What is a Hernia?

 

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- 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. The hernia can cause severe pain and potentially serious problems that could require emergency surgery.

 

- Both men and women can get a hernia. You may be born with a hernia (congenital) or develop one over time. A hernia does not get better over time, nor will it go away by itself.

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What are the problems associated with Hernia?

 

• Inguinal (Groin) Hernia

 

• Umbilical (Belly Button, Naval) Hernia

 

- An umbilical hernia occurs when part of the intestine protrudes through the umbilical opening in the abdominal muscles.

- In children, many umbilical hernias close on their own by age 1 or 2, though some take longer to heal. To prevent

  complications, umbilical hernias that don't disappear by age 4 or those that appear during adulthood may need surgical

  repair.

- An umbilical hernia creates a soft swelling or bulge near the navel (umbilicus).

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- Causes of Umbilical Hernia include:

 

• During pregnancy, the umbilical cord passes through a small opening in the baby's abdominal muscles. The opening normally closes just after birth. If the muscles don't join together completely in the midline of the abdomen, this weakness in the abdominal wall may cause an umbilical hernia at birth or later in life.

 

• In adults, too much abdominal pressure can cause an umbilical hernia, including:

  • Obesity

  • Multiple pregnancies

  • Fluid in the abdominal cavity (ascites)

  • Previous abdominal surgery

  • Chronic peritoneal dialysis

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• Ventral (Incisional) Hernia

 

- When a ventral (also called incisional) hernia occurs, it usually arises in the abdominal wall where a previous surgical

  incision was made. In this area the abdominal muscles have weakened; this results in a bulge or a tear. 

 

- Other sites that ventral hernias can develop are the belly button (umbilicus) or any other area of the abdominal wall.

 

- Causes of a ventral hernia include an incision having been made in your abdominal wall. This will always be an area of

  potential weakness. Hernias can develop at these sites due to heavy straining, aging, injury or following an infection at

  that site following surgery. They can occur immediately following surgery or may not become apparent for years later

  following the procedure.

 

Signs & Symptoms

 

• The common areas where hernias occur are in the groin (inguinal), belly button (umbilical), and the site of a previous operation (incisional).

 

• It is usually easy to recognize a hernia:

 

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- You may notice a bulge under the skin.

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- You may feel pain when you lift heavy objects, cough, and strain during  

   urination or bowel movements, or during prolonged standing or sitting

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- The pain may be sharp and immediate or a dull ache that gets worse

   toward the end of the day

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- Severe, continuous pain, redness, and tenderness are signs that the

   hernia may be entrapped or strangulated

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- These symptoms are cause for concern and immediate contact of your

   physician or surgeon is essential as it may lead to life  

   threatening complications.

 

How do you know if it’s something to worry about?

 

Be sure to call your physician or surgeon if you develop any of the following:

 

• Persistent fever over 101 degrees F (39 C)

• Bleeding

• Increasing abdominal or groin swelling

• Pain that is not relieved by your medications

• Persistent nausea or vomiting

• Inability to urinate

• Chills

• Persistent cough or shortness of breath

• Purulent drainage (pus) from any incision

• Redness surrounding any of your incisions that is worsening or getting bigger

• You are unable to eat or drink liquids

 

How is a Hernia diagnosed?

 

• A doctor will perform a physical exam. If a person has an obvious hernia, the doctor will not require any other tests to make the diagnosis (if the person is healthy otherwise).

• If a person has symptoms of a hernia (dull ache in the groin or other body area or pain with lifting or straining but without an obvious lump), the doctor may feel the area while increasing abdominal pressure (having you stand or cough). This action may make the hernia able to be felt.

• If a person might have an indirect inguinal hernia, the doctor will feel for the potential pathway and look for a hernia by inverting the skin of the scrotum with his or her finger.

• The doctor may order an X-ray, ultrasound, or CT scan.

 

Treatment Options

 

The use of an abdominal wall binder is occasionally prescribed but often, ineffective. Incisional hernias do not go away on their own, and, may enlarge with time. One of the following 3 surgical procedures is preferred to resolve a hernia:

 

• The traditional surgery approach is done through an incision in the abdominal wall.

 

- The cut may go through part or all of a previous incision, skin, an underlying fatty layer and into the abdomen.

- The surgeon may choose to sew your natural tissue back together, but frequently, it requires the placement of mesh

  (screen) in or on the abdominal wall for a sound closure.

- This technique is most often performed under a general anesthetic.

 

• The second approach is a laparoscopic incisional hernia repair.

 

- In this approach, a laparoscope (a tiny telescope with a television camera attached) is inserted through a cannula (a

  small hollow tube).

- The laparoscope and TV camera allow the surgeon to view the hernia from the inside.

- Other small incisions will be required for other small cannulas for placement of other instruments to remove any scar

  tissue and to insert a surgical mesh into the abdomen.

- This mesh, or screen, is fixed under the hernia defect to the strong tissues of the abdominal wall.

- It is held in place with special surgical tacks and in many instances, sutures.

- Usually, three or four 1/4 inch to 1/2 inch incisions are necessary.

- The sutures, which go through the entire thickness of the abdominal wall, are placed through smaller incisions around

  the circumference of the mesh.

- This technique is also usually performed under general anesthesia.

 

• The third approach is the single incision laparoscopic hernia repair surgery. This surgery is quickly becoming the main choice of hernia surgery due to the following key differences with other surgeries:

 

- Less pain and able to return to work quicker than  having a 4 key-hole or open repair surgery.

- Repair of a recurrent hernia is often easier utilizing laparoscopic techniques than open surgery.

- In the event of a second hernia, it is possible to check for and repair a second hernia on the opposite side at the time of

  the surgery.

- Because only one small, single incision is used, single incision laparoscopic hernia repair may be more appealing for

  cosmetic reasons.

 

Prevention

 

• Warm up properly before athletic activity and exercise.

• Strengthen abdominal muscles with strength exercises.

• Rest properly after vigorous exercise, particularly lifting.

• Quit smoking if possible, as coughing can contribute to hernia development.

• Eat a high fiber diet to avoid constipation.

• Maintain a healthy weight.

• Incorporate some stretching and flexibility exercises into your exercise routine.

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