Hernias

Hernia happens when part of an organ or tissue in the body (such as a loop of intestine or a fat tissue) pushes through an opening or weak spot in the abdominal wall. It can push into a space where it doesn't belong even in natural orifice (like the bellybutton or the groin) or one created by a doctor (incision). This causes a bulge or lump.

Hernias are most common in areas like the belly, groin and upper thigh area, and belly button area. They also can happen in any area where you may have had an incision from surgery – like the abdominal wall, lumbar area, thoracic wall.

Hernias usually take a long time to develop or it might develop suddenly. Hernias are caused by a combination of muscle weakness and strain, although the cause of the weakness and the type of strain may vary. Some people are born with hernias – when they are call congenital.

Hernias are actually most common in babies and toddlers. And most teens who are diagnosed with a hernia actually have had a weakness of the muscles or other abdominal tissues from birth (called a congenital defect). In these cases, straining your muscles doesn't cause the hernia; it only makes the hernia more apparent (and painful!).

Here are some types of strain on the body that may induce hernias:

  • obesity or sudden weight gain

  • lifting heavy objects

  • diarrhea or constipation

  • persistent coughing or sneezing

  • pregnancy

These types of strain on their own probably won't give you a hernia. But if there's also a weak muscle, a hernia is more likely to result.

Many hernias are discovered during routine physical exams. As an example, they can be found when your doctor examines your groin and asking you to cough (we call that a cough impulse). Females can get hernias too, especially if they've been pregnant or are obese.

The most common types of hernias are: inguinal, femoral, epigastric (or ventral) and incisional.

  • Inguinal or groin hernias are more common in males than females. In an inguinal hernia, part of the intestines protrudes through an opening in the lower part of the abdomen, near the groin, called the inguinal canal. There is natural passage (created during the foetal development) in this area, that latter on will become the inguinal canal. The inguinal canal is a passageway between the abdomen and the scrotum through which the spermatic cord passes (the testicles hang from the spermatic cord). In females, the inguinal canal is the passageway for a ligament that holds the uterus in place – called round ligament.

    If you have an inguinal hernia, you might be able to see a bulge where your thigh and your groin meet. In males, the protruding piece of intestine may enter the scrotum, which can cause swelling and pain. Other symptoms of an inguinal hernia might include pain when you cough, lift something heavy, or bend over. Most hernias are reducible (they get out and come back in). If the hernia content gets stuck in the inguinal canal and scrotum, it can compromise the blood supply to the content (in case of a fat content, it will cause mostly pain; in case of a small bowel content, it can cause bowel obstruction and even necrosis) – that is why we recommend having almost all the hernias fixed. Inguinal hernias are usually easily fixed with an operation, either but open or laparoscopic approach. Using a mesh reduces significantly the chances of a recurrence ant that is the reason why it is used in almost all the cases.

  • In an epigastric hernia, which is also called a ventral hernia, part of the intestines protrudes through the abdominal muscles located between the belly button and the chest. It usually happens in males - about 75% of epigastric hernias are in males. People with this type of hernia may notice a lump. Surgery is a common way to fix this problem, either by an open or laparoscopic approach.

  • People who had surgery in the abdominal area might get this type of hernia. In incisional hernias, part of the intestines bulges through the abdomen around a surgical incision. In this case, surgery weakened the tissue in the abdominal wall because of many reasons (infection, poor tissue quality, re-operation). This type of hernia requires another surgery to repair it (open or laparoscopic) and it is imperative to use a mesh. The complexity of this operation will rely on the previous operation, size and patient body habitus

  • With the time and aging, a hernia may become larger and more painful. In some cases (mostly large incisional and inguinal hernias), a piece of the intestine could become trapped (this is known as incarceration). In a true surgical emergency, the blood supply could be cut off to the incarcerated intestine (this is known as strangulation). This situation is painful and dangerous because it can cause infection and may cause the strangulated tissue to die and the bowel to get a perforation.

    Having a professional opinion is the best way to assess your risk of having this life threating condition.

 

After your hernia operation

General points to be noted

  • You should avoid heavy lifting for 8 weeks after the procedure otherwise you will have a recurrence.

  • For inguinal, umbilical and small ventral hernias, patients can drive in one week after the procedure if they fell comfortable in doing so.

  • Dressings will need to be removed after 3 days of the procedure and the wound should be re-dressed if wet.

  • If you've had a hernia operation and you notice redness or discomfort around your incision (the area where the cut was made for the operation), be sure to let your doctor know. It could be a sign of infection that needs further treatment.

  • A review follow up appointment must be done in 7 days.