can lead to serious complications when there is a delay in the diagnosis and treatment of the condition. Any type of symptoms which might indicate the incisional hernia must be taken care on a priority basis to prevent the condition from getting severe and painful.
The most common complications from an incisional hernia include:
- Severe pain associated with constipation and nausea due to a portion of the intestine locked in the abdominal wall
- Pain and swelling due to delayed diagnosis or treatment that allows the tissues to grow which exerts more pressure on the surrounding area
- Infection of intestinal tissue as a result of reduced blood circulation to the locked intestines. This is a serious case of an incisional hernia and can be fatal if left untreated
Treatment for an incisional hernia:
An incisional hernia will not heal on its own without a surgery. It can be treated only through surgical intervention. The treatment for an incisional hernia will be determined based on multiple factors such as patient’s general health, anatomy, location and extent of the hernia and desired level of physical activity in the future.
Also, the treatment depends on whether the hernia has affected the results of the original surgery negatively which requires additional procedures prior to closure of the hernia.
In general, an incisional hernia is treated by two types of surgeries which include:
- Open hernia repair: An open hernia repair surgery is the most common surgical technique to treat an incisional hernia and is also known as herniorrhaphy. In this surgical procedure, an incision is made in the abdomen above the hernia to push back any protruding intestine into the abdomen and the opening in the muscle wall is repaired. In some cases, a steel mesh or wire is used to repair and reinforce the weak abdominal area.
- Laparoscopic hernia repair: It is the less invasive surgical procedure in which several small incisions are made in the lower abdomen and a laparoscope (a tube equipped with a camera) is inserted through one of the incisions. The laparoscope displays the images of internal organs on a large monitor that guides the surgeon to repair hernia with other small instruments inserted through the other incisions.
An epigastric hernia is a type of hernia in the epigastric region of the abdominal wall. It is just above the belly button and just below the sternum of the rib cage.
Epigastric hernia is common in both adults and children (infants also). About 2 to 3 percent of all the abdominal hernias are epigastric hernias.
Symptoms of Epigastric Hernia:
Generally a bump is caused in the area below the sternum, or breastbone, and above the umbilicus (belly button). This bump is mainly caused by a mass of fat that has pushed through the epigastric hernia.
The bump will be visible all the time or only when the patient cough, sneeze, or laugh. This bump, or mass, can grow and become larger in few cases.
There is chance of having one or more epigastric hernia at a single point of time.
An epigastric hernia can also cause tenderness and pain in the epigastric region.
Here is a list of emergency symptoms of Epigastric Hernia:
- High fever
- Difficulty urinating
- Discharge from the surgical site
- An increase in pain or swelling at the surgical site
Causes of Epigastric Hernia:
This mainly occurs when the tissues in the abdominal wall don’t close completely during development.
Complications of Epigastric Hernia:
The complications for an untreated epigastric hernia include the following:
- enlarged hernia, it allows parts of the bowel to push through
- increase of pain and tenderness
- bowel blockage
- Hernia becomes so large that’s nearly impossible to repair even with a mesh
A hiatal hernia is a condition that occurs when the upper part of the stomach protrudes into the chest cavity through a small opening in the diaphragm known as esophageal hiatus. This type of hernia occurs among people who are over 50 years old.
Though hiatal hernias are common, they do not usually cause any major problems.
Types of Hiatal Hernia
- Sliding Hernia: As the name implies, a sliding hernia occurs when the junction between the stomach and esophagus slides up through the esophageal hiatus. This happens during the moments of increased pressure in the abdominal cavity. The stomach falls back down to its normal position with the gravity, when the pressure is relieved.
- Paraesophageal Hernia: In this type of hernia, there is no sliding up and down, but a portion of the stomach remains get stuck in the chest cavity.
Causes of Hiatal Hernia:
The main cause of hiatal hernia is due to the increased pressure within the abdominal cavity. The suspected factors that contribute to abdominal pressure and development of hiatal hernia include:
- Inflammation of the esophagus
- Injured hiatal area
- Weakened stomach muscles
- Decreased elasticity of the abdominal muscles from aging or pregnancy
- Poor sitting postures
- Frequent coughing
- Straining with bowel movements
- Congenital defects (being born with a large hiatus)
- Lifting heavy objects
Symptoms of Hiatal Hernia:
Most of the individuals with small hiatal hernias do not experience any symptoms. But, large hiatal hernias can cause a variety of symptoms related to gastroesophageal reflux. These include:
- Heartburn that gets worse while bending over or lying down
- Upper abdominal pain
- Difficulty in swallowing
Complications of Hiatal Hernia:
Though complications from a hiatal hernia are rare, they might happen and can be serious. The most common complication while having hiatal hernia is to have acid reflux which is a backup of stomach acid and other contents into the esophagus. This results in heartburn, which can get worse after having heavy meals or while lying down right after eating.
A list of other complications include:
- Esophageal ulcers
- Esophageal stricture, a narrowing of the esophagus due to the formation of scar tissue from repeated damage to the esophagus
- Barrett’s esophagus, change of the cells lining the lower part of the esophagus due to repeated damage from the reflux
- Strangulated hernia, that results when a paraesophageal hiatal hernia becomes knotted and restricts the blood supply to the stomach
Treatment for Hiatal Hernia:
Most cases of hiatal hernias do not show any symptoms, so no treatment is required. The need for the treatment of the condition is determined by the presence of the symptoms. A hiatal hernia is treated based on the symptoms either through medication or lifestyle changes or surgery.
If an individual with hiatal hernia has acid reflux and heartburn, the treatment would be as follows.
The doctor may prescribe medications that include:
- Antacids to relieve heartburn by neutralizing the stomach acids
- H-2 receptor blockers in order to lower the production of stomach acid
- Proton pump inhibitors to block the production of stomach acid and allow time for the esophagus to heal
Lifestyle and dietary changes:
Lifestyle and activity modifications to treat hiatal hernia include:
- Losing weight
- Quit smoking
- Avoiding heavy lifting
- Improving the posture
- Avoiding bending over or lying down right after eating
- Raising the head of the bed by 4 to 6 inches
The recommended dietary changes include:
- Having more small meals frequently instead of large meals
- Avoiding going to bed right after eating
- Avoiding foods that worsen the acid reflux such as caffeine, chocolate, citrus fruits, alcohol, onions, foods made with tomatoes and spicy foods
Treating hiatal hernia by performing a surgery is rare in cases which the symptoms aren’t controlled by medications and making lifestyle changes.
The types of surgery to treat hiatal hernia include:
- Rebuilding weakened esophageal muscles
- Putting the stomach back into the normal position and tightening the esophageal hiatus
There are various approaches to perform these surgeries which include
- An incision made in the chest, thoracotomy
- An incision made in the abdomen, laparotomy
- Several small incisions made in the abdomen through which a laparoscope is inserted, laparoscopy
An inguinal hernia occurs when tissue which is a part of the intestine, comes out through a weak area in the abdominal muscles. The resulting bulge can be painful, especially when you cough, bend over or try to lift a heavy object.
An inguinal hernia is not necessarily dangerous. It doesn’t improve on its own, however, and can lead to life-threatening complications if left untreated. Doctor may recommend for a surgery to fix an inguinal hernia which is painful or enlarging. Inguinal hernia repair is one of the common surgical procedure.
Symptoms of Inguinal Hernia:
Common signs and symptoms of Inguinal hernia include:
- Burning sensation at the bulge
- Bulge in the area on either side of pubic bone, can notice especially if you cough or strain
- Pain or discomfort in the groin, especially when bending over, coughing or lifting weights
- Weakness in the groin
- Heavy sensation in the groin
- Pain and swelling around the testicles when the protruding intestine descends into the scrotum
- Sudden pain that quickly intensifies
- A hernia bulge that turns red, purple or dark
- Inability to move your bowels or pass gas
Causes of Inguinal Hernia:
There will be no particular cause for some inguinal hernias. Others might occur as a result of the below causes:
- Increased pressure within the abdomen
- Pre-existing weak spot in the abdominal wall
- Combination of increased pressure within the abdomen and a pre-existing weak spot in the abdominal wall
- Heavy activities
- Straining during bowel movements or urination
- Chronic coughing
- Chronic sneezing
Complications of Inguinal Hernia:
Pressure on surrounding tissues. In men, large hernias can extend into the scrotum, causing pain and swelling.
Incarcerated hernia. If the contents of the hernia become trapped in the weak point in the abdominal wall, it can obstruct the bowel, leading to severe pain, nausea, vomiting, and the inability to have a bowel movement or pass gas.
Strangulation, this can lead to the death of the affected bowel tissue. A strangulated hernia is life-threatening and requires immediate surgery.
Risk factors of Hernia:
Few factors that contribute in developing an inguinal hernia are listed below:
- Men are more likely to develop an inguinal hernia than women
- Muscles weaken as age increases
- Family history. Any of blood relatives suffer with the same condition
- Chronic cough, may cause with rigorous smoking
- Chronic constipation
- Pregnancy. Being pregnant can weaken the abdominal muscles
- Preterm birth and low birth weight
- Previous inguinal hernia or hernia repair. Even if your previous hernia occurred in childhood, you’re at higher risk of developing another inguinal hernia.
- Classification of biomaterials and their related complications in abdominal wall hernia surgery, from https://link.springer.com/article/10.1007/BF02426382
- European Hernia Society guidelines on the treatment of inguinal hernia in adult patients, from https://link.springer.com/article/10.1007/s10029-009-0529-7
- Hernia, from https://en.wikipedia.org/wiki/Hernia