Hernia

A hernia occurs when an organ pushes through an opening in the muscle or tissue that holds it in place. For example, the intestines may break through a weakened area in the abdominal wall.

Hernias are most common in the abdomen, but they can also appear in the upper thigh, belly button, and groin areas. Most hernias aren’t immediately life-threatening, but they don’t go away on their own. Sometimes they can require surgery to prevent potentially dangerous complications.

Common hernia types

Inguinal hernia

Inguinal hernias are the most common type of hernia. They make up about 70 percent of all hernias, according to the British Hernia Centre (BHC). These hernias occur when the intestines push through a weak spot or tear in the lower abdominal wall, often in the inguinal canal.

The inguinal canal is found in your groin. In men, it’s the area where the spermatic cord passes from the abdomen to the scrotum. This cord holds up the testicles. In women, the inguinal canal contains a ligament that helps hold the uterus in place.

This type of hernia is more common in men than women. This is because a man’s testicles descend through the inguinal canal shortly after birth, and the canal is supposed to close almost completely behind them. Sometimes, the canal doesn’t close properly and leaves a weakened area prone to hernias.

Hiatal hernia

A hiatal hernia occurs when part of your stomach protrudes up through the diaphragm into your chest cavity. The diaphragm is a sheet of muscle that helps you breathe by contracting and drawing air into the lungs. It separates the organs in your abdomen from those in your chest.

This type of hernia is most common in people over 50 years old. If a child has the condition, it’s typically caused by a congenital birth defect. Hiatal hernias almost always cause gastroesophageal reflux, which is when the stomach contents leak backward into the esophagus, causing a burning sensation.

Umbilical hernia

Umbilical hernias can occur in children and babies under 6 months old. This happens when their intestines bulge through their abdominal wall near their bellybutton. You may notice a bulge in or near your child’s bellybutton, especially when they’re crying.

An umbilical hernia is the only kind that often goes away on its own as the abdominal wall muscles get stronger, typically by the time the child is 1 years old. If the hernia hasn’t gone away by this point, surgery may be used to correct it.

Incisional hernia

Incisional hernias can occur after you’ve had abdominal surgery. Your intestines may push through the incision scar or the surrounding, weakened tissue.

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Hernias are caused by a combination of muscle weakness and strain. Depending on its cause, a hernia can develop quickly or over a long period of time.

Common causes of muscle weakness include:

  • failure of the abdominal wall to close properly in the womb, which is a congenital defect
  • age
  • chronic coughing
  • damage from injury or surgery

Factors that strain your body and may cause a hernia, especially if your muscles are weak, include:

  • being pregnant, which puts pressure on your abdomen
  • being constipated, which causes you to strain when having a bowel movement
  • lifting heavy weight
  • fluid in the abdomen, or ascites
  • suddenly gaining weight
  • surgery in the area
  • persistent coughing or sneezing

The factors that increase your risk of developing a hernia include:

  • a personal or family history of hernias
  • being overweight or obese
  • a chronic cough
  • chronic constipation
  • smoking, which can trigger a chronic cough

Conditions such as cystic fibrosis can also indirectly increase your risk of developing a hernia. Cystic fibrosis impairs the function of the lungs, causing a chronic cough.

The most common symptom of a hernia is a bulge or lumrp in the affected area. In the case of an inguinal hernia, you may notice a lump on either side of your pubic bone where your groin and thigh meet.

You’re more likely to feel your hernia through touch when you’re standing up, bending down, or coughing.

If your baby has a hernia, you may only be able to feel the bulge when they're crying. A bulge is typically the only symptom of an umbilical hernia.

Other common symptoms of an inguinal hernia include:

  • pain or discomfort in the affected area (usually the lower abdomen), especially when bending over, coughing, or lifting
  • weakness, pressure, or a feeling of heaviness in the abdomen
  • a burning, gurgling, or aching sensation at the site of the bulge

Other symptoms of a hiatal hernia include:

  • acid reflux, which is when stomach acid moves backward into the esophagus causing a burning sensation
  • chest pain
  • difficulty swallowing

In some cases, hernias have no symptoms. You may not know you have a hernia unless it shows up during a routine physical or a medical exam for an unrelated problem.

Inguinal or incisional hernias are usually diagnosed through a physical examination. Your doctor may feel for a bulge in your abdomen or groin that gets larger when you stand, cough, or strain.

If you have a hiatal hernia, your doctor may diagnose it with a barium X-ray or endoscopy.

A barium X-ray is a series of X-ray pictures of your digestive tract. The pictures are recorded after you’ve finished drinking a liquid solution containing barium, which shows up well on the X-ray images.

An endoscopy involves threading a small camera attached to a tube down your throat and into your esophagus and stomach.

These tests both allow your doctor to see the internal location of your stomach.

If your child has an umbilical hernia, your doctor may perform an ultrasound. An ultrasound uses high-frequency sound waves to create an image of the structures inside the body.

For a hernia without symptoms, the usual course of action is to watch and wait, but this can be risky for certain types of hernia, such as femoral hernias.

Within 2 years of a femoral hernia being diagnosed, 40 percent result in bowel strangulation.

It remains unclear whether non-emergency surgery is worthwhile for hernia repair in cases of an inguinal hernia without symptoms that can be pushed back into the abdomen.

The American College of Surgeons and some other medical bodies consider elective surgery unnecessary in such cases, recommending instead a course of watchful waiting.

Others recommend surgical repair to remove the risk of later strangulation of the gut, a complication where blood supply is cut off to an area of tissue, which requires an emergency procedure.

These health authorities consider an earlier, routine operation preferable to a more risky emergency procedure.

Types of surgery

Although surgical options depend on individual circumstances, including the location of the hernia, there are two main types of surgical intervention for hernia:

  • open surgery
  • laparoscopic operation (keyhole surgery)

Open surgical repair closes the hernia using sutures, mesh, or both, and the surgical wound in the skin is closed with sutures, staples, or surgical glue.

Laparoscopic repair is used for repeat operations to avoid previous scars, and while usually more expensive, is less likely to cause complications such as infection.

Surgical repair of a hernia guided by a laparoscope allows for the use of smaller incisions, enabling a faster recovery from the operation.

The hernia is repaired in the same way as in open surgery, but it is guided by a small camera and a light introduced through a tube. Surgical instruments are inserted through another small incision. The abdomen is inflated with gas to help the surgeon see better and give them space to work; the whole operation is performed under general anesthetic.

Hernia in children

Inguinal hernia is one of the most common surgical conditions in infants and children.

A 2014 systematic review of 20 years of data on conventional open hernia repair (herniorrhaphy) and laparoscopic hernia repair (herniorrhaphy) in infants and children found that laparoscopic surgery is faster than open surgery for bilateral hernias, but that there is no significant difference in operating time for unilateral inguinal hernia repair.

The rate of recurrence is similar for both types of procedure, but complications, such as wound infection, are more likely with open surgery, especially in infants.

You can’t always prevent the muscle weakness that allows a hernia to occur. However, you can reduce the amount of strain you place on your body. This may help you avoid a hernia or keep an existing hernia from getting worse. Prevention tips include:

  • not smoking
  • seeing your doctor when you’re sick to avoid developing a persistent cough
  • maintaining a healthy body weight
  • avoiding straining during bowel movements or urination
  • lifting objects with your knees and not your back
  • avoiding lifting weights that are too heavy for you

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