Hernia definition

A hernia is a medical condition in which an internal organ pushes through a weak area in the muscle or surrounding tissue wall.¹

Hernias typically develop between the area of the chest and hips. In a majority of cases, they may be asymptomatic or present with mild symptoms. However, people may observe a swelling or lump in the abdominal or groin region.

Specific types of hernias include

• Inguinal hernia - presents with a soft lump in the inguinal region. This is the most frequently occurring type of hernia
• Femoral hernia - occurs when fatty tissue or a portion of the bowel pokes through into the groin at the top of the inner thigh
• Umbilical hernia - occurs when adipose tissue or a portion of the bowel protrudes through the abdominal wall in close proximity to the umbilicus
• Hiatal hernia - a condition that occurs when a person's stomach swells through a weak point in the diaphragm. It can cause severe acid reflux. Often these symptoms can be treated with medication, but if they do not work, the surgery is the best option⁴

Other types of hernias

Congenital diaphragmatic hernia, Incisional hernia, Epigastric, Spigelian hernias.²

Causes

Some hernias may not have an evident cause. However, others could develop as a result of: 

• Increased pressure in the abdomen ( due to abdominal distension, chronic constipation, chronic cough) 
• Weakness in the abdominal wall (due to trauma, long-term corticosteroid use, family history of hernias, collagen disorder)
• Age-related degeneration³

Signs and symptoms - depends of the type of the hernias

1. Noticeable lump or herniation
2. Pain or discomfort that gets worse when coughing, sneeze, lift something or stand for a long time
3. Nausea or vomiting
4. Difficulty exreting or passing wind²

Complications

Obstruction is when the hernia causes a blockage into the bowel preventing the passage of food or gas. This is accompanied by vomiting, abdominal pain and inability to pass faeces or gas. Without surgical intervention, a hernia has the potential to progress into a strangulated hernia.⁵

Incarceration is when the hernia is stuck and cannot be pushed back into the original position. Also, the blood flow is cut off to the area where hernia is located.

Strangulation is a serious complication which can lead to the death of the affected bowel tissue. These are the most serious and need urgent surgery.

Diagnoses and tests

The diagnosis is based on symptoms, physical exam, and possibly imaging tests (depending on the type of hernia).²

Some examples of these tests include:

Ultrasound: An ultrasound scan is able to demonstrate the existence of a hernia, using waves to generate images of the pelvic area and abdomen. In addition, can rule out other causes of pain, such as ovarian cysts or fibroids. This minimally invasive procedure is painless and is frequently selected by healthcare professionals as the primary option for diagnosing hernia.⁶

Magnetic Resonance Imaging (MRI): An MRI uses radio waves and a magnetic field to generate images of the abdomen area and organs. It is recommended especially if the discomfort or pain get worse during a physical activity.⁶

Computer Tomography scan (CT): A CT scan uses X-rays to generate images of the abdominal area and organs, checking for conditions that can cause abdominal pain and swelling. Sometimes, a contrast dye may be administered through a vein in the arm before the test. This improves the visibility of the organs in the images.⁶

Management and treatment

Once a diagnosis has been confirmed, the doctor will evaluate the necessity of performing surgery to repair the hernia.²

If the hernia is small or asymptomatic, or if there are some underlying health conditions that raise the risk of complications associated with surgery, the doctor may suggest a period of observation and monitoring.

Surgery

The main objective of hernia repair surgery is to relocate the internal organs to their anatomically correct position and to repair any weaknesses present in the muscle and body wall to prevent the likelihood of hernia recurrence.

There are three types of hernia surgery:

Open surgery

It occurs when part of the large intestine passes the abdominal wall through the space where the umbilical cord passes before birth. A mesh may be inserted to provide additional support to the weakened area. Can be done under general, local or spinal anaesthetic.

Advantages: shorter operating time, suitable for large hernias

Disadvantages: more time to recover, higher risk of postoperative pain, larger surgical incision and scar

Laparoscopic surgery

several small cuts are made to the outside of the abdomen or groin in order to insert surgical instruments to fix the hernia. A long tube, known as a laparoscope, with a lighted camera on the end, is utilized to examine the surgical area internally.

Advantages: smaller incision, faster recovery, less post-operative pain

Disadvantages: not suitable for all hernias, requires specialized training

Robotic hernia repair

a specially trained surgeon controls laparoscopic surgical tools from a computer console, using robotic arms. A separate arm contains a camera that creates high-definition, three-dimensional images on a computer monitor, which guide the surgeon during the surgery.

Advantages: reduce risk of complications, quicker recovery, enhanced precision

Disadvantages: limited availability, longer operating time

There is a minimal risk of general surgical complications, including excessive bleeding, wound infection, adverse reactions to anaesthesia, or chronic groin pain following inguinal hernia repair. Some individuals may experience temporary difficulty with urination following the surgical procedure.³

Majority of people are discharged and can go home the same day after surgery, or the next day. They are encouraged by surgeons to return to most of their daily activities as soon as they can. However, it is suggested to limit lifting objects more than 10 or 15 pounds.⁶

Prevention of hernia

• Maintain a healthy body weight by having a balanced diet containing vegetables, fruits, food that is rich in fibre and can help prevent constipation, plenty of water⁷
• Exercise regularly, but avoiding heavy lifting or handling heavy objects with caution
• Stop smoking - improves health status and increase quality of life. In addition to being linked to numerous serious diseases, smoking can frequently result in a persistent cough that may contribute to or exacerbate a hernia⁷

FAQs

What is a sports hernia?

This is a type of injury that typically affects athletes, usually in the lower abdomen or groin. The injury may result in prolonged and persistent discomfort similar to a hernia. It is usually a rupture of a tendon or muscle, caused by a sudden movement or twist.⁸

What is the most common type of hernia?

Inguinal hernia is the most common type, representing between 70% and 75% of all hernias.

What are the risk factors that contribute to the development of an inguinal hernia?

Family history, chronic constipation, pregnancy, being older (muscles weaken as you age), being male, previous inguinal hernia or hernia repair.⁷

Summary

Hernias occurs when a part of an organ or tissue pushes through a layer of muscle within the abdominal region. Are a common medical condition that can cause discomfort and have a potential risks if left untreated.

There are different types of hernias which may cause different signs and symptoms. However, there are asymptomatic hernias as well. The types of hernias can vary depending on their location and accompanying symptoms.³

Most of them are external, which means that the lump is toward the outside of the abdomen or groin, and can be visible or palpable. If left untreated, hernias have a tendency to grow bigger over time, resulting in chronic pain that can affect daily activities and potentially leading to complications. Strangulation is the most serious complication and needs urgent surgery.³

Hernias can increase in size and get worse when cough, sneezing, lift objects or stand for a long period of time. In this case, surgery may be recommended if the symptoms are severe or getting worse, or if the hernia is affecting the ability to carry out normal daily activities.⁶

Hernia repair surgery is a common and effective procedure used to correct hernias by reinforcing the weak muscle or tissue.

Each surgery has its advantages and disadvantages. The surgeon will give you all the necessary information and will determine with you the best surgical technique.

After hernia repair surgery, the surgeon will provide information of clear instruction: the type of diet people should follow after a hernia procedure, how to take care of the incision, the importance of avoiding physical effort and for how long.

In some cases, hernias may recur regardless of the treatment used. The causes are related to each patient, and a major risk factors for hernia recurrence are lifestyle, smoking and weight.