Is That a Hernia?
If your abdominal pain is causing you distress and digital medical information from various platforms has made you suspect hernia to be the cause, firstly, relax. Not all abdominal pain are hernias, and not all the time, hernia causes pain.
What Is Hernia?
The abdominal cavity is enclosed by different muscle layers and tissues. Due to certain causes, a weak spot in these muscle layers and connective tissue of the abdominal wall develops, through which contents of the abdominal cavity such as organs (small intestine, a part of the stomach, bladder, etc.) or other tissues protrude or squeeze through.
Though people call it a hernia in general, there are different abdominal hernia types based on their location.
What Are the Different Types of Abdominal Hernias?
The term abdominal hernia is a general term. Based on the location, several types of hernias exist. Abdominal hernias are classified as,
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Abdominal Wall Hernias -
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Epigastric hernia.
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Incisional (ventral) hernias.
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Groin Hernias -
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Inguinal hernias.
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Femoral hernias.
1. Umbilical Hernia:
As its name indicates, an umbilical hernia happens near the belly button region. The protrusion or bulging of the fatty tissue underneath or a part of the intestine through the abdominal wall near the belly button leads to an umbilical hernia.
According to “The European Hernia Society Classification for Abdominal Wall Hernias,” it is said to be an umbilical hernia if it is located 3 cm above or 3 cm below the navel. If you find a bulge near your navel, it can be an umbilical hernia.
Risk Factors -
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Lifting weights.
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Persistent cough.
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Preterm babies.
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Obesity.
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Ascites.
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Chronic abdominal distension.
Prevalence - Umbilical hernia more commonly affects newborns, infants, and adults, especially women during their pregnancy and obese individuals.
An umbilical hernia is more common in newborns, and most of the time, it resolves on its own in these infants. The opening at the region of umbilical cord attachment in infants should close soon after birth. If this happens improperly, weak spots in the abdominal wall can be present through which umbilical hernia occurs. If it does not resolve on its own within four years of age, surgical correction is recommended.
In adults, a bulge near the navel and pain (at times in case of a large hernia) may be present. The bulge can be pushed back inside and reduced. The bulge can become prominent with activities like coughing, lifting weights, shouting, laughing, etc. If the bulge gets more significant, cannot be reduced, becomes painful, and is accompanied by severe pain and vomiting, immediate medical attention must be sought.
2. Epigastric Hernia:
The epigastric hernias occur in the middle of the abdomen, where the abdominal muscles from both sides meet in the midline. Most commonly, it occurs in infants but becomes evident during adulthood because of a lack of symptoms. It is named so because the hernia can occur anywhere in the body's midline above the belly button and below the sternum region.
When the tissues of the abdominal wall do not close properly during the development of the fetus, epigastric hernias can occur. Surgery is needed to correct the condition, and it does not resolve on its own.
3. Spigelian Hernia:
Spigelian hernias develop below the level of the belly button. Since these form in the middle of the abdominal muscles and not under the fat layer, these hernias can go undetected for an extended period. Weakness of the abdominal wall muscles remains to be the cause.
If and when prominent, the bulge in Spigelian hernia is soft to touch and occurs to the side or below the umbilicus. The pain can either be continuous or intermittent. The symptoms can get prominent during lifting weights, bowel movements, and exercise.
Risk Factors -
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Aging.
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Overweight.
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Pregnancy.
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Abdominal injury.
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Lifting weights.
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Ascites.
Prevalence -
Spigelian hernia can mostly affect the elderly aged 50 years and above and especially males.
Though these are rare to occur, Spigelian hernias come with an increased risk of strangulation, and hence it requires immediate surgical management.
These do not occur on their own but occur as a result of complications of abdominal surgery. Once a person’s abdominal area is surgically cut or incision for surgical repair of another condition though the muscles are sutured back, the incision area becomes weak, making it prone to hernia. This can be due to improperly healed surgical wounds.
These also do not heal on their own and require surgery for management. The characteristic hernia bulge becomes prominent whenever the person stands upright or while performing exercises. Parts of abdominal organs tend to squeeze through the unhealed and weak incision area.
Risk Factors -
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Pregnancy.
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Previous abdominal surgery.
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Strenuous activity within three to six months of abdominal surgery.
5. Inguinal Hernias:
These hernias occur in the groin region, that is, the region where the lowest part of the abdomen and thighs meet. While a male fetus is developing, the testicles and spermatic cord descend from the abdomen to the scrotum through an opening within the abdomen called the inguinal canal. This opening is supposed to close intact after the descent. But at times, a weak area at the region of closure takes place. This weakened area is prone to inguinal hernia during adulthood in the presence of risk factors leading to squeezing of parts of the small intestine through the canal.
6. Femoral Hernia:
The femoral veins and artery pass from the abdomen to the leg through an opening in the lower abdominal region called the femoral canal. Femoral hernias are also known as femorocele and mostly present as a painful bulge in the upper thigh region or groin or can be asymptomatic. The bulge, if present, can be pushed back and reduced to make it flat.
Risk Factors -
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Lifting weights.
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Childbirth.
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Strained bowel movements.
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Chronic cough.
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Overweight.
Prevalence -
These are relatively rare hernias, and women are more likely to be affected by femoral hernias than men.
Small femoral hernias do not need specific treatment except for close monitoring and avoiding the risk factors. But large hernias require surgical repair. Femoral hernias can cause stomach pain, hip pain, groin pain, and vomiting in severe cases. This is a medical emergency and needs prompt medical care.
What Symptoms Do Abdominal Hernias Cause?
Mild abdominal hernias usually do not cause serious symptoms. Usual symptoms are,
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A bulge beneath the skin that can be pushed back to make it flat.
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Mild pain with physical stress such as straining while defecating, lifting weights, coughing, etc.
What Is a Strangulated Hernia?
A serious condition called strangulation can be caused by large hernias. It is a life-threatening condition. During strangulation, the blood supply to the herniated tissue or organ like the small intestine will be cut off. When blood supply gets cut off, it can cause the death of the affected tissue or organ, shock, and death of the person as well. Its symptoms include,
Immediately rush to your nearby medical center if you experience these symptoms.
What Commonly Causes Hernia?
Increased pressure in the abdominal cavity is the chief cause of hernia. The following factors increase the abdominal pressure and risk of hernias;
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Aging.
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Pregnancy.
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Ascites.
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Liver problems like cirrhosis.
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Previous hernia.
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Previous abdominal surgery.
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Chronic cough.
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Lofting heavyweights.
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Collagen vascular disease.
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Constipation and strained bowel movements.
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Peritoneal dialysis.
How Are Abdominal Hernias Diagnosed?
Your healthcare provider can easily identify the hernia just by visual inspection and palpation of the affected area. Imaging tests like X-rays, CT (computed tomography), and MRI (magnetic resonance imaging) can be ordered to identify the exact location and assess the inside of the hernia in depth.
Do Abdominal Hernias Need to Be Treated?
Not all abdominal hernias need treatment. Mild hernias that do not cause evident symptoms do not require treatment. However, you need to consult your doctor to ensure that your condition does not require treatment. Your doctor might suggest close monitoring of your hernia to prevent it from heading to a severe form.
How Can Large Abdominal Hernias Be Treated?
Moderate to large hernias require surgical repair for pain relief and to prevent future complications. Hernia repair surgeries are carried out in two techniques. They are,
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Open Hernia Repair - In this method, after general or local anesthesia, your surgeon will cut open the affected area and push the bulged-out contents to suture the weakened area. At times, a mesh will also be placed over the weakened area to reinforce it. You need to take bed rest post-surgery, it takes weeks for complete recovery.
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Laparoscopy - This is a minimally invasive procedure. After general anesthesia, small holes like incisions are made near your affected region of the abdomen. Your abdomen is then inflated with a special gas for a clearer view of the internal organs. Through one incision, a laparoscope with a camera and light at the end is inserted. Based on the video captured by it on the digital screen, your surgeon will insert hernia repair instruments through another hole and repair the hernia with or without a mesh. It will be decided by your surgeon. This procedure causes less scarring and prompt healing post-surgery.
Can Hernias Be Prevented?
Yes, hernias can be prevented whenever the risk factors are under our control. The following measures help prevent one from occurring.
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Maintain healthy body weight.
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Prevent constipation and improve your bowel movements by taking a fibrous diet, eating fruits and vegetables, probiotics, and laxatives (when needed).
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Exercise regularly to promote smooth bowel movements and avoid straining to urinate and pass stools.
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Do not lift weights without proper technique or abruptly.
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If you have a chronic cough, get your cough treated by a doctor.
Conclusion
If you suspect you have a hernia, do not panic or worry, but do not ignore it too. Whether it is causing symptoms persistently or not, whether it is mild or not, you definitely need to visit your doctor to understand the actual status of your condition. If you could not consult a physician physically considering the pandemic, you could teleconsult with one of our specialists online and get yourself assessed.
