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Understanding the Types of Hernia Better

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Understanding the Types of Hernia Better

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The protrusion of an internal organ through a weak spot in the muscles or tissues is called a hernia. Read further to know more about it.

Published At August 18, 2018
Reviewed AtMarch 27, 2024

What Is a Hernia?

A hernia is the protrusion of an internal organ through a weakened area in the muscles or tissues. Most hernias are seen in the abdomen, but they can also be seen in the groin and upper thigh regions. They do not pose an immediate threat to life but require surgery as they do not go away on their own. Surgery can also help prevent future complications.

What Are the Typical Sites of Hernias?

A hernia could occur:

  • Through the diaphragm at the lower chest.

  • In the lower abdominal wall, through the groin.

  • Along the midline of the abdomen in front.

  • Via the incision left by a previous abdominal operation.

What Are the Types of Hernias?

Based on the exact site in the abdomen where the weakness is present, there are different types:

  1. Hiatal Hernia: When a portion of the stomach pushes through the opening in the diaphragm (hiatus) into the chest, it is called a hiatal hernia. This is seen more commonly in people over 50. It causes symptoms of GERD. Acid reflux is the most common symptom of a hiatal hernia. Hiatal hernia is further classified into:

  • Sliding Hiatal Hernia: It is the most common type where the stomach and esophagus slide in and out of the hiatus.

  • Fixed Hiatal Hernia: This type needs surgery, as the part of the stomach that gets protruded and cannot move back and forth during the hiatus. It can cut off the blood supply to the stomach if left untreated.

2. Incisional Hernia: This type of hernia occurs post-surgery in the area weakened by the incision. This is commonly seen when the surgical wound does not heal properly. Doctors commonly refer to this as a ventral hernia.

3. Inguinal Hernia: When the intestines protrude through a weak spot in the lower abdominal canal (groin region), it is called an inguinal hernia. It is more common in men than in women. This hernia can consist of a part of the small intestine or even parts of the female reproductive organs in women. It is sometimes confused with a femoral hernia.

4. Epigastric Hernia: The epigastric region is the part below the ribcage and above the belly button. Hernia in this region is called an epigastric hernia. An epigastric hernia can be felt when one coughs, is stressed for a bowel movement, laughs, and other activities that cause excess pressure on the abdominal wall.

5. Femoral Hernia: It occurs when the intestine pushes into the canal of the femoral artery in the upper thigh, which can also possibly block blood flow to the leg. This is common in women who are pregnant or obese. It results in a small or medium lump in the groin region. Around 2 to 4 % of hernias in the groin region are of this type.

6. Umbilical Hernia: This type of hernia may be seen in the belly button region of very young babies due to their weak abdominal walls. It is especially visible when they cry. With age, the muscles get stronger, and this condition goes away on its own.

7. Ventral Hernia: Any hernia that passes through the abdomen's front wall is called a ventral hernia. Both incisional and umbilical hernias are included. A ventral hernia above the belly button is referred to as an "epigastric hernia."

8. Perineal Hernia: When tissue or organs push through a weakening or opening in the pelvic floor and into the abdominal cavity, it can result in a perineal hernia. These hernias occur seldom.

What Are the Possible Causes of Hernia?

Hernias are usually caused due to muscle weakness and strain. The following condition can result in the combination of both these factors and result in a hernia:

Risk Factors:

  • A positive family history of hernias.

  • Older adults.

  • Obesity.

  • Multiple pregnancies.

  • Chronic constipation.

  • Chronic cough.

  • Smoking.

  • Premature baby and low birth weight.

  • Sudden loss or gain of weight.

  • Malnutrition.

What Are the Signs and Symptoms of a Hernia?

In most cases, hernias do not cause pain. But it can cause pain and discomfort while straining, lifting objects, or standing. If one notices a lump, consult a doctor immediately, as sometimes, hernias can cut off blood supply and cause complications. If one experiences the following symptoms, get immediate medical attention for an inguinal hernia:

  • A sharp, burning pain in the affected area during coughing, sneezing, lifting weights, and quick movements.

  • Pressure and discomfort in the abdomen (in the area of the bulge).

  • Sometimes, no symptoms are felt.

How Does a Doctor Diagnose Hernias?

A hernia is often diagnosed during a routine physical examination. The doctor will feel for an obvious protrusion that gets more visible with coughing. Based on the suspected location, the doctor may order a few tests to visualize the internal organs better.

  1. Abdominal Ultrasound: Here, high-frequency sound waves are used to produce images of the structures in the abdomen.

  2. MRI Scan: Strong magnets and radio waves are used to produce detailed images of the abdomen.

  3. CT- Scan: X-rays are used to produce detailed cross-sectional images of the body.
  4. Barium X-ray or Gastrografin: Here, the patient drinks Gastrografin (a combination of Diatrizoate meglumine and Diatrizoate sodium) or liquid barium, and then a series of X-rays are taken of the digestive tract.
  5. Endoscopy: A flexible, thin tube with a camera at one end is inserted through the patient’s mouth to the stomach.

What Are the Treatment Options for Hernias?

1. Lifestyle Changes:

  • Eat fibrous food.

  • Keep the meals light.

  • Do not lie down immediately after a meal.

  • Stay in the healthy weight range.

  • Strengthen the muscles around the hernia bulge by exercising under the guidance of a qualified physiotherapist.

  • Avoid spicy foods.

  • Stop smoking.

2. Medication:

In certain cases (a hiatal hernia), medications such as antacids help relieve symptoms and are prescribed by the doctor.

3. Surgery:

If a hernia causes pain and other complications, the doctor will suggest a surgical correction. This procedure will involve sewing the weakened area closed. Surgery may be via open or keyhole surgery methods.

How Common Is Hernia?

Hernias are frequent in general, yet certain varieties are more common than others. Approximately 25 % of men, or those who are assigned male at birth, suffer from inguinal hernias. About 20 % of Americans and 50 % of those over 50 have hiatal hernias. 15 % of babies are born with congenital hernias, the majority of which are umbilical. Ten percent of hernias are incisional hernias, and the remaining ninety percent are of various forms.

What Is the Severity of a Hernia?

Although rare, most are not serious. And as time goes on, they could get worse. When a hernia is trapped in the hole, it is forced through and cannot escape; it becomes more dangerous. In extreme situations, the tissue may lose its blood supply, resulting in necrosis or tissue death, which could become painful. Hernias usually require surgical correction at some point because they deteriorate over time.

How Can Hernia Be Prevented?

It is not always possible to prevent a hernia, but these tips can help in preventing some types of hernia:

  1. Quit smoking.

  2. Get a chronic cough treated.

  3. Do not strain while passing stools.

  4. Eat a diet rich in fiber to prevent constipation.

  5. Perform exercises that help strengthen the muscles of the abdomen.

  6. Do not lift very heavy objects.

  7. Make sure one maintains a healthy weight.

What Is a Sports Hernia?

A sports hernia is a groin-related soft tissue injury that hurts. It usually happens when playing sports that call for quick direction shifts or forceful twisting motions.

While they can cause distinct injuries, sports hernias can result in typical inguinal hernias.

  • Inguinal Hernia: The most prevalent kind of groin hernia is called an inguinal hernia, which occurs when abdominal tissue, such as a portion of the intestine, pushes through a hole in the lower abdominal wall to cause a painful bulge.

  • Sports Hernia: Any strain or tear of soft tissue (muscle, tendon, or ligament) in the lower abdomen or groin region is referred to as a sports hernia.

The term "athletic pubalgia" is preferred by the medical community to describe this kind of damage because it may include other tissues and not be the same as a typical hernia.

Conclusion

Complications can arise; however, hernias are frequent and usually not dangerous. The likelihood of pain and other issues increases with time. Before it gets worse, monitor the hernia and visit the physician. One will probably require surgery to repair a hernia because they do not go away by themselves.

Frequently Asked Questions

1.

Which Hernia Is the Most Severe One?

Out of six different types of hernia, strangulated hernias are life-threatening and require emergency interventions. A strangulated hernia traps some amount of vital tissues in its knot, which cuts off the vascular supply of the trapped tissues. The tissue becomes hypoxic and may turn ischaemic due to a compromised blood supply.

2.

Which Type of Hernia Can Be Managed Without Surgery?

A reducible hernia usually goes away when the person lies down or can be pushed back into the abdomen. These hernias do not cause any severe symptoms and may never require surgical repair. But the individuals are advised to keep an eye on the same and not take any untoward change for granted.

3.

Which Is the Most Common Hernia in Females?

Inguinal hernias are the most common hernia in females and are also the most prone to recur. The hernia may contain a part of the female reproductive system with the peritoneum (abdominal wall lining) bulging through the abdominal wall and forming a sac. The second most common in females is an incisional hernia. Additionally, age is a predisposing factor for developing hernias in females.

4.

Which Hernia Forms Just Above the Belly Button?

An umbilical hernia forms just above the belly button when fatty tissues or part of the intestine protrudes through the abdomen near the navel. In adults, this may be a secondary complication borne out of being obese or excessive straining while lifting heavy objects.

5.

What Is the Life Expectancy of a Person With a Hernia?

The prognosis of hernia is quite variable. Some individuals may live for years or even a lifetime without any complications, or even symptoms, while others may develop life-threatening fatal symptoms within a few months. Reducible hernias carry a good prognosis through a lifetime, whereas strangulated hernias require emergency surgery.

6.

What Is Contraindicated When a Person Has Hernia?

The ‘dont’s’ list of hernia includes:
- Reduce food intake.
- Avoid excessive straining during bowel movements.
- Avoid smoking and drinking.
- Do not lie down immediately after meals.
- Do not lift heavy weights.
- Avoid dehydration.

7.

When Does Surgical Hernia Repair Become an Emergency?

Many of the hernias are reducible, and surgery can be avoided. The individuals should keep an eye on the size of the bulge; progressive growth in the size of the hernia is an indication of surgery. Most people delay surgery for months and years. If the hernia is small, surgery is not urgent. Growing hernias and hernias with severe symptoms (pain, nausea, vomiting like in strangulated hernias) require ER visits and surgical interventions.

8.

Is It Possible to Worsen the Hernia by Sitting?

Prolonged sitting can worsen hernia symptoms. Not just sitting, prolonged activities like prolonged standing, sitting, coughing, laughing, sneezing, straining during a bowel movement, sexual intercourse, getting in and out of a car or bed, bending forward, or crossing legs may also contribute to worsening conditions.

9.

What Is Better in Hernia: Sitting or Standing?

Prolonged sitting or standing can worsen hernias. It is advisable to lie down flat on the back or in a 20º Trendelenburg position. These position help alleviate the symptoms and allow gravity to help retract the herniated tissues into the abdomen.

10.

Can Exercise Worsen Hernias?

Heavy exercises like weight training can aggravate hernia and its symptoms. However, some exercises can help relieve some chronic hernia symptoms. These exercises are walking, swimming, jogging, gentle yoga, and cycling.

11.

Are Hernia Surgeries Worth the Hassle?

Hernia surgeries offer good success rates and can prevent rare complications like strangulations leading to ischemia and tissue death. Surgery is recommended if the hernia grows, symptoms worsen, or the hernia is of strangulation type.

12.

What Is the Time Duration of a Hernia Repair Surgery?

Open hernia repair is considered a major surgery that is done under sedation. This procedure usually takes 30 to 45 minutes, and the patients may be discharged on the same day, notwithstanding surgical complications. The total hospital stay might last for two to three days, including post-surgical-overnight observation.

13.

What Is the Reason for a Disappearing Hernia?

Some hernias, like inguinal hernias, are reducible and flattened when lying down as the protrusion retracts into the abdominal cavity. These hernias should be monitored by the individual for any changes in size and increase in the severity of complications.

14.

Is It Possible to Push Back a Hernia?

It is possible to gently push a reducible hernia back into the abdomen with a gentle massage. This is a temporary fix in the early stages. Some patients might live an entire life without any degradation of the hernia, while others need to rise above this temporary fix and opt for a surgical repair.

15.

How Much Do Hernia Surgeries Pain?

After the anesthesia wears off, Hernia surgeries show mild to moderate pain. The intensity of the pain is dependent on the extent of the surgery. It is normal to feel run down or pulled at the site of operation. Most people feel better within a few days, and the conditions improve drastically after a week.
Dr. Madhan Kumar Madathupalayam Velusamy
Dr. Madhan Kumar Madathupalayam Velusamy

Surgical Gastroenterology

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inguinal herniahernia surgeryhernia
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