What Is Hernia?

Overview

A hernia occurs when an organ protrudes through a weakened area in the muscle or tissue that normally keeps it secure. An example of this is when the intestines push through a weakened spot in the abdominal wall. 

While hernias commonly happen in the region between the chest and hips, known as the abdomen, they can also develop in the upper thigh and groin areas. 

Although most hernias are not immediately life-threatening, they do not resolve spontaneously. In some cases, surgery may be necessary to prevent potentially serious complications.

Types of hernia

There are various types of hernias, here are some of the most prevalent ones: 

Inguinal hernia

The inguinal hernia is the most commonly occurring type. It happens when the intestines protrude through a weakened area or tear in the lower abdominal wall, typically in the inguinal canal. 

The inguinal canal is located in the groin area. In men, it is the pathway through which the spermatic cord travels from the abdomen to the scrotum, where it connects to the testicles. In women, the inguinal canal contains a ligament called the round ligament, which helps support the uterus. 

Inguinal hernias are more common in men because, shortly after birth, the testicles descend through the inguinal canal. The canal is expected to close almost completely after the descent, but sometimes it remains partially open, resulting in a weakened area. 

Hiatal hernia:

A hiatal hernia occurs when a portion of the stomach protrudes upward through the diaphragm into the chest cavity. The diaphragm is a muscular sheet that aids in breathing by contracting and drawing air into the lungs. It separates the abdominal organs from those in the chest. 

This type of hernia is most frequently observed in individuals over the age of 50. In children, it is typically caused by a congenital abnormality.¹

Hiatal hernias often lead to gastroesophageal reflux disease (GERD), wherein the stomach contents flow backward into the esophagus, causing a burning sensation. 

Umbilical hernia:

Umbilical hernias can occur in children and infants. They happen when the intestines bulge through the abdominal wall near the navel (belly button). The bulge may become noticeable, particularly when the child cries.²

In the case of an umbilical hernia in children, it often resolves on its own as the abdominal wall muscles strengthen, typically by the age of 1 or 2. If the hernia persists beyond the age of 5, surgery may be performed to correct it.

Adults can also develop umbilical hernias, which can be caused by factors such as obesity, ascites (fluid in the abdomen), or pregnancy. 

Ventral hernia:

A ventral hernia occurs when tissue protrudes through an opening in the abdominal muscles. The size of the hernia may decrease when lying down. 

While a ventral hernia can be present from birth, it is more commonly acquired at some point during a person's life. Factors that contribute to ventral hernia formation include obesity, pregnancy, and strenuous physical activity. ³

Ventral hernias can also arise at the site of a surgical incision, known as an incisional hernia. This can occur due to scarring or weakness of the abdominal muscles at the incision site. 

Causes of hernia

Hernias occur as a result of a combination of muscle weakness and strain. The development of a hernia can vary in speed, ranging from a rapid onset to a gradual progression over an extended period. 

Several common causes of muscle weakness or strain that can contribute to hernia formation include: 

• Congenital condition: some hernias are present from birth, resulting from developmental issues in the womb.
• Aging: as we age, our muscles naturally weaken, making us more susceptible to hernias.
• Injury or surgery: previous injuries or surgical procedures can weaken the muscles, increasing the risk of hernias.
• Strenuous activities and heavy lifting: engaging in vigorous exercise or lifting heavy weights can strain the muscles and potentially lead to a hernia.
• Chronic coughing or COPD: persistent coughing or having chronic obstructive pulmonary disorder (COPD) can put repeated strain on the muscles and contribute to hernia development.
• Pregnancy: the abdominal muscles are stretched during pregnancy, creating a vulnerable state for hernias, especially in cases of multiple pregnancies.
• Constipation: straining during bowel movements due to chronic constipation can strain the muscles, increasing the likelihood of hernias.
• Being overweight or obese: excess weight puts added pressure on the abdominal muscles, making them more susceptible to weakness and hernias.
• Ascites: the accumulation of fluid in the abdomen can exert pressure on the muscles, leading to hernia formation.

Signs and symptoms of hernia

The primary indication of a hernia is the presence of a protruding bulge or lump in the affected region. For instance, in the case of an inguinal hernia, you may observe a lump on either side of the pubic bone where the groin and thigh meet. 

When lying down, the lump may seem to "disappear." However, when standing up, bending down, or coughing, you are more likely to feel the hernia through touch. Discomfort or pain in the surrounding area of the lump may also be experienced.

Certain types of hernias, such as hiatal hernias, can exhibit more specific symptoms. These may include heartburn, difficulty swallowing, and chest pain.

In many instances, hernias are asymptomatic, meaning they do not cause any noticeable symptoms. You may remain unaware of the presence of a hernia unless it is incidentally detected during a medical examination for an unrelated issue or during a routine physical check-up.

Management and treatment for hernia

Surgical repair is the most effective method for treating a hernia. Whether or not surgery is necessary depends on the size of the hernia and the severity of symptoms.⁴

In some cases, a watchful waiting approach may be adopted by your doctor, who will be monitoring the hernia for potential complications. 

Wearing a truss, which is a supportive undergarment that helps hold the hernia in place, may alleviate symptoms in certain situations. However, it is essential to consult your doctor to ensure proper fitting before using a truss. 

For hiatal hernias, over-the-counter (OTC) and prescription medications can be utilized to alleviate discomfort and improve symptoms by reducing stomach acid. These medications include antacids, H2 receptor blockers, and proton pump inhibitors.⁵ 

Diagnosis

To determine your condition, the doctor will begin by conducting a physical examination. During this examination, they will palpate the abdominal or groin area to detect any bulges that may increase in size when you stand, cough, or strain. 

The doctor will ask about the timing of the bulge, any other symptoms experienced, potential triggers, and lifestyle details such as heavy lifting, exercise, smoking history, and personal/family history of hernias. Additionally, information about any past surgeries in the abdominal or groin area will be relevant for diagnosis and treatment considerations.

In addition to the physical examination and medical history, imaging tests will likely be ordered by your doctor to aid in diagnosis. These may include:

• Abdominal ultrasound: this non-invasive procedure utilizes high-frequency sound waves to create images of internal structures.
• Abdominal CT scan: a combination of X-rays and computer technology is employed to generate detailed images.
• Abdominal MRI scan: strong magnets and radio waves are used to produce detailed images of the abdomen.

If your doctor suspects a hiatal hernia, they may order other tests to evaluate the condition of your stomach, such as:

• X-rays of your digestive tract: you will be asked to consume a liquid containing diatrizoate meglumine/diatrizoate sodium (Gastrografin) or a barium solution, which helps visualise the digestive tract on X-ray images.
• Endoscopy: during this procedure, a small camera attached to a flexible tube is inserted through your throat into the esophagus and stomach, allowing for a visual assessment of the internal structures. 

Risk factors

Several risk factors can heighten the likelihood of developing a hernia. These factors include: 

• Premature birth or low birth weight: individuals who were born prematurely or had a low birth weight are at an increased risk of hernias.
• Advanced age: the risk of hernias tends to rise with age.
• Chronic coughing: consistently experiencing a chronic cough can raise abdominal pressure and contribute to hernia development.
• Cystic fibrosis: people with cystic fibrosis have a higher risk of hernias due to the disease's effects on connective tissues.
• Pregnancy: pregnancy, regardless of the number of pregnancies, is a risk factor for hernias due to the strain placed on the abdominal muscles.
• Chronic constipation: persistently struggling with constipation can increase the likelihood of hernias.
• Smoking: smoking weakens connective tissues, making individuals more prone to developing hernias.
• Personal or family history of hernias: having a personal or family history of hernias can indicate a higher susceptibility to developing them.

Complications

Neglecting to address a hernia can potentially lead to serious complications. 

Without proper treatment, the hernia may enlarge, resulting in the manifestation of additional symptoms. The increased size of the hernia can exert excessive pressure on surrounding tissues, leading to swelling and localized pain. 

In some cases, a portion of the intestine may become trapped within the abdominal wall, a condition known as incarceration. This can cause bowel obstruction, resulting in severe pain, nausea, or constipation.

If the trapped segment of the intestine experiences compromised blood flow, it can lead to strangulation. This critical condition can result in infection or necrosis of the intestinal tissue. A strangulated hernia is a life-threatening situation necessitating immediate medical attention. 

Certain symptoms indicate the need for emergency medical care for a hernia. These include:

• A bulge that changes color to red or purple
• Sudden exacerbation of pain
• Nausea
• Vomiting
• Fever
• Inability to pass gas or have bowel movements

FAQs

How can I prevent hernia?

While it's not always possible to completely prevent a hernia, certain lifestyle adjustments can help reduce the risk by minimizing strain on the body. Here are some concise prevention tips:

• Quit smoking 
• Seek medical attention for persistent coughing
• Maintain a moderate body weight
• Avoid straining during bowel movements and urination
• Consume an adequate amount of high-fiber foods to prevent constipation
• Perform exercises that strengthen abdominal muscles

How common is hernia?

Hernias are frequently encountered, especially among men, with approximately 100,000 individuals receiving hernia treatment annually in the UK. ⁶

What does a hernia feels like?

A hernia can be characterized as a soft protrusion or lump, which may exhibit tenderness, pain, or discomfort upon touch. It may become more noticeable and prominent when coughing or straining. The texture of the bulge can vary depending on the specific hernia type and the tissue that is pushing through the weakened area.

What does a hernia look like?

The hernia will manifest as a noticeable bulge or protrusion in the scrotum or groin area. It becomes more evident when standing or exerting pressure. While the bulge usually develops gradually, it can also appear suddenly following actions such as coughing, lifting heavy objects, straining, bending, or laughing.

When should I see a doctor?

If you have a hernia and experience any of the following symptoms, it is crucial to seek immediate medical attention at the nearest emergency department (A&E): sudden and severe pain, vomiting, and difficulty with bowel movements or passing gas.

Summary

A hernia occurs when an organ pushes through a weakened area in the muscle or tissue, commonly in the abdomen. Various types of hernias can develop, such as inguinal, hiatal, umbilical, and ventral hernias, each with specific characteristics. Hernias are typically diagnosed through physical examination and imaging tests. While surgery is often the most effective treatment, watchful waiting or the use of supportive undergarments may be considered. Neglecting a hernia can lead to complications, and immediate medical attention is necessary if certain symptoms arise.