| Hernias
are extremely common. A hernia occurs when part of
an organ (usually the intestines) sticks through a
weak point or tear in the thin muscular wall that
holds the abdominal organs in place. The weakness
of this area can be caused by many different factors;
including pregnancy, gender, age, drastic weight loss
or obesity, prior surgery, genetics, and even excessive
lifting.
A hernia may exist in many different locations, but
most are in the groin (inguinal or femoral), under
the belly-button (umbilical) or arising through an
old incision (ventral or incisional). Hernias may
or may not present pain at the site or cause organ
dysfunction, depending on the person and the extreme
case of the hernia.
Hernias
generally get larger with time, and they usually do
not resolve on their own. If the patient’s health
permits surgery, elective surgical repair will be
performed to relieve discomfort and to prevent complications
such as incarceration (stuck) and strangulation (cutting
off blood supply).
A
hernia that cannot be pushed back into the abdominal
wall by pressure may be trapped or strangulated. Without
treatment, a strangulated section of the intestine
will die, because the blood supply is inadequate.
Urgent surgery is required for incarcerated or strangulated
hernias.
Symptoms
Types of Hernias
Surgery
Recovery
Symptoms
-
Bulge under the skin in the groin, naval area, or
sites of previous operations
- Pain
when lifting, coughing or straining while urinating
or having bowel movements
- Pain
may be sharp, sudden or both
- Pain
may be dull
- Pain
may get worse at the end of the day or when standing
for long periods of time
- Severe,
continuous pain with signs of redness and tenderness
Types
of Hernias
There are several types of hernias, based on where
it is located:
Inguinal
Hernias
An inguinal hernia is a condition in which the intra-abdominal
fat or part of the small intestine bulges through
a weak area in the lower abdominal muscles. This
type of hernia is visible in the groin or scrotum
and is normally diagnosed among men rather than
women.
At
infancy, men can be born with a weak abdominal wall
due to the entry way of the inguinal canal not properly
closing during development in the womb. This makes
it easier for an inguinal hernia to appear. However,
pressure from pulling a muscle, lifting heavy objects,
constipation strain, weight gain and chronic cough
are still factors that can cause a hernia to arise.
Inguinal
hernias are usually detected in a physical examination.
Symptoms include a bulge in the groin, discomfort
or pain, feeling pressure in the groin area, and
a burning or aching feeling at the bulge.
Femoral
Hernia
A femoral hernia is a protrusion of a loop of the
intestine through a weakening in the abdominal wall,
located in the groin near the thigh and tends to
occur more often in women than in men.
Femoral
hernias are usually detected in a physical examination.
Symptoms include groin discomfort or groin pain
aggravated by bending or lifting, and a tender lump
in the groin or upper thigh.
Incisional
Hernia
An incisional hernia can occur due to a prior abdominal
surgery. This type of hernia is typically smaller
and protrudes through the scar of the muscle cavity.
In severe cases, portions of organs may move through
the hole in the abdominal muscle.
Patients
who are at more risk of developing an incisional
hernia are those who gain significant weight after
an abdominal surgery, become pregnant or participate
in heavy lifting. The incision from a patient’s
prior surgery is weakest and most prone to a hernia
while it is still trying to heal.
Incisional
hernias are usually obvious and detected in a physical
examination. Symptoms include large bulge and pain
in the area of the previous surgical incision.
Ventral
Hernia
Ventral hernias occur when part of the intestines
protrudes through the abdominal wall. They are usually
detected in a physical examination. Symptoms include
a bulge in the abdomen area or pain in the region
of the lump. Sometimes these hernias develop because
of a patient’s prior abdominal surgery.
Umbilical
Hernia
Umbilical hernias appear as a bulge around the belly
button. It occurs when the muscle around the navel
doesn’t close completely.
Umbilical
hernias are usually detected in a physical examination
and are obvious to the eye. Symptoms include a bulge
in the naval and pain. If pain is not detected,
surgery is hardly conducted unless the patient advises
their physician to do so.
Hiatal
Hernia
Hiatal hernia is a condition in which a portion
of the stomach protrudes upward into the chest,
through an opening in the diaphragm. The diaphragm
is the sheet of muscle that separates the chest
from the abdomen. It is used in breathing.
The
cause is unknown, but hiatal hernias may be the
result of a weakening of the supporting tissue.
Increasing age (especially those over 50), obesity,
and smoking are known risk factors in adults. In
children, this usually is brought on at birth (congenital).
It is usually associated with gastroesophageal reflux
(acid reflux) in infants.
A
hiatal hernia by itself rarely causes symptoms.
The pain and discomfort are usually due to the reflux
of gastric acid, air, or bile. Reflux happens more
easily in the presence of hiatal hernia, though
a hiatal hernia is not the only cause of reflux.
Reducing
the backflow of stomach contents into the esophagus
(gastroesophageal reflux) will relieve pain symptoms.
Medications that neutralize stomach acidity, decrease
acid production, or strengthen the lower esophageal
sphincter may be prescribed.
Possible
complications that might occur are; slow bleeding
and iron deficiency anemia (due to a large hernia),
pulmonary (lung) aspiration, and strangulation (cutting
off blood supply) of the hernia.
Exams
and tests that are typically performed are Barium
Swallow X-ray and Esophagogastroduodenoscopy (EGD).
Surgery
Most hernias can be repaired with a simple operation
and minimal risks to the patient.
Hernia repair surgery, herniorrhaphy, may be recommended
when a hernia is painful or symptoms interfere with
daily activities. It may also be done when there are
large bulges through a small hole, which interferes
with blood flow or causes a blocked intestine. Most
hernias should be repaired to prevent the possible
complications of restricted blood flow or blocked
intestine. Emergency surgery must be performed if
the intestines become trapped within the hernia.
Our
surgeons are specialists in laparoscopic hernia repair,
which is a minimally invasive technique that avoids
the need for a larger incision. For you, this means
significant benefits over traditional surgeries, including:
-
Less Pain
- Less
Scarring
- Less
Recovery Time
- Less
Risk of Infection
- Less
Time in the Hospital
During
surgery, the bulging tissue or organ is placed back
inside the muscle wall and the muscle tissue is repaired.
In many inguinal hernia repairs, a small piece of
plastic mesh is used to repair the defect in the muscle
tissue.
Recovery
Getting hit where the wound is could cause the skin
to open or it may disrupt the repair (less common).
Adults should avoid heavy lifting or straining for
about 6 - 8 weeks after surgery. Such activity can
disrupt the hernia repair.
Do
not take a submersion bath for at least 5 days after
the operation. Soaking may separate the skin tapes
and the wound could break open. Showering is permitted
the day after surgery. The wound tapes should be carefully
patted dry after showering.
Expect
complete recovery from surgery in about 2 - 4 weeks.
The
rate of hernia recurrence after surgical repair is
generally less than 3%.
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