Understanding hernia
April 26 2018 10:34 PM
Dr. Vishwanath Vasudevan, MBBS, MS (General Surgery), General & Laparoscopic Surgeon, Aster Hospital, Doha

By Dr. V. Vasudevan

A hernia occurs when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue called fascia. The most common types of hernia are inguinal (inner groin), incisional (resulting from an incision), femoral (outer groin), umbilical (belly button), and hiatal (upper stomach).
In an inguinal hernia, the intestine or the bladder protrudes through the abdominal wall or into the inguinal canal in the groin. About 96% of all groin hernias are inguinal, and most occur in men because of a natural weakness in this area.
In an incisional hernia, the intestine pushes through the abdominal wall at the site of previous abdominal surgery. This type is most common in elderly or overweight people who are inactive after abdominal surgery.
A femoral hernia occurs when the intestine enters the canal carrying the femoral artery into the upper thigh. Femoral hernias are most common in women, especially those who are pregnant or obese.
In an umbilical hernia, part of the small intestine passes through the abdominal wall near the navel. Common in newborns, it also commonly afflicts obese women or those, who have had many children.
A hiatal hernia happens when the upper stomach squeezes through the hiatus, an opening in the diaphragm through which the esophagus passes.

What causes Hernias?
Ultimately, all hernias are caused by a combination of pressure and an opening or weakness of muscle or fascia; the pressure pushes an organ or tissue through the opening or weak spot. Sometimes the muscle weakness is present at birth; more often, it occurs later in life.
Anything that causes an increase in pressure in the abdomen can cause a hernia, including:
• Lifting heavy objects without stabilising the abdominal muscles
• Diarrhoea or constipation
• Persistent coughing or sneezing
In addition, obesity, poor nutrition, and smoking, can all weaken muscles and make hernias more likely.
For inguinal, femoral, umbilical, and incisional hernias, symptoms may include:
* An obvious swelling beneath the skin of the abdomen or the groin; it may disappear when you lie down and may be tender.
* A heavy feeling in the abdomen that is sometimes accompanied by constipation or blood in the stool.
* Discomfort in the abdomen or groin when lifting or bending over.
Symptoms of a hiatal hernia may include heartburn and upper abdominal pain.

See your doctor about a Hernia if:
* You suspect that you have a hernia.
* If you cannot get the hernia to go back in; seek medical care immediately, as this is an incarcerated hernia and can lead to organ strangulation.
* You know you have a hernia, and you have pain, are nauseated and vomiting, or are unable to have a bowel movement or pass gas; you may have a strangulated hernia or an obstruction. Seek medical care immediately.

How is a hernia diagnosed?
A physical exam by your healthcare provider is often enough to diagnose a hernia. Sometimes hernia swelling is visible when you stand upright; usually, the hernia can be felt if you place your hand directly over it and then bear down. Ultrasound may be used to see a femoral hernia, and abdominal X-rays may be ordered to determine if a bowel obstruction is present.

What are the Treatments for a Hernia?
In babies, umbilical hernias may heal themselves within four years, making surgery unnecessary. For all others, the standard treatment is conventional hernia-repair surgery (called herniorrhaphy). It is possible to simply live with a hernia and monitor it. The main risk of this approach is that the protruding organ may become strangulated — its blood supply cut off — and infection and tissue death may occur as a result. A strangulated intestinal hernia may result in intestinal obstruction, causing the abdomen to swell. The strangulation can also lead to infection, gangrene, intestinal perforation, shock, or even death.

Conventional treatment for a Hernia

Hernia surgery is performed under either local or general anaesthesia. The surgeon repositions the herniated tissue and, if strangulation has occurred, removes the oxygen-starved part of the organ. The damaged muscle wall will frequently be repaired with synthetic mesh or tissue.
Increasingly, herniorrhaphy is being performed using a laparoscope, a thin, telescope-like instrument that requires smaller incisions and involves a shorter recovery period and less post-operative pain. Hernia repairs are usually performed as an outpatient procedure. There are usually no dietary restrictions, and work and regular activity may usually be resumed in one or two weeks. Complete recovery usually takes three to four weeks, with no heavy lifting for two to three months. Ask your surgeon for specific instructions after your surgery.
Hernias may return after surgery, so preventive measures are especially important to help avoid a recurrence.

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